Psychische Belastungen am Arbeitsplatz sind mit erheblichen Folgen für Beschäftigte und deren Gesundheit verbunden.

ZusammenfassungHintergrundPsychische Belastungen am Arbeitsplatz sind mit erheblichen Folgen fur Beschaftigte und deren Gesundheit verbunden.FragestellungIn dieser Studie werden die wichtigsten Stressfaktoren und die Ressource Handlungsspielraum am Arbeitsplatz von Chirurgen in Deutschland sowie deren psychisches Befinden untersucht und mit Benchmarkwerten einer gro ss en Referenzstichprobe verglichen.MethodeDie Datenbasis bildet eine reprasentative Onlinebefragung von Chirurgen in Deutschland, die uber den Berufsverband der Deutschen Chirurgen angesprochen wurden. Insgesamt haben 643 Chirurgen aus unterschiedlichen Hausern und samtlichen Fachgebieten an der Befragung, die aus validierten Messinstrumenten erstellt wurde, teilgenommen.ErgebnisseFur Chirurgen ist Zeitdruck generell ein hoch ausgepragter Stressor. Daruber hinaus ergeben sich besonders fur Assistenz- und Facharzte ungunstige Belastungskombinationen aus hoher Unsicherheit bei der Zielerreichung und fehlenden Handlungsspielraumen, gepaart mit sehr hohen Erschopfungswerten und niedriger Arbeitszufriedenheit. Zudem zeigt sich, dass Chirurgen aus Einzel- sowie Gemeinschaftspraxen sowie auch Medizinischen Versorgungszentren weniger Stressoren ausgesetzt sind und uber mehr Ressourcen verfugen.SchlussfolgerungenDie Ergebnisse der Befragung legen nahe, dass in Deutschland von einem hohen Ma ss an Burn-out-Gefahrdung bei Chirurgen ausgegangen werden muss, insbesondere bei Assistenz- und Facharzten aus gro ss en Hausern. Eine konzertierte Ma ss nahme aller Akteure des Gesundheitswesens ist notwendig, um eine hohe Qualitat in den operativen Disziplinen aufrechtzuerhalten. AbstractBackgroundPsychological stress at work is associated with detrimental and health-impairing consequences for employees.ObjectiveIn this study major stress factors and the resource job control at the workplace of surgeons and facets of mental health were examined and compared to benchmark results of alarge reference sample.MethodData were collected by arepresentative online survey among surgeons throughout Germany who were contacted via the Professional Association of German Surgeons. In total 643 surgeons from different organizations and different disciplines completed the questionnaire that was developed using well-validated instruments.ResultsTime pressure was the most meaningful stress factor for surgeons. Moreover, the results for medical assistants showed adverse stress combinations of high goal uncertainty and low job control as well as high emotional exhaustion and low job satisfaction. In addition, the results indicated that surgeons in single and group practices as well as in outpatient healthcare centers have less stressors and more job resources.ConclusionThe survey results suggest high levels of burnout risk for German surgeons, especially among medical assistants and medical specialists from large hospitals. In order to maintain ahigh quality in the surgical disciplines, a concerted effort by all players in the healthcare system is necessary.

AIM:To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2 (faecal M2-PK) test for colorectal cancer (CRC) screening based on the currently available studies. METHODS:A literature search in PubMed and Embase was conducted using the following search terms: fecal Tumor M2-PK, faecal Tumour M2-PK, fecal M2-PK, faecal M2-PK, fecal pyruvate kinase, faecal pyruvate kinase, pyruvate kinase stool and M2-PK stool. RESULTS:Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies. The mean faecal M2-PK sensitivity was 80.3%; the specificity was 95.2%. Four studies compared faecal M2-PK head-to-head with guaiac-based faecal occult blood test (gFOBT). Faecal M2-PK demonstrated a sensitivity of 81.1%, whereas the gFOBT detected only 36.9% of the CRCs. Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma (n = 554), with the following sensitivities: adenoma < 1 cm in diameter: 25%; adenoma > 1 cm: 44%; adenoma of unspecified diameter: 51%. In a direct comparison with gFOBT of adenoma > 1 cm in diameter, 47% tested positive with the faecal M2-PK test, whereas the gFOBT detected only 27%. CONCLUSION:We recommend faecal M2-PK as a routine test for CRC screening. Faecal M2-PK closes a gap in clinical practice because it detects bleeding and non-bleeding tumors and adenoma with high sensitivity and specificity.

AIM:To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years, 1997 to January 2007. METHODS:A total of 25 patients (20 female and five male: aged 18-75 years), with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract, were included in the study.The main symptom was abdominal pain.The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control. RESULTS:Eleven strictures were located in the colon, 13 at the anastomosis after ileocecal resection, three at the Bauhin valve and four in the ileum.Four patients had two strictures and one patient had three strictures.Of the 31 strictures, in 30 was balloon dilatation successful in a single endoscopic session, so that eventually the strictures could be passed easily with the standard colonoscope.In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart, sufficient dilatation was not possible.This patient therefore required surgery.Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation, although in one case perforation occurred after dilatation of a recurrent stricture.Available follow-up was in the range of 54-118 mo (mean of 81 mo).The relapse rate over this period was 46%, but 64% of relapsing strictures could be successfully dilated again.Only in four patients was surgery required during this follow-up period. CONCLUSION:We conclude from these initial results that endoscopic balloon dilatation, especially for short strictures in Crohn's disease, can be performed with reliable success.Perforation is a rare complication.It is our opinion that in the long-term, the relapse rate is probably higher than after surgery, but usually a second endoscopic treatment can be performed successfully, leading to a considerable success rate of the endoscopic procedure.

Od początku dwudziestego pierwszego wieku mozliwe stalo sie badanie jelita cienkiego metodą endoskopii kapsulkowej. Niniejsze krotkie doniesienie koncentruje sie na zaletach i wadach tej metody. Wśrod zalet wymienic nalezy znaczny komfort pacjenta, niski odsetek powiklan oraz skutecznośc diagnostyczną w granicach 80%. Z drugiej strony wadami metody są z pewnością brak jakiejkolwiek kontroli nad przebiegiem badania oraz niemozliwośc podjecia dzialan o charakterze terapeutycznym. Metoda ta powinna byc postrzegana jako uzupelniająca w stosunku do procedur endoskopowych, takich jak enteroskopia dwubalonowa, ktorej konsekwencje przenoszące sie na dzialania chirurgiczne zostaly niedawno przedtawione w czaspiśmie „Nowotwory” [1].

The non-operative therapy of clavicle fractures using a figure-of-eight dressing is the treatment of choice in Germany. This strategy is preferred even in cases of dislocated fractures. The procedures of open osteosynthesis are characterized by a huge access trauma. Up-to-date literature shows advantages of the intramedullary pin-osteosynthesis, which can be considered as minimally-invasive. In this study we compare the results of pin-osteosynthesis to the non-operative treatment of athletes.This prospective, controlled, and randomized trial compares the results of 68 athletes with an isolated fracture of the middle-third of the clavicle. One group (n=35) received intramedullary splints, the other group (n=33) had a figure-of-eight dressing instead.Results: Posttraumatic pain is significantly lower in the group that had intramedullary splints. Furthermore, the postoperative mobility of the injured area is better. Measurements of the strength of the injured side 120 days after the trauma show an advantage of the pin-osteosynthesis.The intramedullary titan pin-osteosynthesis is a promising alternative procedure with better results. Current literature and our own results show the advantages of this minimally-invasive osteosynthesis. This strategy allows sports activities soon after the operation, as intramedullary pin-osteosynthesis is an ideal operation of fractures of the middle-third of the clavicle. It is a comparatively easy procedure with few complications.

Introduction. In Germany double balloon enteroscopy (DBE) has been used for about 4 years in diagnostics of the small intestine. Testing for the first time its value in daily surgical practice, we analyzed retrospectively the results of all DBE examinations from December 2004 to September 2006.Material and Methods. During the study period 106 enteroscopies were performed on 75 patients (42 males, 33 females, age 16-84 years). The approach was oral in 75 cases and anal in 31. Most indications were recurrent middle gastrointestinal bleeding.Results. Complete small intestine inspection could be performed completely orally in seven of 106 examinations; and in most cases a combined oral/anal approach was required. Total endoscopy was completed in 21.3% of the patients studied. Pathologies were detected in 41 examinations (54.7%). These included 11 patients with angiodysplasias (14.7%) successfully treated with argon plasma coagulation (APC) and seven patients with small intestinal polyps (9.3%) that could be removed endoscopically. Further findings included diverticulum (6.7%), changes related to Crohn's disease (4.0%), small intestinal tumors (4.0%), extraluminar disorders (2.6%), stenoses (1.3%), and others (8.0%). Secondary diagnoses included colonic/rectal lesions in 5.3% of cases and pathologies of the stomach or esophagus in 4.0%. One patient had severe complications from a perforation following polypectomy. Therapies followed in 40.0% of all patients examined. Surgical interventions were indicated in six of 75 patients (8.0%), specifically five small intestinal resections and one bypass operation due to an infiltrating pancreas carcinoma. Endoscopic interventions were used in 25.3% of patients and medical treatment in 10.7%.Conclusion. With adequate indication, DBE shows very high diagnostic value. Immediate endoscopic therapy is possible in most cases, a considerable advantage over previous methods. Surgery was indicated for 8.0% of those examined in our study group, whereas the literature until now describes surgical indication rates of up to 22%.

Ectopic pancreas is a rare entity but the second most prevalent pancreatic anomaly. Heterotopic pancreas is defined as the presence of pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas. Its aetiology is not clearly established. In 1916, Poppi published for the first time evidence of heterotopic pancreas in the gallbladder. A review of the literature up to the present showed only 28 more cases worldwide of ectopic pancreas in the gallbladder. Aberrant pancreas is incidentally discovered in 2% of autopsies and has been estimated to occur once in every 500 upper abdominal explorations. Ninety per cent of ectopic pancreas is found in the stomach, duodenum, and jejunum. Mostly it is asymptomatic and benign. For this reason, therapy is indicated only in patients with symptoms such as pyloric obstruction, bleeding, and malignant transformation. Surgical resection or endoscopic mucosal resection as a newer method are recommended.

Tumours of the small intestine are very rare. Two-thirds of all neoplasms that occur in the small bowel are malignant. Only 13% of all malignancies of the bowel are detected in the small intestine. One-third of the tumours in the small intestine are benign and lipomas belong to this category. They make up about 1.5-6.5% of all gastrointestinal neoplasms. Lipomatosis of the small intestine was first described by Hellstrom in 1906 but until now, fewer than 30 cases have been reported. The diffuse, nodular-polypoid lipomatosis of the small intestine is extremely rare. It signifies either the presence of multiple lipomas in one segment of the small intestine or of the entire small intestine. We present in this paper a case report of this rare disease, including its diagnosis, therapy and subsequent follow-up. In the discussion we review the literature for the period 1906-2005.

Ektopes Pankreasgewebe ist eine seltene Entität, stellt jedoch nach dem Pankreas divisum die zweithäufigste Anomalie der Bauchspeicheldrüse dar. Es ist definiert als eigenständiges Pankreasgewebe ohne anatomische oder vaskuläre Verbindung zum Pankreashauptorgan. Die Ätiologie von ektopem Pankreasgewebe ist nicht geklärt. Die Gallenblase als Lokalisationsort von aberrierendem Bauchspeicheldrüsengewebe, wie in vorliegender Kasuistik, ist eine Rarität und wurde erstmals 1916 durch Poppi erwähnt. Die Literaturrecherche bis zum gegenwärtigen Zeitpunkt ergab weltweit nur 28 weitere publizierte Fallbeispiele. Ektopes Pankreasgewebe wird in etwa 2% aller Autopsien sowie bei einer von 500 Laparotomien als Zufallsbefund nachgewiesen. In 90% der Fälle findet man es im Magen, Duodenum oder Jejunum. Ektopes Pankreasgewebe ist meist asymptomatisch und benigne. Es bedarf daher nur bei Komplikationen, wie z. B. Passagestörung, Blutung oder maligner Entartung, einer operativen oder neuerdings auch endoskopischen Behandlung.

Die Colitis cystica profunda ist eine seltene benigne Erkrankung des unteren Gastrointestinaltraktes. Erstmalig wurden diese mit Schleim gefüllten zystischen Veränderungen durch Stark 1766 im Rahmen von zwei Autopsien beschrieben und in der Literatur erwähnt. Bis zum gegenwärtigen Zeitpunkt ergab eine entsprechende Literaturrecherche nicht mehr als 160 publizierte Fälle weltweit. Ihre häufigste Lokalisation sind das mittlere und untere Drittel des Rektums und das Colon sigmoideum, sie kann aber im gesamten Gastrointestinaltrakt vorkommen. Die Colitis cystica profunda ist häufig asymptomatisch. Die genaue histologische Sicherung ist wichtig, weil die Colitis cystica profunda ein muzinöses Adenokarzinom des Kolons oder Rektums imitieren kann. Die Therapie ist letztendlich vom Ergebnis der feingeweblichen Untersuchung abhängig.

Einleitung: In den letzten Jahren wurde mehrfach über die Anwendung der endoskopischen Ballondilatation bei Crohn-Stenosen im unteren Gastrointestinaltrakt berichtet. Langzeitergebnisse liegen bislang kaum vor.

The colitis cystica profunda is a very rare benign entity of the lower GI-tract. It was first described by Stark. He found these cysts, filled with mucous, in two autopsies in 1766. The study of the literature showed less than 160 published case reports so far. The most frequent localisation is the middle and lower third of the rectum and the colon sigmoideum, but it also can be found in the entire GI-tract. The colitis cystica profunda is often asymptomatic. The exact histology is very important, because the colitis cystica profunda sometimes imitates a mucinous adenocarcinoma of the colon or rectum. The therapy finally depends on the histopathological result.