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U Engelmann

Publications and source records attributed to U Engelmann.

At least 19 recordsLinked to original sources
PubMed2007

Preoperative erectile function is one predictor for post prostatectomy incontinence.

AIMS: The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. PATIENTS AND METHODS: Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. RESULTS: Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P = 0.024), whereas age (P = 0.759) and nerve sparing prostatectomy (P = 0.504) did not predict PPI. CONCLUSION: Erectile function is a predictor of PPI and should be recorded preoperatively.

Aged↗
PubMed2006

Teleradiology applications with DICOM-e-mail.

For the connection of several partners to a Dicom-e-mail based teleradiology network concepts were developed to allow the integration of different teleradiology applications. The organisational and technical needs for such an integration were analysed. More than 60 institutions including 23 hospitals in the Rhein-Neckar-Region, Germany were connected. The needed functionality was grouped in six teleradiology applications (emergency consultation, tele-guided examinations, expert consultations, cooperative work, scientific cooperations and homework with on call services) and their technical and organisational needs according to availability, speed of transfer, workflow definitions and data security needs was analysed. For the local integration of teleradiology services the setup and workflow is presented for a standalone teleradiology workstation and a server based teleradiology gateway. The line type needed for different groups of applications and users is defined. The security concept and fallback strategies are laid out, potential security problems and sources of errors are discussed. The specialties for the emergency teleradiology application are presented. The DICOM-e-mail protocol is a flexible and powerful protocol that can be used for a variety of teleradiology applications. It can meet the conditions for emergency applications but is limited if synchronous applications like teleconferences are needed.

Computer Security↗
PubMed2006

[Functional and oncological outcome of salvage prostatectomy of locally recurrent prostate cancer following radiation therapy].

BACKGROUND: Although technically challenging, salvage radical prostatectomy (SRP) for radiorecurrent prostate cancer (PCA) is an effective option in carefully selected patients and offers the chance for cure and long-term survival. Sometimes local progression of PCA with subvesical obstruction following radiation therapy requires radical cystoprostatectomy or bladder-preserving urinary diversion. We present our experience with salvage radical prostatectomy in a group of 28 consecutive patients. PATIENTS AND METHODS: Between January 2003 and August 2005, 25 patients underwent radical salvage surgery for locally recurrent PCA following external beam radiation (n=14), high-dose brachytherapy (n=8), and low-dose brachytherapy (n=6). All men had biopsy-proved recurrent or persistent PCA associated with PSA progression following radiation therapy. Preoperative imaging studies included bone scintigraphy and computed tomography without evidence of metastatic disease. Of the 28 men, 11 (39%) presented with bothersome irritative voiding dysfunction and rectal discomfort. Life expectancy was >10 years in all cases. We analyzed preoperative symptoms, treatment-associated morbidity, pathohistological findings, and functional and oncological outcome after a mean follow-up of 12.5 (2-29) months. RESULTS: SRP was performed in all cases without significant intra- and perioperative complications: no rectal lacerations or ureteral lesions were encountered and mean blood loss was 520 (200-950) ml. A total of 21 (75%) men underwent SRP: in 4 cases radical cystoprostatectomy was necessary due to bladder neck infiltration and in 3 men SRP with bladder neck closure and continent appendicovesicostomy was performed due to preexisting urinary stress incontinence. All men with subvesical obstruction experienced significant relief of urgency and significant irritative voiding dysfunction following radical salvage surgery. Pathohistological analysis of the prostatectomy specimen revealed pT1-2b PCA in 19 (67.8%), pT3a/b PCA in 5 (17.8%), and lymph node metastasis or positive surgical margins in 7% of the patients. Two patients demonstrated a pT0 despite positive preoperative biopsies, and 20% demonstrated a Gleason score 8-10. With regard to functional outcome, 25% of the men need 2-3 pads daily whereas 78% of the men are continent. After a mean follow-up of 12.5 (2-29) months, two patients with pT3b and pN1 status exhibit a PSA relapse. CONCLUSION: Salvage RP or RCx is a technically challenging but feasible surgical approach with curative intent for the treatment of locally recurrent PCA in well selected patients preventing significant local complications such as subvesical obstruction, ureteral obstruction, hematuria, and rectal infiltration. Surgery-associated morbidity and complications are low and not comparable to earlier series. The indication for salvage RP requires positive biopsy and negative imaging studies.

Aged↗
PubMed2006

Impact of comorbidities on post-prostatectomy incontinence.

INTRODUCTION: The aim of this retrospective study was to evaluate various factors that may influence post-prostatectomy incontinence (PPI). PATIENTS AND METHODS: 1,088 men with prostate cancer underwent radical retropubic prostatectomy. 742 patients were evaluable for analysis. Continence was defined as usage of no or one pad daily. Mean follow-up was 45 months (12-143). RESULTS: Based on protective pad requirement 100% and 76% of men were continent at baseline and at the time of questionnaire evaluation (at least 12 months), respectively. Univariate analysis was performed to identify factors that may influence the return of continence. Age, body mass index (BMI), previous TUR-P, smoking, hypertension, diabetes and attempted nerve sparing did not predict postoperative continence status. CONCLUSIONS: In contrast to several reports, our analysis revealed that age, BMI, previous TUR-P, smoking, hypertension and diabetes do not have a statistically significant impact on continence after radical retropubic prostatectomy and are therefore not useful as predictors for PPI.

Adult↗
PubMed2006

Sacral colpopexy with concurrent Burch colposuspension in patients with vaginal vault prolapse.

INTRODUCTION: Abdominal sacral colpopexy (SC) is one option in the management of vaginal vault prolapse. In patients who are additionally incontinent an anti-incontinence procedure such as a Burch colposuspension or pubovaginal sling is usually performed at the same time. For those patients undergoing SC who are continent there are no clear guidelines for the use of a 'prophylactic' anti-incontinence procedure. We describe our experience with SC and concurrent Burch colposuspension. PATIENTS AND METHODS: 47 patients (mean age 65 years) underwent SC and concurrent Burch colposuspension. The preoperative diagnostic check-up included a validated questionnaire, clinical examination, urodynamic tests, ultrasound and colpocystorectography. Patients were also evaluated using Stress, Emptying, Anatomic, Protection and Instability (SEAPI) scores. All patients had a uterine or vaginal vault prolapse in combination with a cystocele, enterocele or rectocele. Thirty-three of 47 (70%) patients were continent and 14 (30%) incontinent. Nineteen (40%) of the 33 'continent' patients were found to have occult incontinence. Clinical examination according to the Halfway system showed 9 of 47 (19%), 21 of 47 (45%) and 17 of 47 (36%) patients with grade 2, 3 and 4 vaginal vault prolapse, respectively. Thirty-five of 47 (74%) patients demonstrated a grade-4 cystocele and 12 of 47 (26%) a grade-3 cystocele. The mean follow-up was 34 months and included a questionnaire (SEAPI), clinical examination and ultrasound. RESULTS: Postoperative SEAPI scores showed a statistically significant improvement in all SEAPI domains (p < 0.001). Ninety-four percent of the patients were satisfied, continent and would undergo the surgery again. Three patients were incontinent. No continent patient who underwent concurrent Burch colposuspension had obstructive symptoms or residual urine. Five patients (11%) who had dyspareunia preoperatively were free of this symptom postoperatively. Complications were: dilatation of the upper urinary tract in 2 patients (4%) secondary to distal ureteric deviation by suturing the posterior peritoneum. One patient underwent psoas hitch neoureterocystostomy and 1 patient was successfully treated by insertion of a ureteric stent for 6 weeks. One patient (2%) had a mesh infection necessitating removal of the Gore-Tex mesh. CONCLUSIONS: Sacral colpopexy provides good patient satisfaction, durable pelvic support and restores vaginal function. Due to excellent continence rates concurrent Burch colposuspension should be considered as a joint procedure even in continent patients.

Aged↗
PubMed2005

Standardization of teleradiology using Dicom e-mail: recommendations of the German Radiology Society.

Until recently there has been no standard for an interoperable and manufacturer-independent protocol for secure teleradiology connections. This was one of the main reasons for the limited use of teleradiology in Germany. Various teleradiology solutions have been developed in the past, but the vast majority have not been interoperable. Therefore an ad hoc teleradiology connection was impossible even between partners who were already equipped with teleradiology workstations. Based on the evaluation of vendor-independent protocols in recent years the IT Working Group (AGIT) of the German Radiology Society set up an initiative to standardize basic teleradiology. An e-mail based solution using the Dicom standard for e-mail attachments with additional encryption according to the OpenPGP standard was found to be the common denominator. This protocol is easy to implement and safe for personalized patient data and fulfills the legal requirements for teleradiology in Germany and other countries. The first version of the recommendation was presented at the 85th German Radiology Convention in 2004. Eight commercial and three open-source implementations of the protocol are currently available; the protocol is in daily use in over 50 hospitals and institutions.

Computer Communication Networks↗
PubMed2005

Long-term efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms--a placebo-controlled, double-blind, multicenter trial.

The efficacy and tolerability of a fixed combination of 160 mg sabal fruit extract WS 1473 and 120 mg urtica root extract WS 1031 per capsule (PRO 160/120) was investigated in elderly, male patients suffering from lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia in a prospective multicenter trial. A total of 257 patients (129 and 128, respectively) were randomized to treatment with PRO 160/120 or placebo (127 and 126 were evaluable for efficacy). Following a single-blind placebo run-in phase of 2 weeks, the patients received 2 x 1 capsule/day of the study medication under double-blind conditions over a period of 24 weeks. Double-blind treatment was followed by an open control period of 24 weeks during which all patients were administered PRO 160/120. Outcome measures for treatment efficacy included the assessment of the patients' LUTS by means of the I-PSS self-rating questionnaire and a quality of life index as well as uroflow and sonographic parameters. Using the International Prostate Symptom Score (I-PSS), patients treated with PRO 160/120 exhibited a substantially higher total score reduction after 24 weeks of double-blind treatment than patients of the placebo group (6 points vs 4 points; P=0.003, one tailed) with a tendency in the same direction after 16 weeks. This applied to obstructive as well as to irritative symptoms, and to patients with moderate or severe symptoms at baseline. Patients randomized to placebo showed a marked improvement in LUTS (as measured by the I-PSS) after being switched to PRO 160/120 during the control period (P=0.01, one tailed, in comparison to those who had been treated with PRO 160/120 in the double-blind phase). The tolerability of PRO 160/120 was comparable to the placebo. In conclusion, PRO 160/120 was clearly superior to the placebo for the amelioration of LUTS as measured by the I-PSS. PRO 160/120 is advantageous in obstructive and irritative urinary symptoms and in patients with moderate and severe symptoms. The tolerability of the herbal extract was excellent.

Aged↗
PubMed2005

[Teleradiology with DICOM e-mail: recommendations of @GIT].

E-mail is ideal for ad-hoc connections in teleradiology. The DICOM standard offers the possibility to append DICOM data types as a MIME attachment to any e-mail, thus ensuring the transmission of the original DICOM data. Nevertheless, there are additional requirements (e.g. protection of data privacy) which must be obeyed. Because of the lack of given standards which would grant interoperability as well as manufacturer independence, teleradiology has not been established in Germany until today. Therefore, the IT-Team (Arbeitsgemeinschaft fur Informationstechnologie, @GIT) of the Radiological Society of Germany (Deutsche Rontgengesellschaft, DRG) set up an initiative to standardise telemedicine by using e-mail. Its members agreed that an e-mail-based variant would be the most practicable way to a communication solution -- as easy to implement as to use. In their opinion, e-mail represents the smallest common denominator for a safe data interchange that would fulfill the legal advantages for telemedicine in Germany.

Computer Communication Networks↗
PubMed2005

[Teleradiology: economic research analysis of CT investigations in a small hospital].

PURPOSE: To evaluate, discuss and compare economic aspects of teleradiological applications in CT examinations in a small hospital. Scenario (1): CT examination by an extern institution including transport of a patient. Szenario (2): External consultation of an internal CT examination (teleradiology according to ROV). Scenario (3): Complete in-house radiology department. To evaluate economic aspects of teleradiology service providers. MATERIALS AND METHODS: Costs have been separated into fixed and variable costs in a model. Total costs of 500 CT examinations per year have been calculated for the three scenarios. A break-even analysis has been performed to determine the necessary/minimal number of CTs per year for economical advantages. The number of CT consultations for teleradiology service providers to make profit has been calculated. RESULTS: Scenario (1): This is the most cost-effective scenario for 500 CTs per year, but most time-consuming. Beyond 548 CTs per year using a single slice CT and 965 CTs per year using a multislice CT the teleradiology scenario [scenario (2)] is most cost-effective. Beyond 1065 CTs per year an in-house radiology department [scenario (3)] is economically reasonable. On the basis of 30 Euros per CT consultation a teleradiology service providing system will be profitable starting from 322 CT consultations per year. CONCLUSION: Teleradiology applications are economically reasonable in a wide range in small hospitals. CT teleradiology services can also be provided on a cost-effective basis at a reachable number of consultations.

Cost-Benefit Analysis↗
PubMed2004

[Erectile dysfunction. Are interdisciplinary diagnosis and therapy necessary?].

OBJECTIVE: The last few decades have seen a marked increase in mean life expectancy in Central Europe. This has made elderly people and their quality of life a matter of ever-increasing medical concern. Besides the lack of population based studies in Central Europe, the identifying risk factors for the development of erectile dysfunction (ED) is crucial. METHODS AND MATERIAL: A newly developed and validated questionnaire on male erectile dysfunction was mailed to a representative population sample of 8000 men 30 to 80 years of age in the Cologne urban district. RESULTS: The response included 4489 analysable replies (56,1 %). The median age was 51,8 years. Prevalence of ED was estimated at about 19.2 %, with a steep age-related increase (2,3 - 53,4 %) Therapeutic necessity (defined by co-occurrence of ED and dissatisfaction with sex life), also increases with age. The overall number of ED sufferers seeking therapy was 6,8 %. The following illnesses where seen in the ED group: heart failure (14,7 %), pelvic surgery (18,8 %), diabetes mellitus (20,2 %), peripheral arterial circulatory disorders (21,5 %), herniated disc (23,2 %) and hypertension (32,0 %). Although the pathogenetic pathway remains unclear with a prevalence of 72 % "lower urinary tract symptoms" (LUTS) seems to be an age independent risk factor. In contrast, the prevalence of ED in healthy men was around 6,6 %. CONCLUSIONS: ED is a common disorder, contributing to dissatisfaction with sex life in a considerable proportion of men. ED is frequently associated with chronic diseases. For this reason adequate interdisciplinary diagnostic workup is essential, to offer patients individually adapted treatment.

Adrenergic beta-Antagonists↗
PubMed2004

The integration of medical images with the electronic patient record and their web-based distribution.

Medical images are currently created digitally and stored in the radiology department's picture archiving and communication system. Reports are usually stored in the electronic patient record of other information systems, such as the radiology information system (RIS) and the hospital information system (HIS). But high-quality services can only be provided if electronic patient record data is integrated with digital images in picture archiving and communication systems. Clinicians should be able to access both systems' data in an integrated and consistent way as part of their regular working environment, whether HIS or RIS. Also, this system should allow for teleconferencing with other users, eg, for consultation with a specialist in the radiology department. This article describes a web-based solution that integrates the digital images of picture archiving and communication systems with electronic patient record/HIS/RIS data and has built-in teleconferencing functionality. This integration has been successfully tested using three different commercial RIS and HIS products.

Humans↗
PubMed2004

Treatment of benign prostatic hyperplasia through transurethral needle ablation (TUNA). Review of the literature and six years of clinical experience.

Following FDA clearance and the establishment of Medicare coverage, transurethral needle ablation (TUNA) has become an established and widely-adopted treatment method for BPH in the USA. Germany is lagging behind at present, though a change can also be recognized there. The lack of long-term data has often been criticized. This review presents an overview of clinical outcomes of TUNA, long-term results and patient selection criteria.

Clinical Trials as Topic↗
PubMed2004

Internationalization of healthcare applications: a generic approach for PACS workstations.

OBJECTIVES: Along with the revolution of information technology and the increasing use of computers world-wide, software providers recognize the emerging need for internationalized, or global, software applications. The importance of internationalization comes from its benefits such as addressing a broader audience, making the software applications more accessible, easier to use, more flexible to support and providing users with more consistent information. In addition, some governmental agencies, e.g., in Spain, accept only fully localized software. Although the healthcare communication standards, namely, Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7) support wide areas of internationalization, most of the implementers are still protective about supporting the complex languages. This paper describes a generic internationalization approach for Picture Archiving and Communication System (PACS) workstations. METHODS: The Unicode standard is used to internationalize the application user interface. An encoding converter was developed to encode and decode the data between the rendering module (in Unicode encoding) and the DICOM data (in ISO 8859 encoding). An integration gateway was required to integrate the internationalized PACS components with the different PACS installations. To introduce a pragmatic example, the described approach was applied to the CHILI PACS workstation. RESULTS: The approach has enabled the application to handle the different internationalization aspects transparently, such as supporting complex languages, switching between different languages at runtime, and supporting multilingual clinical reports. CONCLUSIONS: In the healthcare enterprises, internationalized applications play an essential role in supporting a seamless flow of information between the heterogeneous multivendor information systems.

Germany↗