The aim of this study was to evaluate CT imaging in the post-operative follow-up and in the detection of recurrence after radical prostatectomy in cases of prostatic carcinoma. In over 500 patients undergoing radical prostatectomy for prostatic carcinoma, 22 cases with local recurrence were found. CT examinations of the pelvis were retrospectively evaluated in these patients. Local recurrence was detected by PSA uptake and confirmed by transrectal ultrasound (TRUS) in combination with guided biopsy. In 22 cases of confirmed local recurrence, positive results on CT were found in eight patients (36%) and negative results in nine patients (41%). In the remaining five cases (23%), no distinction could be made between scar and local recurrence. All cases definitively classified as recurrent tumour disease showed a soft tissue mass of 2 cm or more. CT sensitivity in local recurrence of prostatic carcinoma after surgery is low. Even in a very careful follow-up, the understaging would be up to 41%. In comparison, PSA, TRUS and needle biopsy are the methods of choice and are superior to CT imaging. Based on these results, there would be no reason for including pelvic CT examinations in the follow-up of prostatic carcinoma after radical prostatectomy.

Zusammenfassung. Für die belastungsstabile Versorgung instabiler 31-A-Frakturen alter Menschen gibt es bislang keinen ¹Goldstandardª. In der vorliegenden Arbeit wird die Eignung des proximalen Femurnagels (PFN) als Standardverfahren zur Versorgung dieser Patientengruppe evaluiert. Hierzu haben wir die Behandlungsergebnisse von 106 Patienten mit proximaler Femurfraktur und einem mittleren Lebensalter von 84 Jahren analysiert. Die operative Versorgung war entweder mittels Endoprothese (n = 31) oder mittels PFN (n = 75) erfolgt. Der PFN war dabei mit kurzen Operationszeiten und geringem Operationstrauma der endoprothetischen Versorgung überlegen. Allerdings ergaben sich keine signifikanten Unterschiede im Outcome der beiden Patientengruppen. Hauptursache hierfür waren die durch die Fallpauschale 17.04 vorgegebenen Sachzwän-ge, die u. a. zu verlängerten Liegezeiten auch frühzeitig mobilisierter Patienten führten. Für die bevorstehende Einführung eines GR-DRG-Systems müssen diese Aspekte Beachtung finden. Der PFN ist bei korrekter Operationstechnik ein optimales Implantat zur Versorgung instabiler A2-und A3-Frakturen und als Standardverfahren auch für alte Patienten zu empfehlen. Die Indikation zu seiner Anwendung darf nicht durch ökonomische Zwänge eingeschränkt werden.Proximal Femoral Nail (PFN) ± Therapy of Choice as FullWeight-Bearing Treatment to Stabilize 31-A-Fractures in Old Patients? There is no ¹gold standardª in full-weight-bearing treatment of instable 31-A-fractures in aged people so far. In the present study we evaluate the applicability of the PFN to be considered as standard procedure in the treatment of mentioned group of geriatric patients. We analysed the treatment results in 106 patients (mean age: 84 years) with proximal femoral fracture. Surgical treatment included either implantation of hip prosthesis (n = 31) or fracture stabilization by PFN (n = 75). Proximal femoral nail-implantation revealed reduced operating times and minor surgical trauma compared to prosthetic care. Overall evaluation of the final outcome demonstrated no significant difference between both groups, though. The mean reason for that seems to be the circumstance of being forced to the specified flat rate per case. This leads to prolonged in-patient treatment, although patients with PFN-implantation experience early mobilization. Realizing the forthcoming introduction of GR-DRG-systems this aspect must be noticed carefully. The Proximal Femoral Nail represents a perfect implant for the treatment of instable A2-and A3-fractures. We can recommend PFN-implantation as full-weight-bearing standard therapy to treat those injuries in aged people. The indication to perform PFN-implantation must not be restricted by economical forces. EinführungIn der Literatur werden zur belastungsstabilen Versorgung proximaler Femurfrakturen die verschiedensten extramedullären und intramedullären Kraftträger diskutiert [1, 3, 9 ± 11]. Für stabile A1-Frakturen wird dabei überwiegend die dynamische Hüftschraube (DHS) als Standardverfahren empfohlen. Fü...

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