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PurposeTo date, over 4.2 million Germans and over 235 million people worldwide have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Uro-oncology (UO) patients are particularly vulnerable but in urgent need of life-saving systemic treatments. Our multicentric study examined the impact of the COVID-19 crisis on the medical care of UO patients in German university hospitals receiving ongoing systemic anti-cancer treatment and to detect the delay of medical care, defined as deferred medical treatment or deviation of the pre-defined follow-up assessment.MethodsData of 162 UO patients with metastatic disease undergoing systemic cancer treatment at five university hospitals in Germany were included in our analyses. The focus of interest was any delay or change in treatment between February 2020 and May 2020 (first wave of the COVID-19 crisis in Germany). Statistical analysis of contingency tables were performed using Pearson’s chi-squared and Fisher’s exact tests, respectively. Effect size was determined using Cramér’s V (V).ResultsTwenty-four of the 162 patients (14.8%) experienced a delay in systemic treatment of more than 2 weeks. Most of these received immuno-oncologic (IO) treatments (13/24, 54.2%,p = 0.746). Blood tests were delayed or canceled significantly more often in IO patients but with a small effect size (21.1%,p = 0.042,V = 0.230). Treatment of patients with renal cell carcinoma (12/73, 16.4%) and urothelial carcinoma (7/32, 21.9%) was affected the most.ConclusionsOur data show that the COVID-19 pandemic impacted the medical care of UO patients, but deferment remained modest. There was a tendency towards delays in IO and ADT treatments in particular.

In Deutschland werden rund 3 % aller Neugeborenen nach einer Kinderwunschbehandlung geboren. Haufigste Methode der assistierten Reproduktion (assisted reproductive technique [ART]) ist die intrazytoplasmatische Spermieninjektion (intracytoplasmic sperm injection [ICSI]). Ob es gesundheitliche Benachteiligungen bei Kindern und Jugendlichen, die nach einer ICSI-Behandlung geboren wurden, gibt, wird kontrovers diskutiert. In der Deutschen ICSI-Langzeitstudie wurde eine Kohorte von Kindern, die nach einer ICSI-Behandlung in den Jahren 1998 bis 2000 geboren wurden, zu drei Untersuchungszeitpunkten hinsichtlich ihrer gesundheitlichen, psychischen und sozialen Entwicklung untersucht (ICSI-Studie I–III). Der Schwerpunkt der ersten Untersuchung war der Schwangerschafts- und Geburtsverlauf sowie die neonatale Gesundheit der Kinder. Im zweiten Untersuchungszeitraum (2004–2006) wurde die somatische und neurologische Entwicklung der Einlinge untersucht, wahrend 2015–2017 (dritter Untersuchungszeitraum) die kardiometabolische und endokrinologische Entwicklung der Jugendlichen sowie deren Lebensqualitat und soziale Entwicklung im Mittelpunkt standen. Insgesamt kann festgestellt werden, dass die physische und psychische Entwicklung der Kinder vergleichbar zu spontan konzipierten Gleichaltrigen verlauft. Die Fehlbildungsrate nach ICSI ist geringfugig erhoht und das Geburtsgewicht etwas niedriger als bei spontan konzipierten Kindern. Die Mehrlingsrate ist erhoht, was u. a. zu mehr Fruhgeburtlichkeit mit entsprechenden Folgen fuhrt. Unterschiede in den metabolischen Faktoren konnen auf ein erhohtes Risiko fur kardiovaskulare Erkrankungen im spateren Lebensverlauf hinweisen. Ob das Verfahren der ICSI zu klinisch relevanten kardiovaskularen Risiken fuhrt, muss in weiteren Studien untersucht werden.

Summary Background and objectives Nonmelanoma skin cancer (NMSC) is the most common malignant neoplasm in Germany. However, little is known about incidence trends of NMSC and its main subtypes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Germany. Material and methods Cancer registry data from fourteen German federal states was used to estimate age-standardized incidence rates by histologic subtype. Annual percentage changes (APC) were estimated in joinpoint regression models, in order to assess trend shifts in the years from 1998 to 2010. Results In Germany, incidence rates of NMSC showed a significant increase from 43.1 cases/100 000 in 1998 to 105.2 cases/100 000 in 2010. Incidence rates and incidence increases revealed large regional variations. Basal cell carcinoma was the most common tumor followed by SCC. Men were more frequently affected than women, but incidence increases were steeper in women. Conclusions Results are consistent with national and international observations. The heterogeneity of incidence rates and their changes among federal states indicate that incidence changes are most likely related to improved case registration practices in German cancer registries.

Zusammenfassung Hintergrund und Studienziele Nicht-melanozytarer Hautkrebs (NMSC = nonmelanoma skin cancer) ist die haufigste Krebserkrankung in Deutschland. Allerdings herrscht weitgehende Unklarheit uber Inzidenztrends des NMSC und dessen haufigste Untertypen, Basalzellkarzinom (BCC) und Plattenepithelkarzinom (SCC), in Deutschland. Material und Methoden Die Daten aus Krebsregistern von 14 deutschen Bundeslandern wurden herangezogen, um altersstandardisierte Inzidenzraten nach histologischen Untertypen zu ermitteln. Anhand von Joinpoint-Regressionsmodellen wurden jahrliche prozentuale Veranderungen berechnet, um Trendanderungen in den Jahren 1998 bis 2010 zu erkennen. Ergebnisse Die Inzidenz von NMSC in Deutschland erhohte sich signifikant von 43,1 Fallen/100 000 im Jahr 1998 auf 105,2 Falle/100 000 im Jahr 2010. Sowohl die Inzidenz als auch ihre Anderung war von Bundesland zu Bundesland sehr unterschiedlich. Der haufigste Tumor war das Basalzellkarzinom, gefolgt vom SCC. Es waren mehr Manner als Frauen betroffen, allerdings war der Anstieg der Inzidenz bei Frauen steiler. Schussfolgerungen Die Ergebnisse decken sich mit nationalen und internationalen Beobachtungen. Die Heterogenitat der Inzidenz selbst und ihrer Anderung je nach untersuchtem Bundesland lasst vermuten, dass die Veranderung der Inzidenz hochstwahrscheinlich auf eine Verbesserung der Fallregistrierungspraxis in den deutschen Krebsregistern zuruckzufuhren ist.

Chronic lymphocytic leukaemia (CLL) patients often remain asymptomatic for several years after diagnosis. When the disease becomes symptomatic or progressive, chemotherapy with fludarabine in combination with an anti-CD20 antibody (FCR) is recommended as standard therapy, except for patients with relevant comorbidity or with del(17p13) oder TP53 mutation. We predict the number of prevalent CLL patients in 2011-2020 who need first-line therapy but are ineligible for FCR treatment. The input parameters of the Markov model are the estimated total CLL incidence (based on German cancer registry data) and clinical data on disease progression and patient characteristics (obtained by a systematic literature research). Plausibility ranges for the estimation of the total CLL incidence are given by the following: (1) inclusion of small lymphocytic lymphoma and (2) an alternative handling of death-certificate-only cases. The number of patients ineligible for FCR treatment increases from approximately 1200 in 2011 to approximately 1450 in 2020. The inclusion of small lymphocytic lymphoma cases results in 10% higher estimates, the alternative handling of death-certificate-only cases in 8% lower estimates. Recently, several new and targeted agents have been approved for CLL patients ineligible for standard treatment. Estimation of patient numbers is a prerequisite for planning of health care and for calculating the costs of treatment. Copyright © 2015 John Wiley & Sons, Ltd.

Obwohl viele Aktivitaten von einer intakten Feinmotorik abhangen, konnte sich bislang kein standardisiertes Assessment durchsetzen. Der 2009 entwickelte 20-Cents-Test (20-C-T) dauert weniger als 5 min. Seine Gutekriterien wurden im Rahmen der vorliegenden Studie untersucht. Es nahmen 300 geriatrische Patienten an der Untersuchung teil. Das ergotherapeutische Urteil aufgrund standardisierter Anamnese und Untersuchung diente als Goldstandard. Verblindete Physiotherapeuten setzten den 20-C-T ein. Jeder 4. Patient litt unter alltagsrelevanten Storungen der Feinmotorik. Der 20-C-T korrelierte mit dem klinischen Schweregrad und war auch fur Patienten mit masiger Storung der Kognition oder des Visus durchfuhrbar. Handigkeit, Alter und Geschlecht hatten keinen signifikanten Einfluss. Die „Intra“- und „Interrater“-Reliabilitat waren gut. Eine standardisierte Uberprufung der Feinmotorik sollte Bestandteil geriatrischen Screenings und Basis-Assessments sein. Die Gutekriterien des 20-C-T zeigen, dass er dafur geeignet ist. Es werden weitere diagnostische Schritte bei allen Patienten, die uber 40 s fur die Aufgabe im 20-C-T benotigen, empfohlen.

Ziel der Studie: Storungen durch Verkehrslarm konnen langfristig zu Gesundheitsschaden fuhren. Wir haben untersucht, ob die subjektiv empfundene Larmbelastigung von Anwohnern stark befahrener Strasen in Lubeck nach der Installation einer Geschwindigkeitsmessanlage (GMA) reduziert werden kann. Methodik: Im August 2012 wurden in 2 stark befahrenen Strasen Lubecks je eine GMA installiert (IG). Die Anwohner im Bereich von 1,5 km vor und hinter der GMA wurden vor (t0), 8 Wochen (t1) und 12 Monate (t2) nach deren Installation schriftlich zu ihrer subjektiven Larmbelastigung befragt. Als Kontrollstrasen (KG) diente eine weitere stark befahrene Strase, ohne GMA sowie 2 Hauptverkehrsadern, in denen bereits seit langerem GMA’s bestehen. Zu t0 und t1 wurden zusatzlich objektive Messungen des Larmschallpegels durchgefuhrt. Ergebnisse: Die Teilnahmerate lag zwischen 35,9% (t0) und 27,2% (t2). In der KG war der Anteil der Frauen (61,4–63,7%) signifikant hoher als in der IG (53,7–58,1%, p Schlussfolgerung: Eine Veranderung des Schallpegels um 0,6 dB ist nur im direkten Vergleich wahrnehmbar, sodass die objektiven Messungen die subjektiven Wahrnehmungen bestatigen. Als alleinige Masnahme zur Larmreduktion (und Gesundheitsforderung) ist das Aufstellen einer GMA daher nicht ausreichend.

Hintergrund Die Ablehnung des Antrags auf ambulante geriatrische Rehabilitation (AGRV) wird in Schleswig-Holstein meist damit begrundet, eine vertragsarztlich verordnete Heilmitteltherapie reiche aus. Wie die Versorgungsrealitat wahrend der 6 Monate nach Antragstellung jedoch aussieht, ist nicht bekannt.

Hintergrund: In Schleswig-Holstein wurde das bevolkerungsbezogene Mammographie-Screening-Programm 2007 eingefuhrt. Die europaische Leitlinie fordert als Qualitatsnachweis fur die Effektivitat des Programms eine Teilnahmerate von 70 %. Schleswig-Holstein gehort mit einer Teilnahmerate von 45 % im deutschlandweiten Vergleich zu den Bundeslandern mit den geringsten Teilnahmeraten. Die Grunde dafur sind unbekannt. Methodik: 20 000 Frauen im Alter von 50–69 Jahren, die nach der Einladung zum Mammographie-Screening nicht an diesem teilgenommen hatten, wurden mittels standardisiertem Fragebogen nach Grunden fur ihre Nicht-Teilnahme sowie zu ihrem Wissen uber das Programm befragt. Die Ergebnisdarstellung erfolgt anhand deskriptiver Statistik. Ergebnisse: Fur die Auswertung lagen 2591 Fragebogen vor (Rucklaufquote 14,8 %). Die Grunde fur eine Nicht-Teilnahme am Mammographie-Screening sind vielfaltig. Am haufigsten gaben die befragten Frauen medizinische Grunde an, oder die personliche Einstellung fuhrte zu einer Nicht-Teilnahme. Organisatorische Grunde waren eher nebensachlich. Zwei Drittel der Frauen sind erst durch das Einladungsschreiben auf das Mammographie-Screening aufmerksam geworden, 25 % der Befragten hatten mit ihrem Arzt daruber gesprochen. Folgerung: Die niedrige Teilnahmerate am Mammographie-Screening in Schleswig-Holstein ist nicht auf organisatorische, sondern vielmehr auf medizinische Grunde und die personliche Einstellung zuruckzufuhren. Moglicherweise liegt ein Informationsdefizit vor, dem durch eine intensivere Beratung durch den (Fach-) Arzt und durch eine weitere Verbreitung von schriftlichen Informationsmaterialen entgegen gesteuert werden konnte.

Background : In 2002, colonoscopy was introduced as a tool for colorectal cancer screening in Germany. The long-term objective was to reduce the incidence in colorectal cancer (CRC) by detection and removal of advanced adenomas. Currently, the effect of colonoscopy screening on the population-based incidence of CRC in Germany is unknown. Methods : We provide data on stage-specific (age-standardized) incidence rates in three federal states in Germany, 6 years after the implementation of colonoscopy. Results : Between 2002 and 2008 a statistically significant decrease in CRC incidence could be observed (annually 3.0%, 95% confidence interval [CI]: −3.8; −2.2). The decline could be observed in all advanced tumor categories (T2, T3, and T4), whereas the incidence of in situ carcinomas (Tis) increased annually by 51.6% (95% CI: 28.0; 79.4) until 2004, and remained stable until 2008. Conclusion : The observed changes cannot be attributed definitively to the screening activities, but the presented data support a possible causal association.

Background: Intranasal corticosteroids (INS) are the first line treatment for allergic rhinitis (AR). To guide clinical decision-making, we created a therapeutic index (TIX) for INS reflecting efficacy and safety. Methods: A Medline search (1966 to June 2009) was carried out to identify all placebo-controlled randomized trials, and observational reports for safety issues, with Dexamethasone, Budesonide (BUD), Fluticasone propionate (FP), Fluticasone furoate (FF), Flunisolide, Mometasone furoate (MF), Triamcinolone (TRIAM), and Beclomethasone dipropionate (BDP) as treatment for AR. Data on three efficacy (nasal symptoms, ocular symptoms, global assessment) and three safety outcomes (epistaxis, growth, systemic ocular effects) were extracted. Meta analyses were performed for each INS and outcome and results were categorised into scores by quartiles. Scores of the three efficacy and safety outcomes were summed up to create summation scores for efficacy (ES) and side effects (AES), respectively with a maximum of 9 points. The TIX was then defined as the ratio of ES and AES. Results: Data of 84 studies were extracted. Based on availability of data, a TIX was calculated for 6 substances. BUD showed the highest efficacy score followed by MF and TRIAM. The lowest scores for side effects were achieved by MF and TRIAM followed by FP. These findings resulted in TIX scores of 7 and 5 for MF and TRIAM, respectively, indicating a high efficacy and low potential of adverse events. Medium scores were reached by BUD and FP and lower scores by BDP and FF. Conclusion: Although safety and efficacy is proven for all available INS by multiple studies, the systematic aggregation and analysis of data allows for a differentiated summary on clinically important features.

When assessing the quality of care, patients' characteristics such as general and health-related life satisfaction, are of major significance. Our study examined the general and health-related life satisfaction of patients with community-acquired pneumonia (CAP). To quantify the general and health-related life satisfaction, we used the validated instrument Questions on Life Satisfaction(Modules) by Henrich and Herschbach. CAP cases included in the German competence network on CAP (CAPNETZ) were asked to answer questions on their personal satisfaction with aspects of their life and health and on the individual importance of each addressed aspect. Data were compared with a normal population sample. In addition, several subgroup analyses were conducted. One thousand eight hundred ninety-nine (50.5%) CAP patients returned the questionnaire within a median time of 3 days. The mean age of the study sample was 55.1 +/- 17.1 years, 47.0% were female. The CAP patients reported not only a lower satisfaction with health (52.1 +/- 42.6 vs. 74.4 +/- 41.5, p < 0.001), but also a lower general life satisfaction (55.0 +/- 35.2 vs. 60.5 +/- 37.3, p < 0.001) than the normative German sample. Subgroup analyses revealed a significantly impaired general life satisfaction in patients with comorbidities (52.2 +/- 34.7) compared with patients without any underlying disease (58.1 +/- 35.4, p = 0.001). A non-significant lower general life satisfaction (53.3 +/- 35.1 vs. 57.0 5 +/- 35.2, p = 0.052) as well as a lower health-related life satisfaction (49.25 +/- 42.0 vs. 55.3 +/- 43.0, p = 0.602) could be observed in men compared with those in women. Patients aged 65 years and older and patients with a severe CAP reported a lower health-related life satisfaction, but a higher general life satisfaction than younger patients or patients with mild CAP. The lower general life satisfaction observed in patients with CAP was found to reflect comorbidity rather than the effects of the pneumonia itself.

Summary Objectives In Germany the estimation of a population based annual incidence of community acquired pneumonia (CAP) in adults has been referred to the denominator problem. To estimate a population based annual incidence of CAP in an urban German area we compared the incidence estimated on four different approaches. Methods We estimated the annual incidence on the basis of the covered population of sentinel practices from Luebeck participating in the German competence network CAPNETZ. We estimated the incidence on the basis of a population based survey, on the basis of the mortality and lethality in Luebeck, and on the basis of data of the regional Association of Statutory Health Insurance Physicians ("Kassenarztliche Vereinigung (KV) Schleswig-Holstein"). Results The annual incidence of CAP in Luebeck was 3.7/1000 inhabitants (95% confidence interval (CI) 2.4–5.5), 6.0/1000 inhabitants, 8.7/1000 inhabitants (95% CI 8.2–9.1), or 10.1/1000 inhabitants (95% CI 9.6–10.5) depending on the approach of estimation. According to this, in Germany we would expect 400,000–680,000 new CAP cases per year. Conclusions The true incidence of CAP in Luebeck might range between 3.7 and 10 per 1000 inhabitants. Comparisons with the rates in the literature are difficult due to the differences in the applied methods.

Nonmelanoma skin cancer (NMSC) is the most common malignant neoplasm in Germany. However, little is known about incidence trends of NMSC and its main subtypes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Germany.Cancer registry data from fourteen German federal states was used to estimate age-standardized incidence rates by histologic subtype. Annual percentage changes (APC) were estimated in joinpoint regression models, in order to assess trend shifts in the years from 1998 to 2010.In Germany, incidence rates of NMSC showed a significant increase from 43.1 cases/100 000 in 1998 to 105.2 cases/100 000 in 2010. Incidence rates and incidence increases revealed large regional variations. Basal cell carcinoma was the most common tumor followed by SCC. Men were more frequently affected than women, but incidence increases were steeper in women.Results are consistent with national and international observations. The heterogeneity of incidence rates and their changes among federal states indicate that incidence changes are most likely related to improved case registration practices in German cancer registries.

Background This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer. Methods The prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups’ baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data. Results The typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values. Conclusions Findings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients’ health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient. Electronic supplementary material The online version of this article (doi:10.1186/s12894-015-0025-6) contains supplementary material, which is available to authorized users.

Background Asthma is an inflammatory disease of the airways, but in clinical practice inflammation is rarely monitored. The aim of this study was to assess the level of airway inflammation in steroid naïve adult and pediatric patients with intermittent asthma over one year. Methods 54 children and 50 adults with intermittent asthma (GINA step 1) were included. On up to 6 visits lung function, airway hyperresponsiveness to methacholine (PC20FEV1), sputum eosinophils and exhaled nitric oxide (FeNO) were assessed. Results 36 pediatric and 34 adult patients were able to produce at least three adequate sputum samples over the study period and were included into the analysis. In 8 children (22%) the percentage of sputum eosinophils was always below 2.5%. A higher level of eosinophils (>2.5%) was found on at least one visit in 16 (44%) and always >2.5% in 12 children (33%). In the adult group the respective numbers were 14 patients (41%) with always low (

Chronic lymphocytic leukaemia (CLL) patients often remain asymptomatic for several years after diagnosis. When the disease becomes symptomatic or progressive, chemotherapy with fludarabine in combination with an anti-CD20 antibody (FCR) is recommended as standard therapy, except for patients with relevant comorbidity or with del(17p13) oder TP53 mutation. We predict the number of prevalent CLL patients in 2011-2020 who need first-line therapy but are ineligible for FCR treatment. The input parameters of the Markov model are the estimated total CLL incidence (based on German cancer registry data) and clinical data on disease progression and patient characteristics (obtained by a systematic literature research). Plausibility ranges for the estimation of the total CLL incidence are given by the following: (1) inclusion of small lymphocytic lymphoma and (2) an alternative handling of death-certificate-only cases. The number of patients ineligible for FCR treatment increases from approximately 1200 in 2011 to approximately 1450 in 2020. The inclusion of small lymphocytic lymphoma cases results in 10% higher estimates, the alternative handling of death-certificate-only cases in 8% lower estimates. Recently, several new and targeted agents have been approved for CLL patients ineligible for standard treatment. Estimation of patient numbers is a prerequisite for planning of health care and for calculating the costs of treatment. Copyright © 2015 John WileySons, Ltd.

The rejection of an application for ambulant geriatric rehabilitation (AGRV) is usually justified by the argument that non-pharmaceutical therapy prescribed by doctors accredited by social housing institutions (SHI) would suffice. The reality in healthcare during the 6 months following an application is unknown.In this study 203 patients who had made an application for AGRV in the second half of 2010 in Flensburg, Lübeck or Ratzeburg were interviewed by telephone.The survey revealed that 25.7% of the applications for AGRV had been rejected. The majority of these patients received no ambulant non-pharmaceutical therapy (e.g. physical therapy, physiotherapy, occupational therapy, speech therapy or psychological therapy), less than 20% received more than 12 therapy sessions and in most cases exclusively physiotherapy. The 141 successful AGRV applicants received additional ambulant therapies of a similar magnitude.The difference between the intensified interdisciplinary therapy offered in the AGRV and additionally and the offer to rejected applicants is substantial.

Objective We aimed to evaluate and compare the efficacy of the bicaval and the biatrial standard techniques in orthotopic heart transplantation. Methods A systematic review with meta-analysis was performed. As data sources, we used the electronic databases EMBASE and Medline (1966–August 2006), hand searching in 4 journals, expert consultation, and reference lists of reviews. Observational and randomized and prospective and retrospective controlled trials that reported outcomes on the 2 techniques of heart transplantation were considered. Results A total of 23 retrospective and 18 prospective studies were included. Meta-analyses of prospective trials including between 228 and 472 patients revealed significant superiority of the bicaval technique in comparison with the biatrial procedure for early atrial pressure (weighted mean difference, −3.95; 95% confidence interval, −6.50 to −1.40), perioperative mortality (odds ratio, 0.41; 95% confidence interval, 0.17 to 0.98), tricuspid valve regurgitation (odds ratio, 0.23; 95% confidence interval, 0.15 to 0.36), and sinus rhythm (odds ratio, 7.01; 95% confidence interval, 2.57 to 19.13). The latter also showed a significant difference in the analysis of retrospective studies (odds ratio, 2.69; 95% confidence interval, 1.55 to 4.66). Conclusion In summary, this systematic review and meta-analysis provides evidence of clinically relevant beneficial effects of the bicaval technique in comparison with those of the standard technique. Nevertheless, the longer-term beneficial effects of the bicaval technique remain to be evaluated.

Ein von uns entwickelter therapeutischer Index (TIX) fur die Therapie der allergischen Rhinitis (AR) mit intranasalen Kortikosteroiden (INS) kann bei der Entscheidungsfindung helfen [1].