[Demographic perspective on the concept of the tailored approach in surgery : Analysis of the quality of life exemplified by inguinal hernia repair]. / Die demografische Perspektive auf maßgeschneiderte Therapieansätze : Eine Analyse der Lebensqualität am Beispiel der Leistenhernie.

INTRODUCTION: The constant increase in life expectancy for over 170 years is one of the biggest achievements of modern society. In Germany the probability of an 80-year-old person becoming 100 years old has increased by a factor of 20 since the 1950s. This fact has various implications for the clinical routine and therapeutic guidelines. In addition to the quantitative factors (e.g. complications, recurrence rate), the quality of life (QoL) as a patient-centered subjective factor should be taken into consideration in the treatment options for hernia repair. To compare heterogeneous cohorts of patients regarding the QoL, a standardization based on representative reference values is absolutely essential. MATERIAL AND METHODS: The study was based on data from the follow-up of 310 patients who underwent inguinal hernia repair at the surgery department of the University Hospital Rostock. The preoperative clinical examination of the patients and a questionnaire were supplemented by a postal follow-up survey postoperatively at a median of 20 months (follow-up rate 66%). Patient pain level was assessed by a visual analogue scale (VAS) and health-unspecific QoL by the EQ-5D questionnaire. Standardization of the EQ-5D was based on a survey on a normative German reference population. RESULTS: Analysis of the patients in the various treatment arms showed significant differences in age composition and health states (American Society of Anesthesologists, ASA scores) of the patient cohorts. A comparison of the QoL between the two mesh-based procedures, the transabdominal preperitoneal (TAPP) procedure and the Lichtenstein procedure, showed that complete recovery is possible after 6 months. A slight decrease in the QoL of the Lichtenstein cohort patients was ascertainable, which can be explained by the method and the higher age of the group. Taking the differences in age of the two groups into account led to a change of the QoL outcome. CONCLUSION: The concept of QoL is currently becoming increasingly more important in the assessment of treatment procedures. When comparing several therapeutic procedures, a standardization must be undertaken to take the heterogeneity of patient cohorts into consideration. Analogous to the relative survival in cancer epidemiology, the measured QoL scores should be put in the relationship to the age and sex-specific reference of the general population in order to demonstrate the actual effect of the disease in question and its treatment.

[The parameter "relative survival": Analysis of regional cancer registry data for prostate cancer]. / Der Parameter "Relatives Überleben" : Analyse regionaler Krebsregisterdaten beim Prostatakarzinom.

BACKGROUND: There is a lack of comparability of relative survival rates due to differences in regional mortality. OBJECTIVE: How should relative survival be calculated to be able to compare regional cancer mortality? MATERIALS AND METHODS: Calculation of relative survival rates of prostate cancer patients from a regional cancer registry using diagnosis year and stage, based on differential mortality tables. RESULTS: Calculation of relative survival for all prostate cancer patients shows a very slight excess mortality after 5 years compared to a matched general population. Introduction of new imaging techniques and PSA screening led to a change in the distribution of diagnosed stages. Differentiation by stage is therefore essential. Thus, patients with UICC stage I, II, and III have a very low excess mortality, while patients with a UICC stage IV have a significantly higher excess mortality; however, it is very surprising that the excess mortality of patients without specification of the UICC stage is similarly unfavorable as in the case of patients with UICC stage IV. CONCLUSION: If data from a regional cancer registry are used, adequate mortality tables from the catchment area of the registry should be used as a reference due to regional mortality differences. Thus, progress in patient survival can be more precisely mapped. With respect to prostate cancer patients, differential consideration by stage is also necessary because improved early detection methods has led to a change in the stage distribution and, thus, survival.

Somatostatin - therapeutic option for chylothorax in preterm neonates. Report on two patients and review of the literature.

We report the use of somatostatin in two preterm neonates with chylothorax and discuss those cases in the light of current literature on the treatment of chylothorax in infants born preterm. Chylothorax, a severe complication in thorax surgery, is also a symptom of different diseases and may even occur spontaneously. Treatment is difficult, especially in preterm neonates with co-morbidities. The standard therapeutic strategy with non-invasive procedures (e.g. enteral diet free of long chain triglycerides or parenteral nutrition) is not always effective. Surgical interventions, like pleurodesis, ligation of the ductus thoracicus, or pleuroperitoneal shunt may be of considerable risk in preterm infants and must be carefully evaluated. Somatostatin is a new non-invasive therapeutic option for the treatment of chylothorax in adults and older pediatric patients. Case reports demonstrate the effectiveness of the somatostatin treatment, mostly in adult patients and in adolescents. There are only few case reports describing the use of somatostatin in preterm neonates. One VLBW (very low birth weight) and one hypotrophic ELBW (extremely low birth weight) neonate (gestational ages of 30+3/7, and 25+2/7 weeks; birth weights of 1270g, and 450g respectively) were treated for chylothorax with continuous infusion of somatostatin in addition to the dietary treatment. The chylothorax disappeared after start of somatostatin. No major side-effects of the somatostatin treatment were observed. As reported in other published pediatric cases, somatostatin seems to be a therapeutic option for the treatment of chylothorax in preterm neonates. In review of the literature we identified another eleven case reports on the treatment of persistent chylothorax with somatostatin or octreotide in preterm neonates. Further observations are needed before somatostatin can be recommended as a standard first-line treatment procedure for chylothorax in infants.

[Psychological stress, knowledge and treatment expectation of parents with a child managed by cochlear implant]. / Psychische Belastung, Informiertheit und Behandlungserwartung von Eltern mit einem Cochlear Implant versorgten Kind.

UNLABELLED: ESTABLISHED KNOWLEDGE: It is known that parents of hard-of-hearing children suffer from an increase in psychosocial stress. SCIENTIFIC QUESTION: How does the psychosocial situation of parents with children who have cochlear implants change during rehabilitation? AIM OF STUDY: It was the aim of this study to demonstrate how parents evaluate retrospectively their own psychological well-being during the process of rehabilitation. METHODS AND RESULTS: We interviewed 87 parents by questionnaires which were mailed to them. Fifty-seven mothers and 46 fathers responded (59% return rate). Parents reported a significant increase in stress, as perceived by themselves, after the time of diagnosis. Of the parents, 25% continued to suffer from psychic stress during rehabilitation as could be demonstrated by the SCL-90-R questionnaire criteria. The expectations by parents were realistic prior to implantation but thereafter increased significantly with time. CONCLUSIONS: The psychological state of parents during the critical phase, after a diagnosis of deafness has been made for their child, has to be considered. Even after an initial phase of shock, parents seemed to be stressed to an extent that required therapeutic intervention.