[Implementation of the 9th revision of medical licensing regulation for physicians in the cross-sectional area "prevention and health promotion" at the German medical faculties]. / Umsetzung der 9. Arztlichen Approbationsordnung im Querschnittsbereich "Prävention und Gesundheitsförderung" an den medizinischen Fakultäten in Deutschland.

The coming into effect of the 9th Revision of German Medical Licensing Regulations for Physicians on October 1st 2003 saw prevention and health promotion become a cross-sectional module of medical training subject to compulsory assessments and a grading system. The individual medical faculties are responsible for content and teaching methods. An initial survey of all 36 German medical facilities shows the current implementation of the new cross-sectional area. In a partly standardised questionnaire these faculties were surveyed on the linking of coordination and realisation, the didactic methodology concept of teaching as well as potentials and difficulties in implementation. The implementation of the cross-sectional area differs in responsibility with regard to coordination and content, time provided, integration of practice in health care and forms of assessment. Whereas consensus exists regarding the relevance and integration of preventive themes in teaching, the picture for health promotion is very heterogeneous.

[Surgical therapy of ileus of the large intestine]. / Chirurgische Therapie des Dickdarmileus.

Acute colonic obstruction is a life threatening emergency. In this prospective study 69 patients suffering from large bowel obstruction, admitted between November 1993 and March 1998 to the University hospital of Bern, were analyzed with regard of the performed surgical procedure. The causes of obstruction were colorectal carcinomas (38%), other malignancies (19%), volvulus (13%), hernias (10%), diverticulitis (7%) and others (13%), 8 benign and 19 malignant lesions were surgically treated without colonic resection, the latter by colostomy (13), ileostomy (5) or bypass (1). All the other 42 patients had their obstruction resected within 24 hours after admission, 24 of them with primary anastomosis and 18 as a two-staged procedure. However, 9/18 (50%) patients never have had restoration of bowel continuity. No three-stage procedure was planned or performed. In-hospital mortality was 4/69 (5.8%), all of them after staged resections due to non-surgical complications. No anastomotic leakage was clinically apparent, neither in one-stage procedures, nor in completed two-stage procedures. Median length of total hospital stay in one-stage and two-stage procedures was 14 and 30 days, respectively. The advantages of one-stage procedures, especially in terms of subtotal colectomy, are discussed on the basis of an overview of the literature.

The course of fibrinolytic proteins in children with malignant bone tumours.

UNLABELLED: To evaluate the role of fibrinolytic and proteolytic proteins in children and adolescents suffering from Ewing sarcoma or osteosarcoma with respect to postoperative complications and late outcome, a prospective two-arm two-centre study was conducted. Plasminogen, plasminogen activator inhibitor (PAI)-1, tissue-type plasminogen activator (t-PA) and urokinase plasminogen activator (u-PA) were investigated in the pre-surgical period and in the postoperative follow-up period in children suffering from Ewing sarcoma (ES; n = 36) or osteosarcoma (OS; n = 39). In addition, the factor V mutation (FV) Q506, protein C, protein S, antithrombin and lipoprotein (a) were determined. All children received LMWH (EnoxaparinR) 1 mg/kg s.c. once daily over a period of 6 weeks to 3 months. Besides a short-lasting increase of PAI-1 in patients with OS on day 1 and in children with Es on day 14, a small and significant but clinically irrelevant difference was found on days 7-10 for plasminogen, t-PA and u-PA. No thromboembolic complications occurred in patients treated with LMWH and having a prothrombotic genetic risk factor. Within one year of surgery 7 out of 36 patients with ES and 5 out of 39 children with OS showed a relapse of their disease. Prior to the first local tumour therapy, 5 out of 7 children with ES and relapse had elevated u-PA concentrations compared with 2 out of 5 children in the OS group. No such differences were found for PAI-1- or t-PA antigen. CONCLUSION: The role of u-PA as a possible follow-up marker for a poorer outcome in children with ES should be evaluated in a prospective multicentre study.