[Robotic-assisted mobilization for an effective mobilization in a COVID-19 patient with ECMO treatment]. / Mobilisationsrobotik für eine qualitativ hochwertige Mobilisation bei einem COVID-19-Patienten mit ECMO-Therapie.

An effective (early) mobilization in COVID-19 intensive care patients with ECMO treatment is very important. Sedation, extracorporeal procedures with the danger of circuit malfunction, large lumen ECMO cannulas with a risk of dislocation and a very severe neuromuscular weakness are factors that could deem mobilization beyond stage 1 of the ICU mobility score (IMS) in some cases difficult or impossible; however, early mobilization is a key point of the ABCDEF bundle to counteract pulmonary complications, neuromuscular dysfunction and enable recovery. The case of a 53-year-old, previously healthy and active male patient with a severe and complicated course of COVID-19 and pronounced ICU-acquired weakness is described. While receiving ECMO the patient could be mobilized using a robotic system. Due to severe and rapidly progressing pulmonary fibrosis, additional low-dose methylprednisolone therapy (Meduri protocol) was implemented. Under this multimodal treatment the patient was successfully weaned from the ventilator and decannulated. Robotic-assisted mobilization has the potential to be a novel and safe therapeutic option for a customized and highly effective mobilization in ECMO patients.

[Implementation of regularly performed resuscitation training at a hyperbaric treatment center]. / Implementierung eines regelmäßigen Reanimationstrainings an einem Druckkammerzentrum.

BACKGROUND: Medical emergency situations and even cardiac arrest can occur during treatment of patients in therapeutic hyperbaric chambers just as in other clinical departments; therefore, high quality structured management should be implemented for dealing with emergencies in this special working area. To ensure this the emergency medical treatment should not only be performed according to the current state of medical knowledge but needs to take the special features of the hyperbaric environment including safety aspects into account. METHOD: This article presents a description of the implementation and effects of routine emergency and resuscitation training at a center for hyperbaric medicine. RESULTS: By simulation of emergencies in a hyperbaric chamber it rapidly became clear that the treatment of medical emergencies and cardiac arrest under hyperbaric conditions has some special features and due to safety aspects cannot always be performed according to current medical guidelines. At the time of this simulation in a real life working environment, previously unknown structural and logistic problems became obvious whereby the solutions contributed to a significant improvement of structural and process quality and could potentially also improve the outcome quality. Furthermore, a positive and lasting learning effect in the fields of quality of resuscitation measures, organization of the workplace, communication skills, logistics and safety aspects was detectable by analyzing participant performance over a period of 4 years. On the part of the participating staff a positive feedback and high acceptance of emergency simulator training was confirmed. CONCLUSION: Through annual compulsory emergency training of the complete staff of the hyperbaric unit at the actual workplace, a structural and confident approach to dealing with emergencies and resuscitation situations was observed. By the use of on-site simulator training even in specialized hospital units, deficits and tentativeness regarding logistics, course of action, organization and communication in emergency situations can be minimized to provide optimum patient care in a real life emergency situation by focusing on the medical measures.

A new theory of micturition and urinary continence based on histomorphological studies. 2. The musculus sphincter vesicae: continence or sexual function?

Results of a histomorphological study of serial sections carried out in frontal, transversal and sagittal directions in 65 bladder necks are presented. It is shown that the trigonal system of the urinary bladder consists of two anatomical structures: first, of a muscle originating from the muscle system of both ureters and converging to form within the bladder the interureteric ridge, the musculus interuretericus and of a second structure forming the actual trigonum vesicae. It is the musculus sphincter trigonalis or musculus sphincter vesicae. This muscle elliptically embraces the internal urethral orifice and is only formed by one muscle lamella. It does not as has often been described extend in any form to the urethra or to the surroundings. The so-called Bell muscle does not exist. During the reproductive years the lower part of the sphincter trigonalis is strongly pervaded with prostate tissue. This could enable the muscle to have a double function: a continence function in accordance with a consequent distinction between the urinary bladder and the urethra as urinary and sexual tract, and during ejaculation the muscle could prevent the retrograde ejaculation and on the other hand the contraction of the muscle could lead to the release of the prostate secretion.

[Priapism--erectile potency following conservative and surgical treatment]. / Priapismus--die erektile Potenz nach konservativer und operativer Behandlung.

Priapism is a rare urologic disease, which is characterized by a pathological, increasingly painful permanent erection of the penis, is appearing without sexual sensations and does not recede spontaneously. The cavernous bodies are affected, not, however, the corpus spongiosum penis and the glans penis. A permanent loss of the erection caused by fibrosation of the trabeculae in the corpora cavernosa is the main complication of the disease. At the instance of 16 cases of the disease conservative and operative methods of therapy are discussed and described as method of choice the cavernosoglandular shunt of puncture after Ebbehøj/Winter is described. It is referred to the prognostic significance of an early, primarily operative treatment.

[Benign prostatic hyperplasia as a frequent senile disease of the male]. / Die benigne Prostatahyperplasie als häufige Alterserkrankung des Mannes.

An adenofibromyomatous proliferation starting from the region of the periurethral glands is referred to as benign prostatic hyperplasia. It is the result of a senile endocrinopathy, which leads to a disbalance of the peripheral hormonal milieu, and of an intraglandular disturbance of the utilization of the hormone. It becomes a disease when it is followed by an increase of the vesical outlet resistance and thus by an obstructive disturbance of the voiding of the urinary bladder. The indication for operation is determined by the degree of the obstruction and its pathophysiological sequelae as well as the complaints of the patients. The conservative therapy is above all symptomatic and indicated only at the initial stage of the disease. The transurethral resection is the operative therapy of choice. In very large hyperplasias the open surgical intervention may be necessary. In inoperable patients a urethral catheter should be renounced for a suprapubic puncture cystostomy. Also after operative ectomy of a benign prostatic hyperplasia the patients may fall ill with a carcinoma of the prostatic gland. Therefore, the duty for undergoing an annual preventive medical examination remains.

[Effect of Mictonorm (propiverin hydrochloride) on the female urethra]. / Zur Wirkung von Mictonorm (Propiverinhydrochlorid) auf die weibliche Urethra.

In a study about drug-induced changes of the urodynamics of the female urethra by Mictonorm 14 women with urge-symptoms were investigated. According to a special examination plan the control of Mictonorm-effect was realized with the analysis of the parameters of the urethra pressure profile at rest and under stress conditions and of the vesico-urethral pressure transmission. The result shows that there were no significant changes of the urodynamics of the female urethra, therefore one can accept selective detrusor effects by oral application.

[Changes induced by Mictonorm in the urodynamics of the detrusor muscle in females with symptoms of the urge to urinate]. / Die Veränderungen der Urodynamik des Detrusors bei Frauen mit Urge-Symptomatik durch Mictonorm.

In a study for the recognition of the urodynamics of the detrusor after administration of the anticholinergic drug Mictonorm 14 patients with obstinate urge symptoms were examined. According to an examination plan every woman underwent three cystometric examinations each which were performed by means of a special urodynamic measuring device. Apart from a distinct improvement of the subjective complaints with the help of significantly different cystometry parameters the change of the urodynamics of the detrusor after therapy may be made evident in the results.

[Operative findings and therapeutic results in patients with primary hyperparathyroidism]. / Operationsbefunde und Therapieergebnisse bei Patienten mit primärem Hyperparathyreoidismus.

In the period from 1976 to September 1982 39 patients with the clinical diagnosis of primary hyperparathyroidism were operated on. Among then were 24 women and 14 men. The most frequent manifestation form is the renal one (n = 26). The proportion of patients with hypercalcaemic crisis was very large (n = 4). Topographically and anatomically the adenomas were most frequently found in the region of the right lower pole of the thyroid gland. 23 patients had a singular adenoma, 11 patients showed multiple adenomas and only 2 had a diffuse hyperplasia. In patients with persisting hyperparathyroidism before a repeated intervention an attempt of localization should be performed by a selective phlebography with taking of blood samples for the determination of PTH. The success of the operation is to be read off most clearly at the behaviour of the post-operative values of serum calcium. In 29 patients a normocalcaemia was achieved. 6 patients showed at first a hypocalcaemia, which however, was only temporary in 4 patients. 3 patients had a persisting hyperparathyroidism. In accordance with the literary data the formation of renal calculi clearly decreased after a successful operation.

[Comparative studies on the evaluation of leukocyturia by means of counting chambers, sediment microscopy and the Cytur test]. / Vergleichende Untersuchungen über die Auswertung der Leukozyturie mittels Kammerzählung, Sediment-Gesichtsfeldmethode und Cytur-Test.

For the purpose of quantitative evaluation of leucocyturias we examined the spontaneous urine (mid-stream method) of 260 patients with nephropathies. The quantitative chamber counting of non-centrifuged urine was compared with the microscopic examination of spun sediment and the Cytur-test. The microscopic examination of spun sediment has to be declined because of high falsely positive and negative results. The Cytur-test is to be performed in a simple way and of high evidence. It is referred to the necessity of an application of test-stripes for leucocyturia.

[Development of methods for the qualitative and quantitative determination of urinary glucose]. / Entwicklungsstand der qualitativen und quantitativen Bestimmungen der Harnglukose.

The methods for proof and determination of urinary glucose practiced in the GDR are discussed and in a comparative determination confronted to the hexokinase method (Glucoquant). Apart from this the Biophan-G stripe was compared with the multi-test stripes Ecur-test (Boehringer) and N-multistix (Ames). The methods of urinary glucose which are declared as obligatory for the GDR in the DAB 7 (D. L.) do no more correspond to the present level of knowledge. The Biophan-G stripe is the exception. By means of Ecur-test and N-multistix an in every case a 98 per cent correct semiquantitative evaluation was obtained in 250 different urines, in the Biophan-G stripe a 94 per cent evaluation.

[Personal experiences in the diagnosis and treatment of primary hyperparathyroidism]. / Eigene Erfahrungen bei der Diagnostsik und Therapie des primären Hyperparathyreoidismus.

It is reported on an interdisciplinary team consisting of internists, radiologists and urologists which treated twelve patients with suspicion of primary hyperparathyroidism. The diagnostics is performed in form of a three-step progamme. A great importance is still ascribed to hypercalcaemia and therefore it serves as leading symptom. By means of the selective determination of parathormones no clear side classification could be achieved. In ten patients the operation could successfully be finished with the exstirpation of one or more adenomas of the parathyroid glands. A special importance deserves the intensive postoperative control with regular determinations of serum calcium in order to encounter in time a hypocalcaemia with tetanies by applications of calcium. It is referred to the necessity to search for an adenoma of the parathyroid gland at the slightest suspicion of the presence of a primary hyperparathyroidism.

[Urodynamic studies on normal bladders and bladders in metabolic disorders using diabetes mellitus as an example]. / Urodynamische Untersuchungen an der gesunden und stoffwechselgestörten Harnblase am Beispiel des Diabetes mellitus.

In various diseases of the kidney and the urinary bladder, in disturbances of potency and diseases of the outer genital the diabetes mellitus play an essential role. It was the aim the present investigations to establish with the help of manometric examinations of the urinary bladder in diabetics as well as in a comparative group which had no disturbed metabolism in what extent there exist objectively provable differences of the parameters chosen by us. From the results is to be stated that in diabetics, despite a slight increase of the capacity of the urinary bladder, a significant increase of the sphincter opening pressure and of the voluntary tonus of the sphincter is present. We explain these changes as an expression of a beginning disturbance of the innervation of the urinary bladder. In males of this age group from this result disturbances of miction which may lead to incorrect judgments, particularly in connection with a prostatic adenoma.

[Immunological studies after the cryosurgical treatment of urologic tumors]. / Immunologische Untersuchungen nach kryochirurgischer Behandlung urologischer Tumoren.

It is stated that a general final evidence is not yet possible from the existing results of immunological investigations and it may be possible only when taking into consideration the extensive furthering controls mentioned. On the basis of the therefore further existing uncertainty in the evaluation of the immunological valency of the cryotherapy, which is expressed also in literature, the originally optimistic suggestions concerning an increased immune response to the cryotherapy must be judged critically. Even when the clininically favourable courses after cryotherapy, above all in the treatment of the penis carcinoma, may be impressible--a cryospecific immune reaction was not to be proved by the test systems at our disposal.