[Outpatient Care of People with Dementia within Residential Communities in Germany--Care Potential and Cost]. / Ambulant betreute Demenz-Wohngemeinschaften in Deutschland--Pflegepotenzial und Kosten.

BACKGROUND: Since the 1980s dementia residential communities (DRC) have been established as part of the health-care landscape and as an alternative to inpatient long-term nursing care. Information about (a) the residents (b) the care potential and (c) the cost of DRCs are still lacking. METHODS: A nation-wide postal questionnaire was sent to n=332 DRCs managed by n=151 organizations. The sample was based on an internet search with various combinations of search terms such as "outpatient" and "residential care communities". The questionnaire contained questions about the resident's social-demography, nursing care level and the utilization, financing and cost structures of DRCs. RESULTS: In total 81 organizations with n=88 DRCs replied to the questionnaire. Overall n=794 persons were living in these communities, most of the residents were female (80%, n=522), and 67% of the residents were older than 80 years. The nursing care level was high, 27% of the DRC residents reached the highest stage. Only 5% of the DRCs capacity was vacant. 86% of the communities stated to be able to provide nursing care for the residents until the end of their life. Almost half (48%) of the residents received money from the social welfare. The total average amount of cost per place per month was 3,265.08€ (excluding costs of services related to health insurance). CONCLUSIONS: DRCs are caring for residents with high nursing care levels. Costs of these communities vary to a large extent but are in addition comparable to inpatient long-term nursing care. Thus, interested persons should obtain information about cost, financing and care concepts. The low level of vacant capacity demonstrates the demand for DRCs in Germany. Studies with the objective to evaluate quality of care, care concepts and suitable clients for those communities are needed to develop this living concept.

[Foreign body in proximal ureter after selective embolisation of a renal artery]. / Fremdkörpermaterial im proximalen Ureter nach selektiver Nierenarterienembolisation.

Colic attacks by a foreign body in the urinary tract are very rare and mostly follow iatrogenic manipulation. This case report focuses on ureteric colic thought to result from radiological embolisation material. It is of practical interest because embolisation of prolonged bleeding after endourological procedures is widely done.An 80-year-old woman with a long history of nephrolithiasis underwent percutaneous nephrolithotomy. She suffered from a continuous, transfusion-obligatory bleeding. The source of bleeding was treated with embolisation by coiling. About 2 years later, the patient presented with persistent pain on the right abdominal side and urinary obstruction. A dislocation of the coils into the ureteropelvic junction was diagnosed. After primary ureteral stenting, the foreign body was removed via ureterotomy.

[Torsion of the spermatic cord after prophylactic orchidopexy]. / Hodentorsion nach prophylaktischer Orchidopexie.

INTRODUCTION: Torsion of the spermatic cord is a urological emergency. The torsion of a fixed testis is rare. In the differential diagnosis of acute scrotum it remains a true challenge. CASE REPORT: A 13-year-old boy presented in the emergency service with acute left testicular pain and vomiting. In the patient's history a right orchiectomy due to testicular torsion and a left prophylactic orchidopexy were remarkable. Due to the clinical suspicion of re-torsion an immediate surgical exposure of the testis was performed. Intraoperatively a torsion of the left spermatic cord was found. After detorquation, there was no significant sign of recovery observed. In order to preserve the endocrine function, the single testis was maintained. During follow-up, necrosis of the left testis was noticed, and a secondary left orchiectomy was necessary three weeks after first operation. After loss of both testes the patient was referred to a paediatric endocrinological consultant and testosterone substitution was started. CONCLUSION: Even though very rare, orchidopexy does not exclude re-torsion of a fixed testis, regardless of the employed operative technique and sutures used. It should be considered in the differential diagnosis of acute scrotum. Operative detorquation should not be delayed and, in order to avoid loss of the affected testis, diagnostic procedures should kept short. After orchidopexy the patient and his relatives must be informed about the possibility of a re-torsion.

[Partial unilateral penile thrombosis of corpus cavernosum due to hyperhomocysteinemia. Case report and references]. / Partielle einseitige Schwellkörperthrombose bei Homozysteinämie. Fallbericht und Literaturübersicht.

Partial unilateral penile thrombosis of the corpus cavernosum is a very rare disease and occurs mainly in young men. The leading symptoms are perineal swelling and pain, while erectile function is maintained. The exact pathogenesis of this condition remains unclear. This is the first report of partial penile thrombosis due to hyperhomocysteinemia. Magnetic resonance imaging is the procedure of choice in diagnostics of partial penile thrombosis. For the treatment of partial penile thrombosis, surgical procedures are increasingly being replaced by more conservative treatments with analgesics and heparinization. Both surgical and conservative treatment provides excellent outcomes. A table provided in this article lists all published cases and refers to pathogenesis, diagnostics, therapy, and follow-up.