Michael Neubrand

Phase II study of photodynamic therapy and metal stent as palliative treatment for nonresectable hilar cholangiocarcinoma.

BACKGROUND The combination of photodynamic therapy and biliary drainage by plastic endoprosthesis insertion has produced promising results in the treatment of nonresectable hilar cholangiocarcinoma. The feasibility and efficacy of intraductal photodynamic therapy with subsequent biliary drainage by self-expandable metal stent insertion were evaluated in a prospective phase II study. METHODS Twenty-four patients were treated with photodynamic therapy after sensitization with porfimer sodium. A plastic endoprosthesis was inserted immediately thereafter and replaced by a metal stent 4 weeks later. A retrospectively analyzed group of 20 patients treated only with biliary drainage served as a historical control group. RESULTS In 19 of the 24 patients, insertion of a metal stent was technically feasible. The 30-day and 60-day mortality rates were 0%. A significant decrease in serum bilirubin was noted in all patients and quality of life remained stable throughout follow-up. Mean and median survival were, respectively, 15.9(3.1) and 9.9: 95% CI [6.4, 13.4] months after photodynamic therapy. In the control group, mean and median survival were, respectively, 12.5(3.4) and 5.6: 95% CI [3.7, 7.6] months, which was not statistically significantly different from the photodynamic therapy group. CONCLUSIONS Photodynamic therapy with consecutive biliary drainage by insertion of a self-expandable metal stent is feasible. With respect to the small benefit in overall survival, randomized controlled trials are warranted.

Gallstone recurrence after shock-wave therapy

BACKGROUND/AIMS The long-term outcome of nonoperative gallstone therapy depends on both absence of stones and absence of biliary pain. The aim of the present study was to determine the rate of stone recurrence and the rate of symptoms within 5 years after successful shock wave lithotripsy combined with bile acid therapy. METHODS One hundred consecutive patients (single stones, n = 89; 2 or 3 stones, n = 11) were followed up for a median of 4.3 years after stone disappearance and discontinuation of bile acids. RESULTS Twenty-three of the 100 patients developed recurrent stones. Calculated by actuarial analysis, the recurrence rate was 7% +/- 3%, 11% +/- 3%, 13% +/- 4%, 20% +/- 5%, and 31% +/- 7% (mean +/- SD) at 1, 2, 3, 4, and 5 years, respectively. The recurrent stones were small (6 +/- 5 mm) and were associated with recurrent biliary pain in 14 (61%) of the 23 patients. Repeated shock wave lithotripsy and/or bile acid medication resulted in stone disappearance in only 10 of 20 patients with recurrence. CONCLUSIONS The long-term rate of stone recurrence after lithotripsy of primarily solitary gallbladder calculi is lower than expected from post-bile acid dissolution trials. Recurrence of stones frequently is associated with recurrence of biliary pain.

Tendenzen der Geometriedidaktik der letzten 20 Jahre

Geometry is a broad and complex area, both as a part of mathematics and as a school subject. According to that characteristic of geometry, changes and developments in the teaching practice and in the educational reflexions of geometry are likely to be very unhomo-genous and difficult to identify. In this paper the authors try to describe some of these changes in geometry education in Austria and (West-) Germany since the end of the “new math”-period in the beginning of the 70’s. Part 1 describes the development of geometry education as a process of increasing awareness of the complexity of geometry learning and teaching, and the related research and development Part 2 exemplarily describes discussions in some specific areas of geometry education, working out typical insights and arguments. To come closer to the classroom level, part 3 discusses different approaches to geometry instruction taking into consideration the complexity of geometry learning and teaching observed in parts 1 and 2.

Endoscopic manometry of esophageal varices: evaluation of a balloon technique compared with direct portal pressure measurement

BACKGROUND/AIMS Recently, a non-invasive endoscopic balloon technique for esophageal manometry was published. In the present study, we assess its methodological aspects together with the relationship to portal pressure. METHODS In 20 patients with liver cirrhosis who had received an intrahepatic portosystemic stent-shunt (TIPS), we evaluated portal and variceal pressure before and after balloon occlusion of TIPS (random order). Portal pressure was measured continuously via a portal venous catheter, and variceal pressure was determined at the same time independently by two endoscopists using two balloon techniques (inflation until varix collapses; deflation until varix reappears). RESULTS Overall, mean (+/-SD) portal pressure (28.5+/-7 mmHg) was significantly higher (p<0.001) than mean variceal pressure (24.4+/-6 mmHg). Balloon manometry-determined variceal pressure values were 10+/-15% higher with the inflation technique (26.2+/-7 mmHg) than with the balloon deflation technique (22.6+/-6 mmHg, p<0.001). Portal pressure and variceal pressure correlated significantly (p<0.001; balloon inflation: r=0.61, balloon deflation: r=0.66, mean values of inflation and deflation: r=0.68). Short-term TIPS occlusion led to mean increases of 52% and 35% in portal pressure and variceal pressure, respectively. The manometry results of both endoscopists correlated well with either balloon technique (r> or =0.93; p<0.001) and we saw no adverse effects. CONCLUSIONS Variceal balloon manometry provides non-invasive variceal pressure data which correlate to portal pressure assessed prior to and after short-term TIPS occlusion. However, probably due to variance in collateral anatomy, variceal pressure does not exactly predict portal pressure and its acute changes in the individual patient. The averaged variceal pressure of the inflation and deflation balloon technique provides the best relation to portal pressure combined with a good interobserver reliability and warrants further clinical evaluation.

Kompetenzstufen in PISA

ZusammenfassungWolfram Meyerhöfer wirft zum wiederholten Mal den PISA-Designern vor, mit unangebrachten Hintergrundmodellen und/oder daraus abgeleiteten Beschreibungen zu arbeiten. Diesmal geht es um die „Kompetenzstufen”.In unserem Beitrag soll (noch einmal!) deutlich gemacht werden, dass die Kompetenzstufen in PISA-2000 eigentlich Leistungsstufen sind und die Beschreibungen möglicher Schülertätigkeiten bei der Lösung von Aufgaben diese Stufen illustrieren und nicht definieren.

Naturwissenschaftliche Teilkompetenzen im Ländervergleich

Beim Vergleich der Lander der Bundesrepublik hinsichtlich der naturwissenschaftlichen Grundbildung zeigten sich deutliche Unterschiede (Prenzel u.a., 2002a). Das Spektrum der Landermittelwerte reicht von 461 Punkten auf der internationalen Skala (M = 500, SD = 100) bis hin zu 508 Punkten. Damit haben zwar selbst die leistungsstarksten Lander, Bayern, Baden-Wurttemberg, Sachsen und Thuringen, noch nicht ganz das Niveau von Osterreich und Schweden erreicht und liegen weit hinter Finnland und dem Vereinigten Konigreich zuruck. Die Variationsbreite zwischen den Landern der Bundesrepublik Deutschland ist aber so betrachtlich, dass eine vertiefende Analyse dieser Unterschiede lohnenswert scheint.

Hochschuldidaktische Überlegungen zum Fundamentalsatz der Algebra

Proofs of the fundamental theorem of algebra, especially that of Kneser and Artin, are discussed under the viewpoint of university education for prospective teachers. The emphasis does not lie on a presentation of the proofs, but on a discussion of certain didactical criteria which may lead to an educational evaluation of the proofs. The discussed questions are: Do the proofs enlarge knowledge, e.g. about the number system? Are the proofs based on intuitively capable ideas? Would it be possible, that the proof of the fundamental theorem of algebra becomes the center and the integrating moment of an algebra course for teacher students? The last question is answered in the affirmative in the case of Artin’s proof via Galois theory.

Aktualisierte S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) zur Prävention, Diagnostik und Behandlung von Gallensteinen: AWMF-Register-Nr. 021/008

This guideline provides evidence-based key recommendations for the prevention, diagnosis and therapy of gallstones and upgrades the 2007 version. The guideline was developed by an interdisciplinary team of gastroenterologists and surgeons, and patient support groups under the auspice of the German Society for Gastroenterology and Metabolic Diseases and the German Society for General Surgery and Surgery of the Alimentary Tract. The guideline used structural S3 consensus-based methodology and includes statements on clinical practice, medical education, prevention, quality assurance, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone diseases.

Leitlinienreport zur aktualisierten S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) zur Prävention, Diagnostik und Behandlung von Gallensteinen: (AWMF-Register-Nr. 021/008)

Die Leitlinie zur Pravention, Diagnostik und Therapie von Gallensteinen aktualisiert die Leitlinie der Deutschen Gesellschaft fur Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten und der Deutschen Gesellschaft fur Allgemein- und Viszeralchirurgie aus dem Jahr 2007. Die Leitlinie wurde interdisziplinar von Gastroenterologen und Chirurgen erstellt. Sie basiert auf den Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften fur eine systematische evidenzbasierte Konsensus-Leitlinie der Entwicklungsstufe S3 und berucksichtigt die klinische Anwendbarkeit der Studienergebnisse. Zudem werden Praventionsmoglichkeiten beschrieben, Qualitatsindikatoren definiert, okonomische Auswirkungen berucksichtigt und Vorschlage zur sektorenubergreifenden Behandlung von Patienten mit Gallensteinerkrankungen formuliert.

Influence of ursodeoxycholic acid on intestinal motility, pancreatic secretion and serum levels of pancreatic polypeptide and motilin

INFLUENCE OF URSODEOXYCHOLIC ACID ON INTESTINAL MOTILITY, PANCREATIC SECRETION AND SERUM LEVELS OF PANCREATIC POLYPEPTIDE AND MOTILIN. Michael Neubrand, Susanne Kampmann, Katrin Eschmann, Christoph Reichel, Peter Malfertheiner, Enrique Dominguez-Munoz, Tilman Sauerbruch, Univ of Bonn, Bonn, Germany; Univ of Magdeburg, Magdeburg, Germany; Univ of Santiago di Composte1a, Santiago, Spain; Univ of Bonn, Bonn, Spain.