The collateral caval shunt as an alternative to classical shunt procedures in patients with recurrent duodenal varices and extrahepatic portal vein thrombosis

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation

The collateral caval shunt as an alternative to classical shunt procedures in patients with recurrent duodenal varices and extrahepatic portal vein thrombosis

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal. cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation

The collateral caval shunt as an alternative to classical shunt procedures in patients with recurrent duodenal varices and extrahepatic portal vein thrombosis

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation

Viscum album L. extracts in breast and gynaecological cancers: a systematic review of clinical and preclinical research

<p>Abstract</p> <p>Background</p> <p><it>Viscum album </it>L. extracts (VAE, European mistletoe) are a widely used medicinal plant extract in gynaecological and breast-cancer treatment.</p> <p>Methods</p> <p>Systematic review to evaluate clinical studies and preclinical research on the therapeutic effectiveness and biological effects of VAE on gynaecological and breast cancer. Search of databases, reference lists and expert consultations. Criteria-based assessment of methodological study quality.</p> <p>Results</p> <p>19 randomized (RCT), 16 non-randomized (non-RCT) controlled studies, and 11 single-arm cohort studies were identified that investigated VAE treatment of breast or gynaecological cancer. They included 2420, 6399 and 1130 patients respectively. 8 RCTs and 8 non-RCTs were embedded in the same large epidemiological cohort study. 9 RCTs and 13 non-RCTs assessed survival; 12 reported a statistically significant benefit, the others either a trend or no difference. 3 RCTs and 6 non-RCTs assessed tumour behaviour (remission or time to relapse); 3 reported statistically significant benefit, the others either a trend, no difference or mixed results. Quality of life (QoL) and tolerability of chemotherapy, radiotherapy or surgery was assessed in 15 RCTs and 9 non-RCTs. 21 reported a statistically significant positive result, the others either a trend, no difference, or mixed results. Methodological quality of the studies differed substantially; some had major limitations, especially RCTs on survival and tumour behaviour had very small sample sizes. Some recent studies, however, especially on QoL were reasonably well conducted. Single-arm cohort studies investigated tumour behaviour, QoL, pharmacokinetics and safety of VAE. Tumour remission was observed after high dosage and local application. VAE application was well tolerated. 34 animal experiments investigated VAE and isolated or recombinant compounds in various breast and gynaecological cancer models in mice and rats. VAE showed increase of survival and tumour remission especially in mice, while application in rats as well as application of VAE compounds had mixed results. <it>In vitro </it>VAE and its compounds have strong cytotoxic effects on cancer cells.</p> <p>Conclusion</p> <p>VAE shows some positive effects in breast and gynaecological cancer. More research into clinical efficacy is warranted.</p

Die Eingriffsregelung des Bundesnaturschutzgesetzes Ein Instrument zur Sicherung von Natur und Landschaft?

TIB Hannover: RN 7887(44) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Introducing a curricular program culminating in a certificate for training peer tutors in medical education

Aim: Student tutorials are now firmly anchored in medical education. However, to date there have only been isolated efforts to establish structured teacher training for peer tutors in medicine. To close this gap, a centralized tutor training program for students, culminating in an academic certificate, was implemented at Heidelberg University Medical School. The program also counts within the scope of the post-graduate Baden-Württemberg Certificate in Academic Teaching (Baden-Württemberg Zertifikat für Hochschuldidaktik).Method: Based on a needs assessment, a modular program comprised of four modules and a total of 200 curricular units was developed in cooperation with the Department for Key Competencies and Higher Education at Heidelberg University and implemented during the 2010 summer semester. This program covers not only topic-specific training sessions, but also independent teaching and an integrated evaluation of the learning process that is communicated to the graduates in the form of structured feedback. In addition, to evaluate the overall concept, semi-structured interviews (N=18) were conducted with the program graduates.Results: To date, 495 tutors have been trained in the basic module on teaching medicine, which is rated with a mean overall grade of 1.7 (SW: 0.6) and has served as Module I of the program since 2010. A total of 17% (N=83) of these tutors have gone on to enroll in the subsequent training modules of the program; 27 of them (m=12, f=15) have already successfully completed them. Based on qualitative analyses, it is evident that the training program certificate and its applicability toward the advanced teacher training for university instructors pose a major incentive for the graduates. For successful program realization, central coordination, extensive coordination within the medical school, and the evaluation of the attained skills have proven to be of particular importance.Conclusion: The training program contributes sustainably to both quality assurance and professionalism, as well as to solving the issue of resources in medical education. The introduction and continued development of similar programs is desirable.Zielsetzung: Studentische Tutorien sind in der medizinischen Lehre inzwischen fest verankert. Bislang gibt es jedoch lediglich vereinzelte Bestrebungen, eine strukturierte medizindidaktische Ausbildung für studentische TutorInnen zu etablieren. Um diese Lücke zu schließen, wurde an der Medizinischen Fakultät Heidelberg ein zentrales didaktisches Qualifizierungsprogramm für TutorInnen implementiert, das mit einem universitären Zertifikat abschließt und im Rahmen des postgraduellen "Baden-Württemberg Zertifikat für Hochschuldidaktik" angerechnet wird. Methodik: Auf Basis einer Bedarfsanalyse wurde in Kooperation mit der Abteilung Schlüsselkompetenzen und Hochschuldidaktik der Universität Heidelberg ein modulares Programm bestehend aus vier Bausteinen und insgesamt 200 Unterrichtseinheiten (UE) entwickelt, das im Sommersemester 2010 implementiert wurde. Dieses beinhaltet sowohl themenspezifische Schulungen als auch eine eigenständige Lehrtätigkeit sowie eine integrierte Auswertung des Lernprozesses, welche den AbsolventInnen in Form eines strukturierten Feedback rückgemeldet wird. Zudem wurden halbstrukturierte Interviews (N=18) zur Bewertung des Gesamtkonzepts mit den AbsolventInnen geführt. Ergebnisse: Bislang wurden 495 TutorInnen im Grundlagenbaustein zu Medizindidaktik geschult, der mit einer durchschnittlichen Gesamtnote von 1,7 (SW: 0,6) bewertet wird und seit 2010 den Baustein I des Programms bildet. Insgesamt 17% (N=83) dieser TutorInnen haben sich seitdem in das aufbauende Qualifizierungsprogramm eingeschrieben, 27 von Ihnen (m=12, w=15) haben es bereits erfolgreich abgeschlossen. Anhand qualitativer Analysen wird ersichtlich, dass das übergeordnete didaktische Zertifikat und dessen Anrechenbarkeit im Rahmen der hochschuldidaktischen Ausbildung für Dozierende ein großer Anreiz für die AbsolventInnen ist. Für die erfolgreiche Implementierung erweisen sich insbesondere eine zentrale Koordinationsstelle, eine umfangreiche Abstimmung auf Fakultätsebene sowie die Auswertung der erworbenen Qualifizierung als wichtig.Schlussfolgerung: Das Qualifizierungsprogramm leistet einen nachhaltigen Beitrag zur Qualitätssicherung und Professionalisierung einerseits und zur Lösung der Ressourcenproblematik in der medizinischen Lehre andererseits. Die Einführung und Weiterentwicklung ähnlicher Programme ist wünschenswert

The collateral caval shunt as an alternative to classical shunt procedures in patients with recurrent duodenal varices and extrahepatic portal vein thrombosis

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal. cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation

Oekologisches Planungsinstrument Berlin Naturhaushalt/Umwelt Abschlussbericht

With 63 refs., 30 tabs., 52 figs., 37 mapsSIGLEAvailable from TIB Hannover: RN 8908(91-130) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman