Der Body Mass Index als Entscheidungsgrundlage für medizinisch indizierte Brustreduktionen

Summary: PURPOSE: Breast reduction is a highly emotional theme and bears conflicting interest groups: (1) women who are suffering from symptomatic macromastia and therefore would wish to have their breast reduction paid by the insurers, irrespective of the amount of resection weight, (2) the insurance companies, who are ready to cover only really medically indicated operations and due to a lack of objective parameters often apply the very strict, arbitrary criterium for a minimum resection weight of 500g per breast, and (3) the surgeons, who try to provide a fair, scientific basis for the differentiation between cosmetic and reconstructive indications for breast reductions for the sake of both the patients and the insurance parties. Concerned about such a generalizing rule, we undertook a retrospective review of our patients' charts with both cosmetic and reconstructive indications to judge the available, more-level minimum resection weight standards and see wether they were appropriate to use, or to provide an objective and measurable guideline for a scaled amount of breast reduction beyond the 500 g-resection-rule, adapted to the individual woman's body proportions. METHODS: 136 women could be included in the study. The resection weight was recorded and correlated to various parameters of the body proportions such as weight, height, the body mass index (BMI) and the body surface. The results were compared to the available minimum resection weight rules. RESULTS: The resection weight ranged from 55 to 1530g (mean, 450g ± 266g; median, 406g). Overweight was present in 36% of all patients, whereas obesity was present in 7.5 % of women. The mean BMI was 25.1 kg/m2. Of the twenty-four patients (18%), who were classified a priori as having a cosmetic indication, 4 (18%) had more than 500g breast tissue resected bilaterally. On the other hand, in 55% of reconstructive patients less than the predicted 500g of breast tissue had been resected. From all examined parameters the BMI had the highest correlation to the resected mean breast tissue (r = 0.64, p ≤ 0.001). DISCUSSION: Our retrospective review thus showed that with an arbitrary 500g breast resection-rule all women beyond the mean values for weight and height were clearly put at a disadvantage. Also not completely solving this problem are the already available, more objective guidelines for graded minimum resection weight recommendations which have relied on the body weight or the body surface area, parameters that both had a much lower correlation to the resected breast tissue in the patient group than the BMI. We therefore suggest using the BMI as the basis for a graded, more-level weight resection standard for reconstructive breast reductions. This algorithm is related solely to objectifying data and thus avoids biases from empirically derived data or hardly quantifiable breast (or obesity) related pain syndromes, and respects all the different body builds of wome

A body mass index related scale for reconstructive breast reduction

Breast reduction is a highly emotional topic, involving three conflicting interests: (a) women suffering from symptomatic macromastia, (b) health insurance companies, and (c) surgeons. Many insurance companies, including those in Austria, cover (if at all) only breast reductions with a minimum resection weight of 500g per breast, irrespective of the physical build of the woman involved. We retrospectively reviewed 136 patients' charts from both cosmetic and reconstructive breast reduction operations and compared the breast resection weight to various parameters of body proportions such as height, weight, body mass index (BMI), and body surface area to determine the parameter best correlated to the weight of breast tissue resected. From this we developed a graded scale for guiding future operations irrespective of a woman's body build. The resection weight ranged from 55 to 1530g (mean 450±266, median 406); mean BMI was 25.1. The arbitrary 500g breast resection rule discriminates against women of nonaverage weight or height: of 24 patients (18%) with a cosmetic indication 4 had more than 500g breast tissue resected bilaterally, while in 62 reconstructive patients (46%) less than the arbitrary 500g breast tissue was resected. The parameter best correlated to the mean weight of breast tissue resected (sum of both breasts) was BMI. We therefore suggest using the BMI as the basis for a graded weight resection guideline for reconstructive breast reductions. The BMI-based scale treats equally women of all types of body build. In women with a BMI greater than 30 (classified as adiposity) we recommend that breast reduction be postponed, and a general body weight reduction program be undertaken for the sake of a higher impact on general well-bein

Possibilities and limits of questionaire based soft skills evaluation as admission criteria for medical schools

Mit der Neuregelung der Studienplatzverteilung von 2005 haben die Universitäten in Deutschland die Möglichkeit, bis zu 60% der Studienplätze nach universitätseigenen Kriterien zu vergeben. Implizit wird vom Gesetzgeber und der öffentlichen Meinung gefordert, nicht-leistungsbezogene Kriterien und Persönlichkeitsmerkmale verstärkt zur Bewerberauswahl einzusetzen (Motivation, Identifikation, Vermeidung von Fehlvorstellungen). Da in Anbetracht der Bewerberzahlen mündliche Auswahlgespräche als ungeeignet erscheinen, wurde vom Fachbereich Medizin der Johann Wolfgang Goethe Universität ein Fragebogen entworfen, um nichtschulische Leistungen zu erfassen. Dieser Fragebogen wurde am Beginn des Wintersemesters 2005/2006 von allen Studienanfängern der JWG-Universität Frankfurt und der Medizinischen Universität Innsbruck ausgefüllt. Entgegen der initialen Erwartungen der Verfasser gaben nur etwa 15% Prozent Medizin-spezifische berufliche Vorerfahrungen an (Rettungsdienst, Ausbildung als Krankenschwester/pfleger oder ähnliches); dagegen wurden von etwa 60% angegeben, mindestens ein Musikinstrument zu spielen oder länger sportlich aktiv gewesen zu sein. Die Zusammenstellung der Selbstangaben zeigt, dass Medizin-relevante Vorkenntnisse nur bei einem kleinen Anteil der Studienbewerber in größerem Umfang vorhanden sind. Aufgrund der großen Streuung in der Art und Dauer der angegebenen Vorleistungen sollte die Erhebung von Parametern zur Beurteilung von soft skills, z.B. durch Online-Fragebogen, als (Vor)Selektionsinstrument nur sehr vorsichtig eingesetzt werden.Due to a reorganization in the admission procedure for German medical students in 2005 Medical Faculties may admit up to 60% of their students according to specific university criteria. Both legislation and public opinion implicitly require nonacademic criteria and personality traits to be included into the selection criteria (motivation, identification, avoidance of misconceptions). Since interviews appear to be not suitable for the high number of applicants the Medical Faculty of the Johann Wolfgang Goethe University in Frankfurt/Main has developed a questionnaire covering extracurricular achievements. This questionnaire has be answered by first year students of the JWG university Frankfurt and the Medical University Innsbruck at the begin of the winter term 2005/2006. Contrary to initial expectations, only 15% of the students stated specific job experience in a medically related field (emergency service, nurse or similar occupations), whereas more than 60% indicated to play at least one instrument and/or being engaged in sports activities. The summary of these self experiences indicate that only a minority of admitted students have medically related experience to a larger degree. The wide variation in time and duration given for the activities indicate that (online) questionnaires should be treated carefully as a preselection method for medical studies admission

A body mass index related sacle for reconstructive breast reduction

Breast reduction is a highly emotional topic, involving three conflicting interests: (a) women suffering from symptomatic macromastia, (b) health insurance companies, and (c) surgeons. Many insurance companies, including those in Austria, cover (if at all) only breast reductions with a minimum resection weight of 500 g per breast, irrespective of the physical build of the woman involved. We retrospectively reviewed 136 patients' charts from both cosmetic and reconstructive breast reduction operations and compared the breast resection weight to various parameters of body proportions such as height, weight, body mass index (BMI), and body surface area to determine the parameter best correlated to the weight of breast tissue resected. From this we developed a graded scale for guiding future operations irrespective of a woman's body build. The resection weight ranged from 55 to 1530 g (mean 450±266, median 406); mean BMI was 25.1. The arbitrary 500 g breast resection rule discriminates against women of nonaverage weight or height: of 24 patients (18%) with a cosmetic indication 4 had more than 500 g breast tissue resected bilaterally, while in 62 reconstructive patients (46%) less than the arbitrary 500 g breast tissue was resected. The parameter best correlated to the mean weight of breast tissue resected (sum of both breasts) was BMI. We therefore suggest using the BMI as the basis for a graded weight resection guideline for reconstructive breast reductions. The BMI-based scale treats equally women of all types of body build. In women with a BMI greater than 30 (classified as adiposity) we recommend that breast reduction be postponed, and a general body weight reduction program be undertaken for the sake of a higher impact on general well-being

Loss of transcriptional activation of the potassium channel Kir5.1 by HNF1β drives autosomal dominant tubulointerstitial kidney disease

Contains fulltext : 181105.pdf (publisher's version ) (Closed access

FAM111A is dispensable for electrolyte homeostasis in mice

Autosomal dominant mutations in FAM111A are causative for Kenny-Caffey syndrome type 2. Patients with Kenny-Caffey syndrome suffer from severe growth retardation, skeletal dysplasia, hypoparathyroidism, hypocalcaemia, hyperphosphataemia and hypomagnesaemia. While recent studies have reported FAM111A to function in antiviral response and DNA replication, its role in regulating electrolyte homeostasis remains unknown. In this study, we assessed the role of FAM111A in the regulation of serum electrolyte balance using a Fam111a knockout (Fam111a−/−) C57BL/6 N mouse model. Fam111a−/− mice displayed normal weight and serum parathyroid hormone (PTH) concentration and exhibited unaltered magnesium, calcium and phosphate levels in serum and 24-hour urine. Expression of calciotropic (including Cabp28k, Trpv5, Klotho and Cyp24a1), magnesiotropic (including Trpm6, Trpm7, Cnnm2 and Cnnm4) and phosphotropic (Slc20a1, Slc20a2, Slc34a1 and Slc34a3) genes in the kidneys, duodenum and colon were not affected by Fam111a depletion. Only Slc34a2 expression was significantly upregulated in the duodenum, but not in the colon. Analysis of femurs showed unaffected bone morphology and density in Fam111a−/− mice. Kidney and parathyroid histology were also normal in Fam111a−/− mice. In conclusion, our study is the first to characterise the function of FAM111A in vivo and we report that mice lacking FAM111A exhibit normal electrolyte homeostasis on a standard diet

Möglichkeiten und Grenzen der Fragebogen-gestützten Erhebung von Soft skills als Zulassungskriterien zum Medizinstudium [Possibilities and limits of questionaire based soft skills evaluation as admission criteria for medical schools]

[english] Due to a reorganization in the admission procedure for German medical students in 2005 Medical Faculties may admit up to 60% of their students according to specific university criteria. Both legislation and public opinion implicitly require nonacademic criteria and personality traits to be included into the selection criteria (motivation, identification, avoidance of misconceptions). Since interviews appear to be not suitable for the high number of applicants the Medical Faculty of the Johann Wolfgang Goethe University in Frankfurt/Main has developed a questionnaire covering extracurricular achievements. This questionnaire has be answered by first year students of the JWG university Frankfurt and the Medical University Innsbruck at the begin of the winter term 2005/2006. Contrary to initial expectations, only 15% of the students stated specific job experience in a medically related field (emergency service, nurse or similar occupations), whereas more than 60% indicated to play at least one instrument and/or being engaged in sports activities. The summary of these self experiences indicate that only a minority of admitted students have medically related experience to a larger degree. The wide variation in time and duration given for the activities indicate that (online) questionnaires should be treated carefully as a preselection method for medical studies admission. [german] Mit der Neuregelung der Studienplatzverteilung von 2005 haben die Universitäten in Deutschland die Möglichkeit, bis zu 60% der Studienplätze nach universitätseigenen Kriterien zu vergeben. Implizit wird vom Gesetzgeber und der öffentlichen Meinung gefordert, nicht-leistungsbezogene Kriterien und Persönlichkeitsmerkmale verstärkt zur Bewerberauswahl einzusetzen (Motivation, Identifikation, Vermeidung von Fehlvorstellungen). Da in Anbetracht der Bewerberzahlen mündliche Auswahlgespräche als ungeeignet erscheinen, wurde vom Fachbereich Medizin der Johann Wolfgang Goethe Universität ein Fragebogen entworfen, um nichtschulische Leistungen zu erfassen. Dieser Fragebogen wurde am Beginn des Wintersemesters 2005/2006 von allen Studienanfängern der JWG-Universität Frankfurt und der Medizinischen Universität Innsbruck ausgefüllt. Entgegen der initialen Erwartungen der Verfasser gaben nur etwa 15% Prozent Medizin-spezifische berufliche Vorerfahrungen an (Rettungsdienst, Ausbildung als Krankenschwester/pfleger oder ähnliches); dagegen wurden von etwa 60% angegeben, mindestens ein Musikinstrument zu spielen oder länger sportlich aktiv gewesen zu sein. Die Zusammenstellung der Selbstangaben zeigt, dass Medizin-relevante Vorkenntnisse nur bei einem kleinen Anteil der Studienbewerber in größerem Umfang vorhanden sind. Aufgrund der großen Streuung in der Art und Dauer der angegebenen Vorleistungen sollte die Erhebung von Parametern zur Beurteilung von soft skills, z.B. durch Online-Fragebogen, als (Vor)Selektionsinstrument nur sehr vorsichtig eingesetzt werden

<i>P2x</i> subunit expression in response to the loss of <i>P2x6</i> function in the kidney.

<p>a-f) The mRNA expression levels of <i>P2x1</i> (a), <i>P2x2</i> (b), <i>P2x3</i> (c), <i>P2x4</i> (d), <i>P2x5</i> (e), <i>P2x7</i> (f), in kidney of <i>P2x6</i>^<i>+/+</i> (Black bars), <i>P2x6</i>^<i>+/-</i> (Striped bars), <i>P2x6</i>^<i>-/-</i> (white bars) mice were measured by quantitative RT-qPCR and normalized for <i>Gapdh</i> expression. Data (n = 10) represent mean ± SEM and are expressed as the fold difference when compared to the expression in <i>P2x6</i>^<i>+/+</i> mice.</p

Metabolic Parameters of P2x6 Mice.

<p>Metabolic Parameters of P2x6 Mice.</p