[Occupational cancer of the urinary tract-incidence, reporting behavior, and administrative procedures]. / Berufsbedingte Tumoren der ableitenden Harnwege ­ Häufigkeit, Meldeverhalten und administratives Vorgehen.

Tumors of the urinary tract are among the most common types of occupational cancer. A significant proportion of about 5-15% may be of occupational etiology. Suspicion of an occupational genesis is subject to mandatory reporting. However, epidemiological analyses show that the number of reports received by accident insurance companies and employers' liability insurance associations is significantly lower than expected. Finally, the economic and administrative effort in surveying a patient's occupational history hinders adequate reporting. By routinely and systematically using a structured questionnaire as part of clinical routine in our hospital, a significantly improved detection of justified suspected cases (from about 4.8% to about 67% of the theoretically expected value) has been achieved since about 2006. In addition to improved medical care and adequate compensation for recognition as an occupational disease, disease-related care is subject to extra-budgetary remuneration in Germany (UV-GOÄ).

[Urinary bladder cancer as a late sequela of spinal cord injury : Decision-making aids for assessment of this causal association]. / Harnblasenkarzinom als Spätfolge einer Querschnittlähmung : Entscheidungshilfe für eine Zusammenhangsbegutachtung.

BACKGROUND: There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association. MATERIALS AND METHODS: A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids. RESULTS: It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSION: The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.

[Prerequisites for a convincing (neuro-)urology opinion : Importance of objectivity in the legal sense of full proof, occurring under duty of compliance of the surveyed person]. / Voraussetzungen für ein überzeugendes (neuro)urologisches Gutachten : Stellenwert der Objektivierung im Sinne des Vollbeweises unter Mitwirkung(spflicht) des Probanden.

Convincing urological expert opinions require the objectification of medical history complaints of health and functional disorders in the legal sense of obtaining full proof. This means that there is such a high degree of likelihood, beyond any doubt of a reasonable person observing the condition (Bundessozialgericht Entscheidung [BSGE] 32, 203/207). This requires a comprehensive general and special medical history survey, as well as a series of urological examination procedures in the hands of experienced urologists. In addition, it is necessary to observe the fundamentals of the various legal areas, from which the opinion order comes from, without exception. However, it would not be possible in all cases to achieve an unequivocal clarification of the problem in question. Nevertheless, it should be ensured that the best possible approximation to the actual truth of the case is reached. In this way, the democratic fundamental right of all the appraised persons to equal treatment could be met in the best possible way and optimal support to the commissioning institutions would be made available.

[Procedures for determining occupational diseases in cases of urological disorders]. / Das Berufskrankheitenverfahren bei urologischen Erkrankungen.

According to section sign 202 of the German Social Security Code VII, individuals diagnosed with bladder cancer or renal cell cancer who had been occupationally exposed to carcinogens known to induce cancer in these human tissues must be reported to the statutory accident insurance. In this paper, the course of the administrative procedure, particularly considering the reporting procedure and screening for occupational risk factors by a CD-based tool, developed by the authors, is described.

[Clinical relevance of acetylator phenotyping in 196 urothelial tumor patients]. / Untersuchung zur klinischen Relevanz der Acetyliererphänotypisierung bei 196 Urotheltumorpatienten.

A total of 196 patients with urothelial tumours were phenotyped for N-acetyltransferase 2 by the molar ratio of two caffeine metabolites excreted in urine. The proportion of "slow" acetylators, who are genetically predisposed to urothelial tumours if they have been exposed to aromatic amines in the past, in the entire group was 55%, within the range in a normal population. Among 40 patients with assumed former occupational exposure to aromatic amines, 65% were "slow" acetylators. Invasiveness, histopathological grading of the urothelial tumour at the time of first diagnosis, and course were not related to acetylator phenotype.

Occupational history and genetic N-acetyltransferase polymorphism in urothelial cancer patients of Leverkusen, Germany.

OBJECTIVES: The study was designed to realize possible shifts in the ratio of slow to fast acetylators within a group of 196 urothelial cancer patients in an area with earlier benzidine production. METHODS: The subjects were interviewed for occupational and nonoccupational risk factors. The patients were phenotyped for N-acetyltransferase 2 (NAT2) by Grant's caffeine test. A subgroup of 54 patients was additionally genotyped for NAT2. RESULTS: The antimode in the NAT2 phenotyping with the caffeine test (AFMU: IX ratio) was 1.0, as evidenced by additional genotyping of the subgroup of 54 patients. The prevalence of slow acetylators in the entire group of bladder cancer patients was 55%, in accordance with published figures for European populations. In a subgroup of 40 patients with occupational histories as workers in chemical or rubber industries 65% were slow acetylators. In a further subgroup of 28 cases having specifically worked at chemical production sites of the local chemical industry, 68% were slow acetylators. CONCLUSIONS: In contrast to earlier studies, this study shows no increased prevalence of slow acetylators among urothelial cancer patients in comparison with the normal population. However, in subgroups of cases with a likelihood of past occupational contacts with aromatic amines, there was a trend towards a higher representation of slow acetylators. This finding is in accordance with observations of others that the percentage of slow acetylators in urothelial cancer patients is generally decreasing, possibly because the production of benzidine and benzidine-based dyes ceased in the early 1970s.

[Urothelial diseases as an occupational disease]. / Urothelerkrankungen als Berufskrankheit.

The number of urothelial tumors of the lower urinary tract caused by occupational exposure is expected to markedly exceed the number of diseases which are actually compensated. The German compensation system for diseases is explained using the example of disease number 1301 which applies to bladder diseases due to aromatic amines. A standard procedure for the evaluation of the percentage of disability ("MdE") caused by tumors of the urinary bladder is presented. Important working areas which are associated with an elevated tumor risk of the lower urinary tract are mentioned. Cancerogenic aromatic amines can also be liberated in the human organism from soluble, i. e. bioavailable, azo dyes by reductive cleavage. Therefore, as a first step, a detailed work history (starting from the beginning of apprenticeship) must be obtained in all cases of urothelial tumors because of the very long latency time of tumors of the urothelium which can be up to fourty years and higher.

[Propionate negative saccharolytic bacteroides strains (B. oralis)-occurrence, identification, antimicrobial susceptibility and serological behaviour (author's transl)]. / Propionatnegative saccharolytische Bacteroides-Stämme (B. oralis)-Vorkommen, Identifizierung, Chemotherapeutika-Empfindlichkeit und serologisches Verhaltin

Twenty-three propionate negative non-pigmented Bacteroides strains were isolated from mixed infections (peritonitis, endometritis, abscess of the abdominal wall etc.) as well as vaginal secretions of healthy parturients in the course of 3 years. The cultures were indole negative, produced acetic, isobutyric and isovaleric acids and had a final pH of 5.0-5.5 in glucose broth; they were assigned to B. oralis as described by LOESCHE and coworkers in 1964. tpathogenic significance of this organism may be assumed in those cases of mixed infection where the microbial association consisted solely of gram-positive species with low virulence (lactobacilli, Staphylococcus epidermidis, Peptococcaceae). Antibiotic susceptibility of 12 B. oralis strains was studied by tube dilution tests. Resistance to cephalosporins was detected in 8 strains, about half of them were resistant to ampicillin and penicillin G. Like other Bacteroides species, the B. oralis strains showed resistance to aminoglycosides and sensitivity to clindamycin, chloramphenicol and erythromycin. The serological behaviour of 9 B. oralis strains was studied in cross-agglutinationation and gel-diffusion experiments. Cross-reactivity was particularly pronounced in immunodiffusion tests with autoclaved extracts. According to the results obtained, the strains belonged to a homogeneous group with 1-2 identical antigens. These B. oralis antigens were shared by B. melaninogenicus ss. intermedius 2965. There were, however, no cross-reactions between the aforementioned strains and B. melaninogenicus ss. melaninogenicus 8117/1. The taxonomic implications of a close relationship between B. oralis and B. melaninogenicus ss. intermedius are discussed.