Nach der notfallmäßigen Vorstellung des Patienten aufgrund von persistierend febrilen Temperaturen zeigten sich positive Blutkulturen mit Enterococcus faecalis und eine Vegetation auf der Mitralklappe in der Echokardiografie. Die Diagnose einer E.-faecalis-Endokarditis wurde gestellt und eine entsprechende antimikrobielle Kombinationstherapie mit Amoxicillin und Gentamicin begonnen. Im Verlauf erfolgte die Umstellung von Gentamicin auf Ceftriaxon aufgrund einer akuten Nieren-Funktionseinschränkung gemäß KDIGO-Stadium AKI 1. Es wurde zudem ein mechanischer Mitralklappen-Ersatz durchgeführt. Nach einer fortlaufenden antimikrobiellen Therapie von 5 Wochen erfolgte eine notfallmäßige Rückverlegung aus der kardiologischen Rehabilitation aufgrund von akuten Flankenschmerzen mit Emesis. Klinisch präsentierte sich der 64-jährige Patient mit Druckdolenz im rechten Abdomen. Laborchemisch zeigte sich eine akute Nierenschädigung AKI 3, bei Mikrohämaturie im Urinstatus. Sonografisch zeigte sich eine Stauung des rechten Nierenbecken-Kelchsystems. In der Abdomen-CT stellte sich ein Konkrement in der Harnblase dar. Das 7×3×2mm große Konkrement wurde durch die Miktion ausgeschieden und bestand zu 100% aus Amoxicillin. Somit wurde die Diagnose einer Amoxicillin-Urolithiasis gestellt. Die Dosierung von Amoxicillin wurde nierenadaptiert reduziert. Aufgrund eines initial unklaren Entzündungszustands im Rahmen eines Dressler-Syndroms wurde die Kombinationstherapie nach 8 Wochen anstelle der geplanten 6 Wochen beendet. Zu diesem Zeitpunkt war der Kreatininwert noch leichtgradig erhöht. Nach zwei Wochen lag dieser wieder im Normbereich. Zwei Jahre später ist der Patient ohne Rezidiv der Endokarditis. Bei einer intrarenalen Ausfällung von Kristallen kommt es zu einer Kristall-Nephropathie, was eine seltene Nebenwirkung von Amoxicillin darstellt. Wie in diesem Fall kann eine massive Ausfällung von makroskopischen Kristallen im Nierenbecken sogar zu einer Urolithiasis mit einer obstruktiven Nephropathie führen. Dieser Fall demonstriert die Wichtigkeit einer regelmäßigen Überprüfung der Nierenfunktion bei einer Therapie mit Amoxicillin, insbesondere der hochdosierten Therapie mit langer Therapiedauer.
This retrospective study evaluates the survival rates, complications, and patient satisfaction associated with zygomatic implants in severe maxillary atrophy, focusing on 2 approaches: Quad Zygoma (4 zygomatic implants) and Hybrid Zygoma (2 zygomatic and 2 standard implants). A total of 76 patients classified as Cawood Grade VI, treated between 2007 and 2021, were included in this study. The primary outcome measure assessed was implant survival rate, while secondary outcomes included complications, patient satisfaction, and willingness to undergo the procedure again. The study included 69 patients with atrophic maxilla and 8 with tumor resection, receiving a total of 262 zygomatic implants, 220 in the Quad Zygoma group and 42 in the Hybrid Zygoma group. The mean follow-up duration was 67.6 ± 49.7 months. Eight implant failures were recorded (3 early and 5 delayed), resulting in an overall survival rate of 96.9%. Biological complications were observed in 27.6% of patients, with sinusitis in 16 patients and soft tissue issues in 5. Technical complications occurred in 6.5% of cases, including screw fractures and loosening of the screws. A patient satisfaction survey of 40 patients indicated high levels of satisfaction, with most expressing a willingness to undergo the procedure again. In conclusion, Zygomatic implants have been shown to have favorable outcomes in patients with severe upper Maxillary atrophies. Both the Quad and Hybrid techniques have shown promising long-term results. However, some complications can occur due to the implants' proximity to important anatomical areas.
Ovarian cancer is a highly aggressive disease with a poor prognosis, largely due to challenges in early detection. Traditional screening methods, including transvaginal ultrasound (TVS) and CA125 testing, have notable limitations in detecting early-stage disease and are not advised for widespread use. This article examines emerging early detection technologies, such as novel biomarkers, circulating DNA, PCR assays from Pap swabs, autoantibodies, microRNAs, and advanced imaging techniques. Future advancements in therapeutic methods may enhance survival outcomes linked to early detection. While general population screening remains unendorsed, targeted screening might be valuable for high-risk groups, such as those with Lynch syndrome, but should not replace risk-reducing surgeries. Developing comprehensive screening guidelines for high-risk individuals is essential for improving early detection and survival rates in ovarian cancer.
Introduction Extended pelvic lymph node dissection (ePLND) in men undergoing robot-assisted laparoscopic radical prostatectomy (RARP) is a widely used procedure. However, little is known about anatomical site-specific yields and subsequent metastatic patterns in these patients. Patients and methods Data on a consecutive series of 1107 patients undergoing RARP at our centre between 2004 and 2018 were analysed. In men undergoing LN dissection, the internal, external and obturator nodes were removed and sent in separately. We performed an analysis of LN yields in total and for each anatomical zone, patterns of LN metastases and complications. Oncological outcome in pN+ disease was assessed including postoperative PSA persistence and survival. Results A total of 823 ePLNDs were performed in the investigated cohort resulting in 98 men being diagnosed as pN+ (8.9%). The median (IQR) LN yield was 19 (14–25), 10 (7–13) on the right and 9 (6–12) on the left side ( P < 0.001). A median of six (4–8) LNs were retrieved from the external, three (1–6) from the internal iliac artery, and eight (6–12) from the obturator fossa. More men had metastatic LNs on the right side compared to the left (41 vs. 19). Symptomatic lymphoceles occurred exclusively in the ePLND group (2.3% vs. 0%, p = 0.04). Postoperatively, 47 (47.9%) of men with pN+ reached a PSA of < 0.1μg/ml. There was no association between a certain pN+ region and postoperative PSA persistence or BCRFS. The estimated cancer specific survival rate at 5 years was 98.5% for pN+ disease. Conclusion Robot-assisted laparoscopic ePLND with a high LN yield and low complication rate is feasible. However, we observed an imbalance in more removed and positive LNs on the right side compared to the left. A high rate of postoperative PSA persistence and early recurrence in pN+ patients might indicate a possibly limited therapeutical value of the procedure in already spread disease. Yet, these men demonstrated an excellent survival.
