[Plea for a work policy aiming autonomy and recovery in child and adolescent psychiatry]. / Pleidooi voor autonomie- en herstelbevorderend werken in de kinder- en jeugdpsychiatrie.

When a child or adolescent is admitted to a High & Intensive Care (HIC) unit for adolescents, this implies that they find themselves in a severe psychiatric crisis. The work policy aiming autonomy and recovery is a vision that has been implemented in the treatment method at the HIC unit for adolescents. This policy focuses on the recovery of young people, in which learning to understand their own story and learning taking responsibility, are essential components. Sharing these experiences from doctors and patients aims to increase knowledge about this policy. The consistent implementation of this vision and method will result in high-quality care, more recovery and reduction of urge and coercive interventions. Calls are made for a broad-based implementation of a work policy aiming autonomy and recovery in the Netherlands.

Influence of surgeon's experience on fluoroscopy time during endourological interventions.

INTRODUCTION AND OBJECTIVE: Fluoroscopy time influences radiation exposure of both surgeons and patients during endourological interventions. Changes in fluoroscopy habits of endourological surgeons after being informed about their fluoroscopy times were evaluated depending on their endourological experience. MATERIALS AND METHODS: From April 2010 to April 2011, 402 endourological interventions in 337 Patients were assessed. Evaluated interventions were ureter stent placement (USP), ureter stent change (USC) nephrostomy change (NC), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL). Fluoroscopy time (FT) and operation time (OT) were recorded. For USP, USC and NC, the surgeons were divided into two groups: group I with >2 years of endourological experience and group II with <2 years experience. URS and PCNL only were performed by experienced surgeons. After 6 months, all surgeons were informed about their mean detected results. Both groups were compared, and changes in FT and OT in the second part of the study were analysed. RESULTS: Surgeons reduced their median fluoroscopy times up to 55 % after being informed about their fluoroscopy manners. Experienced surgeons reduced both operation and fluoroscopy times significantly for USP, USC and NC. For URS and PCNL, and OT and FT, the differences were not statistically significant. Inexperienced surgeons were not able to reduce both OT and FT significantly. CONCLUSION: If experienced surgeons are informed about their fluoroscopy time during endourological interventions, fluoroscopy times can be reduced significantly in easy procedures, which leads to less radiation exposure of surgeons and patients. Inexperienced surgeons have less possibility to influence their fluoroscopy manners.

Extracellular microenvironment and cytokine profile of the ureterovesical junction in children with vesicoureteral reflux.

PURPOSE: Vesicoureteral reflux is caused by a defective valve mechanism of the ureterovesical junction. Previous studies have revealed structural and metabolic changes in the intravesical ureter, impairing its contractile properties. Smooth musculature and nerves are replaced by collagen, while matrix degrading enzymes are over expressed. We investigated the presence of regulating cytokines and the extracellular matrix composition to elucidate further the pathophysiology of vesicoureteral reflux. MATERIALS AND METHODS: Ureteral endings were obtained from 28 children during antireflux surgery, and 14 age matched autopsy specimens served as controls. Routine histological sections were immunostained for insulin-like growth factor-1, nerve growth factor, transforming growth factor-beta1, tumor necrosis factor-alpha and vascular endothelial growth factor. Smooth muscle staining was supplemented by tenascin C, tetranectin and fibronectin detection. Staining patterns were investigated using computer assisted, high power field magnification analyses. RESULTS: Tumor necrosis factor-alpha and transforming growth factor-beta1 were significantly more abundant in vesicoureteral reflux samples, whereas insulin-like growth factor-1, nerve growth factor and vascular endothelial growth factor were more prevalent in healthy controls. Fibronectin was intensely expressed in refluxing ureters, while it was scarce in healthy children. Tenascin C was notable within the urothelium of both groups. Only vesicoureteral reflux samples displayed tenascin C in the musculature and connective tissue. Tetranectin staining was only detected in vesicoureteral reflux. CONCLUSIONS: Several cytokines are differentially expressed in primary refluxing ureters, indicating an ongoing tissue remodeling process in the ureterovesical junction region. Additionally, the smooth muscle coat is widely lacking, while extracellular matrix proteins typical for tissue shrinkage and reorganization are over expressed. These alterations are likely to contribute to the malfunctioning active ureteral valve mechanism in primary vesicoureteral reflux.

Toxicological potential of 2-alkylcyclobutanones--specific radiolytic products in irradiated fat-containing food--in bacteria and human cell lines.

Food irradiation has been considered as a safe processing technology to improve food safety and preservation, eliminating efficiently bacterial pathogens, parasites and insects. This study aims to characterize the toxicological potential of 2-alkylcyclobutanones (2-ACBs), radiolytic derivatives of triglycerides, formed uniquely upon irradiation of fat-containing food. In irradiated food they are generated proportionally to fat content and absorbed radiation dose. The cyto- and genotoxic potentials of various highly pure synthetic 2-ACBs were studied in bacteria and human cell lines. While pronounced cytotoxicity was evident in bacteria, no mutagenic activity has been revealed by the Ames test in Salmonella strains TA 97, TA 98 and TA 100. In mammalian cells genotoxicity was demonstrated mainly by the induction of DNA base lesions recognized by the Fpg protein as determined by both the Comet Assay and the Alkaline Unwinding procedure. Formation of DNA strand breaks was observed by the Alkaline Unwinding procedure but not by the Comet Assay. The extent of cytotoxicity and genotoxicity were dependent on chain length and degree of unsaturation of the fatty acid chain. Further studies will have to clarify mechanisms of action and potential relevance for human exposure situation.

[Nationwide survey among institutes of microbiology in academic medicine : Is the interdisciplinary approach the right way to treat patients with urogenital infections?] / Infektiologisch interessierte Urologen werden gebraucht : Nationale Umfrage universitärer Mikrobiologien zur interdisziplinären Zusammenarbeit von Urologie und Mikrobiologie.

BACKGROUND: Increasing antibiotic resistance is a current and severe problem in medicine, especially in urology. Multidisciplinary antibiotic stewardship programmes are an important approach to counteract increasing resistance rates. This approach includes collaboration between urologists and microbiologists. OBJECTIVES: The primary endpoint was to describe the current setting of interdisciplinary work of urologists and microbiologists in university hospitals in Germany. The secondary endpoints were the identification of problems of this interdisciplinary approach in daily routine and implications for the future in patient treatment. MATERIALS AND METHODS: A newly developed, 24-item questionnaire was sent to 34 German microbiology departments at medical universities between June and October 2016; the departments were contacted up to four times. Only complete questionnaires were included in our analysis. RESULTS: The response rate was 50.0%. In the majority of the urological cases a microbiologist was only contacted sporadically and asked for advice, but on the other hand most of the microbiologists think that this contact and discussion about the patient is reasonable and preferable. Of the respondents, 82.4% think that with a consequent interdisciplinary approach there might be lower antibiotic resistance rates in the future. One essential problem of ideal microbial diagnostics and therapeutic advice is that the microbiologist does not receive all relevant information upon request. This might be the case in up to 76.5%. Other problems are of economic nature or shortage of manpower. CONCLUSION: Interdisciplinary patient care between urologists and microbiologists is reasonable and preferable. This approach has the potential of decreasing antibiotic resistance rates in the future.

[Urogynaecological training situation in Germany : Gap between demand and reality]. / Urogynäkologische Aus- und Weiterbildungssituation in Deutschland : Kluft zwischen Anspruch und Realität.

BACKGROUND: With increasing life expectancy, progressive demographic change and decreasing societal stigmatization of incontinence urologists and gynaecologists are increasingly faced with urogynaecological challenges. To date however, urogynaecology is a poorly standardized area of expertise in both disciplines. Therefore, the urogynaecology training, especially in Germany, is very heterogeneous and requires evaluation as well as improvement. MATERIALS AND METHODS: The GeSRU-Academics research group "Functional urology and LUTS" evaluated this subject nationwide among urological and gynecological trainees and their chief physicians by using a comprehensive questionnaire (34/38 multiple-choice items) between April 2015 and May 2016. RESULTS: 336 urological residents and 190 chief physicians as well as 171 gynaecological residents and 175 chief physicians participated in the survey. Of all trainees, 70.0 % stated a personal interest in urogynaecology, but 45.4 % (gynaecological residents) and 52.9 % (urological residents) mention not to receive a standardized training in their own department. The chief physicians' survey resulted in discrepancies concerning the same question, <10 % of all residents do not receive a standardized urogynaecological training from their point of view. However, standardized urogynaecological training is of importance for those chief physicians. CONCLUSIONS: There is a discrepancy between expectations and reality of urogynaecological education and training. To enable a well-structured and standardized urogynaecological education and training, it is compulsory to focus on an interdisciplinary cooperation and to promote multidisciplinary development. A broad-based, well-designed training network and curricula should be established and used consistently.

[Prostate biopsy: Procedure in the clinical routine]. / Prostatabiopsie : Durchführung im klinischen Alltag.

Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling. Together with the histopathological results these features provide essential information for risk stratification, diagnostics and therapy decisions. The evolution of prostate biopsy techniques as well as the use of PSA testing has led to an increased identification of asymptomatic men, where further clarification is necessary. Significant efforts and increased clinical research focus on determining the appropriate indications for a prostate biopsy and the optimal technique to achieve better detection rates. The most widely used imaging modality for the prostate is TRUS; however, there are no clearly defined standards for the clinical approach for each individual biopsy procedure, dealing with continuous technical optimization and in particular the developments in imaging. In this review the current principles, techniques, new approaches and instrumentation of prostate biopsy imaging control are presented within the framework of the structured educational approach.

Interference by toxic metal ions with DNA repair processes and cell cycle control: molecular mechanisms.

Nickel, cadmium, cobalt, and arsenic compounds are well-known carcinogens to humans and experimental animals. Even though their DNA-damaging potentials are rather weak, they interfere with the nucleotide and base excision repair at low, noncytotoxic concentrations. For example, both water-soluble Ni(II) and particulate black NiO greatly reduced the repair of DNA adducts induced by benzo[a]pyrene, an important environmental pollutant. Furthermore, Ni(II), As(III), and Co(II) interfered with cell cycle progression and cell cycle control in response to ultraviolet C radiation. As potential molecular targets, interactions with so-called zinc finger proteins involved in DNA repair and/or DNA damage signaling were investigated. We observed an inactivation of the bacterial formamidopyrimidine-DNA glycosylase (Fpg), the mammalian xeroderma pigmentosum group A protein (XPA), and the poly(adenosine diphosphate-ribose)polymerase (PARP). Although all proteins were inhibited by Cd(II) and Cu(II), XPA and PARP but not Fpg were inhibited by Co(II) and Ni(II). As(III) deserves special attention, as it inactivated only PARP, but did so at very low concentrations starting from 10 nM. Because DNA is permanently damaged by endogenous and environmental factors, functioning processing of DNA lesions is an important prerequisite for maintaining genomic integrity; its inactivation by metal compounds may therefore constitute an important mechanism of metal-related carcinogenicity.

A socioeconomic, clinical and serological study in an African city of prostitutes and women still married to their first husband.

The aim of this paper was to compare women involved in prostitution with a group of women still married to their first husband and reporting having had only one sexual partner, in order to ascertain what factors if any contributed to women going into prostitution or staying still married to their first husband, their only sexual partner, and thereafter to compare clinical and serological aspects of the gynaecological conditions of the women in these two groups. The role of prostitutes in transmission of sexually transmitted diseases (STD) is widely recognised. Socioeconomic factors determining whether a woman will drift into prostitution or have a stable first marriage are largely unknown as are prevalence rates of STD, pelvic inflammatory disease (PID) and cervical cancer in these women. A socioeconomic, clinical and serologic study is reported for 2111 Ethiopian women attending teaching hospitals and maternal and child health clinics in Addis Ababa, analysing basic demographic data of three groups of women: (i) 278 engaged in prostitution, (ii) 730 still married to their one and only sexual partner, and (iii) 1103 single, widowed, divorced or married to their second or subsequent partner. Thereafter groups (i) and (ii) were compared and contrasted with regard to further socioeconomic, clinical and serological associations. The most significant socioeconomic associations for women in prostitution were low income (95% had < 50 Ethiopian birr [< U.S. $25] per month), ethnic group, and the timing of first coitus in relation to the menarche (81% were first married by age 15), in that order. Women still married to their first sexual partner had higher income, higher age at first marriage and longer duration of marriage. Sero-prevalence rates of STD in prostitutes were high: gonorrhoea 88%, genital chlamydiae 78%, syphilis (TPHA) 62%, HSV2 and HBV 46%, and chancroid 19%: 67% had PID and 2.9% cervical cancer. In comparison, rates for women married to their first and only sexual partner were: gonorrhoea 40%, genital chlamydiae 54%, syphilis (TPHA) 19%, HSV2 33%, HBV 35%, chancroid 13%, PID 47% and cervical cancer 1%. While the very high prevalence of STD in women involved in prostitution is not so unexpected, the high rate of STD in women still married to their first and only sexual partner is indicative of male promiscuity. Control of prostitution and diseases spread by it, together with education of both men and women is a national priority.

STDS in women attending family planning clinics: a case study in Addis Ababa.

For cultural reasons modern contraception has been slow to gain acceptance in Ethiopia. Knowledge about contraception and abortion is still limited in many family and community settings in which it is socially disapproved. By 1990 only 4% of Ethiopian females aged 15-49 used contraception. Little is known of sexually transmitted disease (STD) prevalence in family planning (FP) attenders in Africa in general and Ethiopia in particular, even though attenders of family planning clinics (FPCs) are appropriate target groups for epidemiological studies and control programmes. A study of 2111 women of whom 542 (25.7%) attended FPCs in Addis Ababa showed utilisation rates to be highest in women who were: Tigre (33%) or Amhara (31%), aged 20-34 years (30%), age 16 or older at first marriage/coitus (28%:38% in those first married after 25 years); who had a monthly family income of 10 Ethiopian Birr (EB) or more (33%:36% for those with income 100-500 EB), three or more children (37%), more than five lifetime husbands/sexual partners (39%); or were bargirls (73%) or prostitutes (43%). The seroprevalence rates for all STDs, higher in FPC attenders compared with other women, were syphilis (TPHA) 39%, Neisseria gonorrhoeae 66%, genital chlamydia 64%, HSV-2 41%, HBV 40% and Haemophilus ducreyi 20%. Only 4% of FPC attenders had no serological evidence of STD: 64% were seropositive for 3 or more different STD. Clinical evidence of pelvic inflammatory disease (PID) was also more common in the FPC attenders (54%), 37% having evidence of salpingitis. The FPC provides a favourable setting for screening women likely to have high seroprevalence of STD, who for lack of symptoms will not attend either an STD clinic nor a hospital for routine check up. We recommend that measures be taken to adequately screen, treat and educate FPC attenders, their partners, and as appropriate and when possible their clients, in an attempt to control STDs and ultimately HIV in the community. Social, economic and cultural factors in the occurrence of STDs, prostitution, family planning and modern contraception coverage in Ethiopia are identified and deficiencies of current programmes briefly discussed with the objective of targeting services more effectively.

Interference by toxic metal ions with zinc-dependent proteins involved in maintaining genomic stability.

Metal ions are essential components of biological systems; nevertheless, even essential elements may have toxic or carcinogenic properties. Thus, besides As(III) and Cd(II), also Ni(II) and Co(II) have been shown previously to disturb different types of DNA repair systems at low, non-cytotoxic concentrations. Since some metals exert high affinities for SH groups, we investigated whether zinc finger structures in DNA-binding motifs of DNA repair proteins are potential targets for toxic metal ions. The bacterial formamidopyrimidine-DNA glycosylase (Fpg protein) involved in base excision repair was inhibited by Cd(II), Cu(II) and Hg(II) with increasing efficiencies, whereas Co(II), As(III), Pb(II) and Ni(II) had no effect. Furthermore, Cd(II) still disturbed enzyme function when bound to metallothionein. Strong inhibition was also observed in the presence of phenylselenyl chloride, followed by selenocystine, while selenomethionine was not inhibitory. Regarding the mammalian XPA protein involved in the recognition of DNA lesions during nucleotide excision repair, its DNA-binding capacity was diminished by Cd(II), Cu(II), Ni(II) and Co(II), while Hg(II), Pb(II) and As(III) were ineffective. Finally, the H(2)O(2)-induced activation of the poly(ADP-ribose)polymerase (PARP) involved in DNA strand break detection and apoptosis was greatly reduced by Cd(II), Co(II), Ni(II) and As(III). Similarly, the disruption of correct p53 folding and DNA binding by Cd(II), Ni(II) and Co(II) has been shown by other authors. Therefore, zinc-dependent proteins involved in DNA repair and cell-cycle control may represent sensitive targets for some toxic metals such as Cd(II), Ni(II), Co(II) and Cu(II), as well as for some selenium compounds. Relevant mechanisms of inhibition appear to be the displacement of zinc by other transition metals as well as redox reactions leading to thiol/disulfide interchange.

[Hepatitis B and C: incidence and regional distribution of hospitalizations in Austria]. / Hepatitis B und C: Inzidenz und regionale Verteilung der Hospitalisationen in Osterreich.

UNLABELLED: The aim of this study was to describe the incidence as well as the geographical distribution of hospitalizations due to hepatitis B or C (according to ICD 9) in Austria between 1996 and 1998. The data were taken from the MBDS (Minimum Basic Data Set) which contains medical, demographical and administrative recordings of every in-patient treated in an Austrian hospital. Hepatitis B: The mean value of SHR (standardized hospitalization rate) amounted to 3.2/100.000 for the entire area of Austria. Among all Austrian provinces, Vorarlberg yielded the highest regional value (6.4/100.000), Burgenland the lowest one (1.9/100.000). Considerably high regional values of SHR were found in most districts of Vorarlberg, as well as in Vienna and the eastern districts of Lower Austria. Hepatitis C: The mean value of SHR amounted to 8.4/100.000 for the entire area of Austria. Regional SHR values in Austrian provinces ranged widely from 2.9/100.000 (Burgenland) to 15.1/100.000 (Salzburg), some provinces (Salzburg, Carinthia) showed a marked increase of hospitalizations within the observation period. The highest regional values of SHR were found in and around the districts of Salzburg, Villach, and Klagenfurt. CONCLUSIONS: The differences observed in SHR values of Austrian districts cannot be accounted for by local differences of Hepatitis prevalence alone. They are supposedly also due to local differences of the health care system, as well as the clinical, diagnostical or documentational practices in hospitals in different regions. In order to evaluate MBDS-Data quality, a post-hoc comparison with external data stemming from three Austrian multicenter studies was performed. A remarkable correspondence in geographical distribution of hepatitis C patients was found between the two data sets. This is considered an argument in favour of the validity of MBDS-Data.

Is cervical cancer in Ethiopian women the result of a sexually transmitted disease?

Cervical cancer is the most prevalent cancer of women in Ethiopia and sexually transmitted diseases are highly prevalent in the country. In order to establish a possible cause and effect relationship between sexually transmitted diseases and cervical cancer, likely etiological socio-economic factors for these two conditions have been analysed. While residence, income, age at first coitus, age, number of sexual partners, marital status/profession and duration of sexual life affect both conditions, there is a significant difference between the most important factors in the etiology of the separate conditions. Serological testing shows a high prevalence of gonorrhea, which was used as a marker of STD. Women with gonococcal antibodies had evidence of increased exposure to other STD; there was no such correlation for cervical cancer. Our results indicate that STD per se is unlikely to be a primary cause of CC in Ethiopia. It appears probable that the etiology of CC in Ethiopia is multifactorial. Early exposure of the immature cervical epithelium to STD, the trauma of repeated childbirth, and multiple sexual partners in women whose defence factors are impaired by chronic malnutrition, add up to a major medico-socio-economic factor. The evidence presented here suggests that CC in Ethiopia is not so much the result of a sexually transmitted disease, but a sociosexual disease.

[Hospitalizations due to hepatitis A, B and C in Austria 1996-1998]. / Hospitalisationen infolge Hepatitis A, B und C in Osterreich 1996-1998.

The aim of this study is to analyse the data of all Austrian in-patients who had been hospitalized between 1996 and 1998 with the main diagnosis "viral hepatitis" (according to ICD 9), in order to present data for epidemiological as well as health-economical considerations. The data used stem from the "Minimum Basic Data Set" (MBDS) which contains medical as well as demographical recordings of every in-patient treated in an Austrian public hospital. Hepatitis A: Values of the standardized hospitalization rate (SHR) ranged from 2.6/100,000 (1998) to 4.7/100,000 (1997). On age classes, the highest values regularly were observed in school-children (7-13/100,000 per year). Significant differences between males and females were not revealed. Among the Austrian federal states, Vienna was found to jut out (6.8/100,000 per year), probably due to its high proportion of immigrants from high-endemic regions. Hepatitis B: Values of SHR were found to be stable with about 3/100,000 per year. On age classes, rates increased rapidly in adolescents, reached the peak in young adults (aged 20 to 29 years: 5/100,000 per year) and, then, decreased slowly. Males were slightly, but not significantly, more affected than females. Interestingly, a respectable number of young children (aged 0 to 4 years) were hospitalized in 1997 and 1998 (1998: 4.4/100,000). Comparing the Austrian federal states, Vorarlberg (6.4/10,000 per year) and Vienna (4.5/100,000 per year) yielded the highest values of SHR. Hepatitis C: In the years observed, values of SHR were ascending successively from 6/100,000 (1996) to 9.7/100,000 (1998). On age classes, the highest risk of hospitalization was found for adults aged between 35 and 74 years (10-20/100,000 per year). Among the Austrian federal states, values of SHR differed considerably; Salzburg (15.1/10,000 per year) and Kärnten (Carinthia) (12.1/100,000 per year) were found to yield the highest values.

Chlamydial infection in a population of Ethiopian women attending obstetric, gynaecological and mother and child health clinics.

The prevalence of chlamydial infection was assessed in 1,846 Ethiopian women attending clinics in Addis Ababa. Sera were tested for type-specific anti-chlamydial antibodies using purified chlamydial antigens (C. trachomatis A-C (CTA-C), C. trachomatis D-K (CTD-K), Lymphogranuloma venereum (LGVI-3), and C. pneumoniae (CPn), in a micro-immunofluorescence (micro-IF) test. Three levels of chlamydial infection were established. Sera with: 1) antibodies to CTA-C, CTD-K, LGV 1-3 and CPn singly or in combination, are considered as evidence of overall exposure to chlamydial species (OEC); 2) antibodies to CTD-K and LGV 1-3 are considered as evidence of exposure to genital chlamydial pathogens (GENCI); 3) IgM titre > or = 1/8, or Ig G titre > or = 1/64 to CTD-K and LGV 1-3 alone or at a similar level with antibodies to CTA-C and CPn is considered as being evidence of active genital chlamydial infection (AGCI). OEC was found in 84 pc, GENCI in 60 pc and AGCI in 42 pc. Infection was highest in family planning and lowest in antenatal clinic attenders. OEC increased progressively with age while GENCI and AGCI peaked at ages 35 to 49. Chlamydial infection was highest in those married and sexually active < 13 years of age (OEC 88 pc, GENCI 69 pc, AGCI 49 pc); the lowest income groups (OEC 85 pc, GENCI 65 pc, AGCI 45 pc); those with more than five sexual partners (OEC 92 pc, GENCI 78 pc and AGCI 65 pc); with highest prevalence in bargirls (OEC 97 pc, GENCI 84 pc, AGCI 75 pc). Fifty pc had clinical evidence of past or present infection in the urethra, salpinges or bartholin glands (USB). OEC, GENCI and AGCI were associated with PID. The association of seropositivity with USB was remarkably similar for both gonorrhoea and chlamydial infection: we recommend adoption of a treatment regimen effective for both infections. The micro-IF test is a useful epidemiological tool for identifying the of antibodies to chlamydial pathogens. Use of antigen pools CTA-C, CTD-K LGVI-3 and CPn enables a distinction to be made between genital and non-genital infections. The problem of symptomatic and asymptomatic chlamydial disease needs to be addressed urgently.

PIP: In Addis Ababa, Ethiopia, purified chlamydial antigens were used in a micro-immunofluorescence (micro-I) test to detect type-specific antibodies against various chlamydial species in blood samples from 1846 women attending family planning, prenatal, and postnatal clinics. The antigens were for Chlamydia trachomatis A-C (CTA-C), Chlamydia trachomatis D-K (CTD-K), Lymphogranuloma venereum (LGV 1-3), and C. pneumonia (CPn). The researchers considered sera with antibodies to CTA-C, CTD-K, LGV 1-3, and CPn independently or in combination as evidence of overall exposure to chlamydial species (OEC) and those to CTD-K and LGV 1-3 as evidence of exposure to genital chlamydial pathogens (GENCI). They considered sera with IgM titre of 1/8 or more, or IgG titre of 1/64 or more to CTD-K and LGV 1-3 alone or at a similar level with antibodies to CTA-C and CPn as evidence of active genital chlamydial infection (AGCI). 84% were categorized as OEC. 60% were categorized as GENCI. 42% were categorized as AGCI. The prevalence of chlamydial infection was greatest in family planning clients and lowest in pregnant women (OECD: 88% vs. 78%, p = 0.004; GENCI: 63% vs. 54%, p 0.02; and AGCI: 46% vs. 31%) (p 0.01). The geometric mean of the titre was also highest in family planning clients and lowest in pregnant women (85% vs. 58%). The most significant factor for chlamydial infection was being married and having first coitus before age 13 (OEC: 88% vs. 75% for first coitus at 18 years; p 0.001). Other risk factors included low income (p 0.005), more than 5 sexual partners (p 0.01), bar-girl occupation (p 0.001), and Amhara and Oromo ethnic groups (p 0.001). 50% of all women had clinical evidence of past or present infection in the urethra, fallopian tubes, and/or bartholin glands. Women with pelvic inflammatory disease (PID) were more likely to have chlamydial infection than those with no infection in the urethra, fallopian tubes, or bartholin glands (OEC: 95% vs.83%; GENCI: 86% vs. 58%; AGCI: 72% vs. 38%) (p 0.001). PID was also associated with gonorrhea.

Teenage obstetric and gynaecological problems in an African city.

OBJECTIVE: To measure the prevalence of sexually transmitted diseases (STD), pelvic inflammatory disease (PID), cervical cancer, pregnancy and use of contraception in teenagers, and to determine socioeconomic factors associated with these conditions to aid planners of medical services and promotion of sexual health. SUBJECTS: 181 Ethiopian teenagers and 1,845 women aged 20 to 45 years for comparison. SETTING: Gynaecological outpatient department, antenatal, postnatal and family planning clinics, in two teaching hospitals and a mother and child heath centre in Addis Ababa, Ethiopia. METHODS: Results of serologic tests for STD, clinical evidence of PID, and cervical cytology were analysed against socio-economic factors. RESULTS: In teenagers early age at first marriage/coitus, more common in those of rural origin, was associated with poverty, a greater number of lifetime sexual partners, and prostitution: 40 pc were first sexually active before the menarche. Prevalence of seropositivity to specific STD pathogens was; Treponema pallidum (TPHA) 21 pc, Neisseria gonorrhoeae (gonococcal antibody test: GAT) 40 pc, genital chlamydiae 51 pc, hepatitis B virus 36 pc, herpes simplex virus (HSV-2) 32 pc, and Haemophilus ducreyi 16 pc: 92 pc of teenagers were seropositive to one or more STD's. STD seroprevalence was higher in those with more than one sexual partner, those sexually active by age 15 (very high in those sexually active by age 12), those involved in prostitution and those attending the family planning clinic. Forty three pc had clinical evidence of PID; one married at age 10 had invasive cervical cancer by age 18; 40 pc of teenagers were pregnant compared with 25 pc of those aged 20 to 45; 21 pc attended for family planning; of regular FPC attenders 81 pc were GAT seropositive. CONCLUSION: Despite legislation early age of sexual debut is common, STD and PID are widely prevalent, the pregnancy rate in adolescents is high and contributes to the national population growth rate. Action is required at family, medical and governmental level to encourage cultural acceptance that marriage and sexual activity should not occur before the age of 16 years, with education appropriate to culture to prevent STD. Similar studies are recommended in other countries to establish a baseline for informed strategy regarding prevention of STD and health education.

PIP: A survey of 181 Ethiopian females ages 14-19 years recruited from health facilities in Addis Ababa revealed a high incidence of obstetric and gynecologic problems. All subjects completed a questionnaire administered by a female health worker and underwent a gynecologic examination and serologic tests. 49% of subjects were married and 18% were divorced; 11% were prostitutes. Age at first intercourse was under 12 years in 18%, 13-15 years in 38%, and 16 years or above in 44%; 40% were sexually active before menarche. 92% of adolescents had at least one sexually transmitted disease (STD), predominantly gonorrhea (40%), genital chlamydia (51%), hepatitis B (36%), herpes simplex virus (32%), and syphilis (21%), and 43% had clinical signs of pelvic inflammatory disease (PID). 53% had had at least one pregnancy. The earlier the age at first intercourse, the more likely it was that the adolescent would have multiple sexual partners and several STDs; adolescents in this category were also more likely to be from poor families from rural areas. Only 21% were attending a family planning clinic for annual check-ups; 14% of these females were using contraception. Although only 8% were infertile at the time of assessment, 23% had clinical evidence of salpingitis--a risk factor for future infertility. Given the long-term health risks (e.g., infertility, cervical cancer, and gonorrhea-related infant morbidity) associated with the patterns observed among these adolescents, it is recommended that STD education receive higher priority and that the Ethiopian Government consider greater enforcement of the law prohibiting sexual intercourse and marriage before the age of 16 years.

[The impact of ultrasound in urology]. / Stellenwert des Ultraschalls in der Urologie.

Ultrasound is of great importance in the diagnosis of acute and chronic diseases in urology, such as kidney colic, testicular torsion, low-grade kidney trauma or for follow-up of vesicoureteral reflux, evaluation of infertility, measurement of residual urinary volume and the detection of cancer. An ultrasound examination is time and cost-effective without exposure to ionizing radiation and is routinely performed by practitioners as well as in the clinical daily routine. With technical innovations, such as contrast-enhanced ultrasound or real time elastography, it would for instance be possible to extend the application field of ultrasound. However, in some fields of investigation ultrasound still lacks accuracy and despite its many advantages the validity of ultrasound findings sometimes has to be verified with computed tomography (CT) or magnetic resonance imaging (MRI).

[Imaging diagnostics of the prostate]. / Bildgebung der Prostata.

Prostate cancer is the most common malignancy of men with approximately 32,000 new cases of prostate cancer in Germany and approximately 11,000 men who would die of the disease each year. For early diagnosis of prostate cancer PSA testing is used, whereas at present screening cannot be recommended due to the lack of confirmed medical and economic benefits. Regarding the imaging modalities, ultrasound of the prostate, currently performed in combination with elastography and histoscanning, magnetic resonance imaging of the prostate in combination with endorectal coils and positron emission tomography combined with computed tomography (PET-CT) are the methods of choice. Using these methods benign prostatitis can be differentiated from prostate cancer and staging of the tumor can be accomplished. On the other hand using these imaging methods it is possible to define the dominant intraprostatic lesion with different sensitivities and specificities, which is important for minimally invasive therapeutic strategies.

[Imaging of prostate cancer by diagnostic radiology and nuclear medicine]. / Radiologisch-nuklearmedizinische Bildgebung des Prostatakarzinoms.

The diagnostic methods in radiology and nuclear medicine for the imaging of prostate cancer as well as for the detection of locoregional recurrent disease and positive lymph nodes have progressed dramatically over the past years. Regarding technical advances in magnetic resonance imaging (MRI) and the new tracers used in nuclear medicine, an increase in sensitivity up to 85-90% and in specificity up to 75-90% has been achieved. Especially in MRI, efforts had been made to implement multiparametric imaging using the diagnostic methods of spectroscopy and diffusion-weighted sequences and by including dynamic contrast enhancement studies. In addition, by the use of dedicated, lymph-node specific contrast media, "ultrasmall paramagnetic iron particles" (USPIO), up to 100% of all pathological lymph nodes were detected in the published studies. Also in the field of nuclear medicine there have been relevant advances such as the development of specific tracer substances, which can be coupled to 18fluorine, a nuclide that is characterised by a longer half-life time than 11C and is therefore usable even in sites without an in-house cyclotron. Using this nuclide, the sensitivity and specificity rates in the detection of primary prostate cancer as well as in locoregional recurrences have been increased to values between 85 and 95%.