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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS); 20170514-20170517; Magdeburg; DOCP 055 /20170609/
    Publication Date: 2017-06-09
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH); 20110507-20110511; Hamburg; DOCDI.06.10 /20110428/
    Publication Date: 2011-04-28
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 3
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Psycho-Social-Medicine; VOL: 9; DOC06 /20121025/
    Publication Date: 2012-10-26
    Description: Objectives: As in nearly all European countries, demographic developments in Germany have led to both a relative and an absolute increase in the country's elderly population. The care and support needed by these people is primarily provided by relatives or friends and close acquaintances within the home environment. The major challenges for society are to sustain, promote and support these informal resources. In order to achieve this, it is crucial that family caregivers are provided with situation-specific services that support them and relieve their burden of care. The major challenges for society are therefore to sustain, promote and support informal resources and to provide the opportunity for the use of services aimed at assisting and relieving the burden of family caregivers.Methods: In the context of the EUROFAMCARE study, 1,003 family caregivers from Germany were interviewed at home about their experiences using a standardized questionnaire. Included in the study were primary caregivers providing at least four hours of personal care or support per week to a relative aged 65 years or older. Subjects solely providing financial support were excluded. In this paper, a linear regression analysis has been conducted to analyse impact of sociodemographic factors on the utilisation of support services.Results: The family caregivers were 54 years on average (SD=13.4), 76% of them were female. The dependent elderly were 80 years on average (SD=8.3), and 69% of them were women. 60% of them were receiving long-term care insurance benefits. Use of support services aimed directly at family caregivers is very low. After including certain services aimed primarily at those in need of care but also often serving as a source of relief for family caregivers, the percentage of caregivers using support services increased slightly. Among sociodemographic characteristics, caregivers' gender and education level have the greatest influence on services use. Other influential factors are caregivers' perception of their caregiving burden and their assessment of the dependent family member's need for assistance and support.
    Description: Einleitung: Wie in vielen europäischen Ländern führt der demografische Wandel auch in Deutschland zu einer relativen und absoluten Zunahme älterer Menschen. Die notwendigen Pflegeleistungen werden vorwiegend durch Familienangehörige, Freunde oder nahe Bekannte im häuslichen Umfeld erbracht. Häufig stellt diese Aufgabe für die pflegenden Angehörigen sowohl physisch wie auch psychisch eine hohe Belastung dar. Dabei zeichnet sich die Tendenz ab, dass nicht nur das Alter der Pflegebedürftigen, sondern auch das der pflegenden Angehörigen und somit auch deren Erkrankungsrisiko steigt.Die Pflege in der häuslichen Umgebung möglichst lange aufrecht zu erhalten, entspricht nicht nur dem Wunsch der meisten Gepflegten, sondern ist angesichts der enormen Kosten auch eine sozialpolitische Zielsetzung. Um dies zu ermöglichen, sind Entlastungs- und Unterstützungsangebote für pflegende Angehörige von großer Bedeutung. Die gesellschaftliche Herausforderung besteht darin, diese Angebote und ihre Inanspruchnahme zu erhalten, zu fördern und die informellen Ressourcen zu stärken.Methodik: Das EU-geförderte Projekt EUROFAMCARE gibt einen Überblick über die Situation pflegender Angehöriger älterer Menschen im Hinblick auf Verfügbarkeit, Bekanntheit, Inanspruchnahme und Akzeptanz von Angeboten, die zur Unterstützung und Entlastung beitragen können. In Deutschland wurden 1.003 persönliche Gespräche mit pflegenden Angehörigen durchgeführt. Die befragten Personen mussten die Hauptpflegeperson sein und mindestens 4 Stunden pro Woche einen älteren Angehörigen (65 Jahre oder älter) pflegen oder betreuen. Zur Datenerhebung diente ein standardisierter Fragebogen (Common Assessment Tool, CAT). In diesem Artikel wurden lineare Regressionsanalysen durchgeführt und Faktoren identifiziert, die sich auf Unterschiede in der Pflegeorganisation und Inanspruchnahme von unterstützenden Diensten beziehen, unter besonderer Berücksichtigung von Alter, Geschlecht und sozioökonomischen Status.Ergebnisse: Das Durchschnittsalter der Pflegenden betrug 54 Jahre (s=13,4); 76% waren weiblich. Die pflegebedürftigen Personen waren im Durchschnitt 80 Jahre alt (s=8,3), und 69% waren Frauen. 60% der Hilfs- und Pflegebedürftigen bezogen Leistungen aus der Pflegeversicherung. Eines der zentralen Ergebnisse der Studie ist eine insgesamt geringe Inanspruchnahme von Entlastungs- und Unterstützungsangeboten für Pflegende. Sie variiert sehr stark innerhalb der verschiedenen Gruppen pflegender Angehöriger und unterscheidet sich je nach spezifischer Pflegesituation. Unterschiede der Pflegeorganisation lassen sich beispielsweise in verschiedenen Altersgruppen der Befragten feststellen. Ebenso variiert die Inanspruchnahme von Diensten bei pflegenden Männern und Frauen.Die Möglichkeiten sich über Unterstützungsangebote zu informieren und diese bei Bedarf in Anspruch zu nehmen, hängen mit den verfügbaren Ressourcen, die aus der sozialen Lage resultieren, zusammen. Vor allem haben Geschlecht und Bildung einen Einfluss auf die Inanspruchnahme von Unterstützungsleistungen. Als weitere Einflussfaktoren wurden die subjektiv empfundene Belastung der Pflegenden sowie der Unterstützungsbedarf der Pflegebedürftigen identifiziert.
    Keywords: health services utilization ; family caregivers ; enabling factors ; predisposing factors ; need factors ; behavioral model of health services use ; ddc: 610
    Language: English
    Type: article
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  • 4
    ISSN: 1432-1076
    Keywords: Cushing's disease ; Pituitary adenoma ; Infancy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report an 18-month-old girl with Cushing's disease caused by a large adenoma of the pituitary gland. Tumour size and extension were determined by X-ray, CT-scan and angiographic studies. The endocrinological findings were typical for this disease: elevated plasma levels of ACTH, cortisol, 17-Hydroxyprogesterone (17-OHP) and testosterone, elevated urinary excretion of 17-Ketosteroids (17-KS) and 17-Hydroxycorticoids (17-OHCS). Dexamethasone failed to suppress ACTH and cortisol plasma levels. TRH induced only a minimal TSH increase. Following LH-RH injection gonadotropin levels rose to pubertal values. The hGH response to insulin-induced hypoglycaemia was subnormal. After resection of the tumour the infant died because of non-treatable arrhythmia. Histological findings showed a non-differentiated adenoma with extension into the subarachnoid space and into nerve tissues. In vitro lysine-vasopressin (LVP) and arginine-vasopressin (AVP) exhibited only weak stimulatory effects on the ACTH secretion of the tumour cells.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 130 (1979), S. 193-198 
    ISSN: 1432-1076
    Keywords: Pituitary adenoma ; Prolactin secretion ; Somatotropin deficiency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A boy aged 9 years and 8 months was evaluated for headache and an enlarged sella. His neurological status and visual fields were normal. After injection of radiographic contrast agent, computerized axial tomography showed evidence of an intrasellar tumor. The most striking endocrine abnormalities were growth hormone insufficiency after arginine infusion and after insulin-induced hypoglycemia, and excessively elevated prolactin levels ranging between 1220 ng/ml and 1560 ng/ml. A slightly granulated, acidophilic pituitary adenoma was selectively removed by the trans-sphenoidal approach. The function of the anterior pituitary improved post-operatively. Growth hormone secretion after insulin-induced hypoglycemia returned to normal, and the basal serum prolactin levels decreased, but are still three times higher than normal.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1076
    Keywords: Key words Lymphocytic hypophysitis ; Germinoma ; Diabetes insipidus ; Panhypopituitarism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report the clinical course of a prepubertal girl with central diabetes insipidus (DI) and consequent panhypopituitarism evolving over a period of 10 years due to lymphocytic hypophysitis and subsequent germinoma. Two years after the diagnosis of central DI was established, MRI revealed a thickened pituitary stalk. Later pituitary enlargement and increasing thickening of the pituitary stalk impinging on the optic chiasm required a trans-sphenoidal biopsy which disclosed active hypophysitis with lymphocytic infiltrates and necrosis. High dose dexamethasone treatment only temporarily halted the disease process. Therefore, stereotactic radiation therapy was performed as a rescue treatment and MRI findings almost reversed. However, the subsequent MRI showed multiple intracranial lesions identified histologically as a germinoma and a standard chemotherapy and radiation was performed. Conclusion The diagnosis of diabetes insipidus in children requires long-term follow up beyond the pubertal age in order to establish the underlying cause. In contrast to lymphocytic hypophysitis in adults, lymphocytic hypophysitis in prepubertal children may represent the first sign of a host reaction to an occult germinoma.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Virchows Archiv 399 (1983), S. 277-287 
    ISSN: 1432-2307
    Keywords: Pituitary ; Hyperplasias ; Immunocytochemistry ; Ultrastructure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Surgical specimens of 15 normal and 106 para-adenomous anterior pituitaries were studied immunocytochemically and in part electron microscopically for the presence of hyperplasia. GH cell hyperplasia was found in 13% of all normal pituitaries, in 6% of the cases with Prolactin secreting adenomas and in 9% of the cases with ACTH secreting adenomas. Prolactin cell hyperplasia occured in nearly equal percentages (17–23%) in normal pituitaries and in areas adjacent to GH-, Prolactin-or ACTH-secreting adenomas or adjacent to inactive adenomas. Previous findings of relatively more frequent Prolactin cell hyperplasia occuring together with Prolactin producing adenomas have to be revised. Prolactin cell hyperplasia as a primary source of hyperprolactinemia is very rare and almost always occurs in conjunction with oncocytic adenomas. ACTH cell hyperplasia was found in 13% of the normal pituitaries, in 14% of the cases with Prolactin secreting adenomas, in 58% of the cases with ACTH producing adenomas and in 40% of the pituitaries with GH secreting adenomas. We have no explanation for the latter result. ACTH cell hyperplasia may be the primary cause of Cushing's disease (18% of all Cushing cases). Hyperplasia of TSH cells in normal pituitaries was rare (7%) and with the exception of Prolactin producing adenomas (22%) was not found near adenomas. Clinical-pathological correlations are discussed.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-2307
    Keywords: Pituitary adenoma ; Sellar gangliocytoma ; Immunohistology ; Ultrastructure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three cases of a composite sellar tumour composed of a gangliocytoma and an adenoma are presented. Two patients who showed acromegaly and hyperprolactinaemia had a gangliocytoma and a growth hormone (GH)-prolactin cell adenoma in close proximity. The gangliocytoma contained growth hormone-releasing hormone (GHRH) by immunohistochemistry. At the electron microscopical level, the gangliocytoma was characterized by numerous synaptic vesicles. The third patient, a child with Cushing's disease, presented a corticotropin-releasing hormone (CRH)-positive gangliocytoma in close contact with an adrenocorticotropic hormone (ACTH) secreting adenoma, the latter a typical densely granulated ACTH cell adenoma. Ultrastructurally, the gangliocytoma revealed synaptic vesicles and sparse secretory granules. The results suggest that gangliocytomas may promote the development of pituitary adenomas by hypersecretion of releasing hormones. Whereas 20 cases of sellar GHRH producing gangliocytomas in acromegaly are reported in the literature, the combination of a CRH-positive gangliocytoma and an ACTH cell adenoma in Cushing's disease is apparently the first case.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Keywords: Transsphenoidal cephalocele; surgical approach; adult.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ Transsphenoidal cephalocele rarely occurs in adults. We describe two adult cases with transsphenoidal cephaloceles. The first case was a 53-year-old female who presented with spontaneous cerebrospinal fluid (CSF) rhinorrhea. Magnetic resonance (MR) imaging demonstrated a transsphenoidal meningocele. Surgical repair was attempted via the transsphenoidal route. Rhinorrhea recurred at one month and also two years later. Transsphenoidal surgical repairs were repeated. There has been no evidence of CSF leakage in the four years of follow-up after the last surgery. Transsphenoidal repair seems to be the most suitable approach in this case. The second case was a 26-year-old female with secondary amenorrhea, diabetes insipidus, bitemporal hemianopsia, and see-saw nystagmus. MR imaging demonstrated a transsphenoidal encephalocele with the optic chiasma and infundibular recesses descending into the meningocele and an agenesis of the corpus callosum. The first operation was performed via the transnasal route and the second by sublabial transmaxillary transsphenoidal approach six months later. Postoperative MR imaging revealed reduction of the encephalocele. There was neither worsening nor noticeable improvement in the neurological or endocrinological function. However, in this type, complete repair is often impossible, and non-radical surgery such as transsphenoidal repair may be indicated as most suitable. They should be selected with careful assessment referring to MR findings and clinical symptoms and signs.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 66 (1982), S. 123-126 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors describe a microsurgical pressure-irrigation-suction system (MPIS) which allows a rapid adjustment of suction and irrigation to the operative situation by one-hand manipulation. This system is especially suitable for transsphenoidal microsurgery of pituitary disorders and has proved its usefulness in 60 such operations.
    Type of Medium: Electronic Resource
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