An 83-year-old female patient was admitted to the hospital with breathing difficulties and weight loss. An autopsy revealed adenocarcinoma of the lung and colon in the late stages. Molecular testing found that both cancers had a BRAF V600E mutation, which is rare for two separate cancers to share. The autopsy also uncovered several other previously unknown medical conditions, demonstrating the importance of autopsies for quality control and teaching.
An 83-year-old female patient was admitted to the hospital with breathing difficulties and weight loss. An autopsy revealed adenocarcinoma of the lung and colon in the late stages. Molecular testing found that both cancers had a BRAF V600E mutation, which is rare for two separate cancers to share. The autopsy also uncovered several other previously unknown medical conditions, demonstrating the importance of autopsies for quality control and teaching.
Kongressplakat pathologie dworak grading system prof. hansen_din a0Klinikum Lippe GmbH
This study evaluated the Dworak tumor regression grading (TRG) system as a prognostic indicator for 159 rectal cancer patients treated with neoadjuvant chemoradiotherapy. Patients were observed for a mean of 42.5 months. A univariate Kaplan-Meier analysis found that patients with Dworak TRG grades 3+4 had a mean progression-free survival of 121 months, significantly higher than the 53.6 months for patients with grades 1+2. A multivariate analysis identified Dworak TRG grade and postoperative nodal stage as independent risk factors. The study concludes that Dworak TRG is an important prognostic indicator of progression-free survival and that subclassifying into grades 1+2 and 3
This study developed and tested a non-language specific speech test using made-up syllables to evaluate speech in cleft patients from different cultural and language backgrounds. The test was administered to 41 cleft patients and 39 non-cleft individuals from Germany, Iran, and India. Two speech pathologists independently rated audio recordings of the tests and found significant differences in hypernasality, nasal emissions, and consonant errors between cleft patients and non-cleft controls from the same language group. While inter-rater agreement was poor, the test was able to distinguish speech characteristics between cleft and non-cleft individuals across different languages and cultures.
This study evaluated the use of vascularised fatty tissue flaps to replace excised parotid tissue and prevent Frey's syndrome in 37 patients who underwent parotidectomy between 2008-2017. The fatty flaps took an average of 17 minutes to dissect and were stable for up to 9 years of follow up. None of the patients reported symptoms of Frey's syndrome such as flushing or sweating when eating. The flaps were an easy technique that avoided donor site morbidity compared to other options and successfully prevented Frey's syndrome in all patients.
1) The study compared the effects of dexamethasone, tranexamic acid, and a combination of both on post-rhinoplasty edema and ecchymosis in 60 patients who underwent primary open rhinoplasty.
2) Patients were divided into 4 groups: dexamethasone only, tranexamic acid only, combination, and placebo. Medications were given intravenously before and after surgery.
3) Edema and ecchymosis were evaluated on a scale of 0-4 on postoperative days 1, 3, and 7. The dexamethasone, tranexamic acid, and combination groups had significantly lower edema and ecchymosis ratings compared to the placebo
This study compared information obtained from standard computed tomographic angiography (s-CTA) scans and modified CTA (m-CTA) scans of the deep circumflex iliac artery (DCIA) flap to cadaver dissections. The m-CTA scans showed longer visible DCIA lengths, better visualization of branching patterns, and more detail on vessel course compared to s-CTA scans. However, s-CTA scans allowed bilateral evaluation while m-CTA only showed the injected side. Both CTA methods provided more information than cadaver dissections for preoperative planning of DCIA flaps.
This document describes a new minimally invasive technique for harvesting a deep circumflex iliac artery (DCIA) flap for jaw reconstruction using virtual surgical planning and 3D printed surgical guides. Virtual planning based on CT scans allows for precise preoperative design of the bone flap and surgical guide. The guide enables a medial approach to the pelvis to harvest the flap, preserving important anatomical structures and muscles to reduce donor site morbidity. Initial results found the new technique allowed for shorter recovery times and less complaints about walking or hip profile changes compared to standard approaches.
This study analyzed the three-dimensional morphology of ears in 240 Caucasian volunteers aged 21-65. 3D scans were taken and distances, angles, and proportions between landmarks on the ears were measured. The results showed that the distance between the subaurale and superaurale, as well as the width of the ear, significantly increased with age. The lower quadrant of the ear extended the most with increasing age. The ear continues changing shape in adulthood even after body growth stops. These measurements can help surgeons plan operations to achieve aesthetic outcomes for patients of different ages.
This study assessed parental risk factors for cleft lip and palate (CL/P) in 187 children with CL/P and 190 non-cleft children. The study found that family history of clefts, lack of folic acid consumption during pregnancy, and consanguineous marriage were strongly associated with increased risk of a child being born with CL/P. Children with CL/P also had significantly higher rates of other congenital abnormalities and physical problems compared to non-cleft children. The findings suggest expecting mothers with a family history of CL/P or who engage in consanguineous marriages should take extra precautions to prevent CL/P in their children.
2016 wahl-immunotherapy with imiquimod and interferon alfa for metastasized m...Klinikum Lippe GmbH
1) The document describes the case of a 90-year-old woman with metastatic Merkel cell carcinoma (MCC) that was treated with a combination of local and systemic immunotherapy.
2) Treatment included weekly intralesional injections of interferon alfa-2a along with topical imiquimod cream 3 times per week, as well as subcutaneous injections of pegylated interferon alfa-2b.
3) This combination led to the regression of all cutaneous metastases and lymph node metastases within 4 months, and the patient remained alive 30 months after starting immunotherapy, suggesting locally metastasized MCC can be controlled with local and systemic immunotherapy.
1) The study examined the effect of using acellular dermal grafts in combination with Z-plasty technique for secondary cleft lip deformities.
2) 18 patients underwent scar revision, submucosal tunneling, Z-plasty, and placement of an acellular dermal graft.
3) Quantitative measurements before and after surgery found significant improvements in symmetry, defect height, and lip thickness, indicating acellular dermal grafts with Z-plasty can effectively treat secondary cleft lip deformities.
This document describes a technique for reconstructing full-thickness defects of the lower third of the nose using a three-layer approach. A reversed nasolabial flap is used to reconstruct the nasal lining, an auricular cartilage graft provides structural support, and a forehead flap provides skin coverage. The technique was used in 21 patients and resulted in satisfactory aesthetic and functional outcomes in most cases. Combined flaps from local and distant sites incorporating cartilage can effectively reconstruct large nasal defects while restoring the three anatomical layers.
2016 heinz-two-step reconstruction of non-marginal auricular defectsKlinikum Lippe GmbH
This document describes a two-step surgical technique for reconstructing non-marginal full-thickness defects of the auricle. In the first step, tissue from the preauricular and retroauricular regions is used to reconstruct the anterior and posterior surfaces of the auricle defect. In the second step, performed two weeks later, the tissue pedicles are separated and adjusted. Thirteen patients underwent this procedure with excellent esthetic outcomes, low morbidity, and patient satisfaction. Vertical and horizontal dimensions of the reconstructed auricles changed minimally. The two-step technique provides an improved method for reconstructing central auricle defects.
This study retrospectively evaluated 34 patients with class III dentofacial deformities who underwent either maxillary advancement or mandibular setback surgery. Pre- and post-operative lateral cephalograms were analyzed to compare changes in 14 soft tissue parameters between the two surgical approaches. Statistically significant differences were found for cervical length, which increased after maxillary advancement but decreased after mandibular setback. Some other aesthetic parameters were found to be superior after maxillary advancement compared to mandibular setback. The study aims to help determine the best surgical approach for correcting class III deformities while optimizing aesthetic outcomes.
This study compared the clinically usable bone regions of the ilium and fibula for mandible reconstruction. Measurements were taken of 241 ilia, 91 mandibles, and 60 fibulas. The ilium offered a similar total usable bone length to the fibula but maintained a more constant bone thickness throughout, whereas the fibula's dimensions varied significantly. In some fibulas, only a small portion of the total bone length could actually be used. The study suggests the ilium may be a better donor site than the fibula, especially for women requiring occlusal rehabilitation after mandible reconstruction.
This study compared outcomes of 86 patients who underwent reconstruction of facial soft tissue defects following tumor excision using various surgical techniques, including non-vascularised skin grafts, local flaps, a modified face-lift technique, and microvascular free flaps. The face-lift technique resulted in shorter hospital stays and lower rates of ectropion than other methods for defects under 60 cm2. It provided the best aesthetic outcomes but was limited to smaller defects. Microvascular free flaps were necessary for the largest defects over 60 cm2 due to the amount of tissue needed.
2015 heinz-repairing a non-marginal full-thickness auricular defect using a r...Klinikum Lippe GmbH
This document describes a surgical technique using an anterior pedicled retroauricular flap (APRF) to reconstruct full-thickness defects of the central non-marginal area of the ear. The APRF is harvested from the postauricular skin in two stages and used to reconstruct both the posterior and anterior surfaces of the defect. The procedure was performed successfully in 11 patients to repair conchal defects, with good aesthetic outcomes, minimal donor site morbidity, and high patient satisfaction. The APRF provides an effective method to reconstruct central ear defects while maintaining ear size and shape with minimal stress on the flap.
This document discusses the use of techniques from aesthetic rhinoplasty in reconstructive nasal surgery after tumor resection. The authors used osteotomy and tip shaping techniques in 17 patients to reshape the nasal framework after removing underlying bone or cartilage. This increased the margin of safety and reduced the size of the defect, allowing tension-free primary closure with local tissue flaps. Patients were satisfied with the aesthetic and functional outcomes. The techniques require knowledge of procedures from aesthetic rhinoplasty but can improve reconstruction results.
Kongressplakat pathologie dworak grading system prof. hansen_din a0Klinikum Lippe GmbH
This study evaluated the Dworak tumor regression grading (TRG) system as a prognostic indicator for 159 rectal cancer patients treated with neoadjuvant chemoradiotherapy. Patients were observed for a mean of 42.5 months. A univariate Kaplan-Meier analysis found that patients with Dworak TRG grades 3+4 had a mean progression-free survival of 121 months, significantly higher than the 53.6 months for patients with grades 1+2. A multivariate analysis identified Dworak TRG grade and postoperative nodal stage as independent risk factors. The study concludes that Dworak TRG is an important prognostic indicator of progression-free survival and that subclassifying into grades 1+2 and 3
This study developed and tested a non-language specific speech test using made-up syllables to evaluate speech in cleft patients from different cultural and language backgrounds. The test was administered to 41 cleft patients and 39 non-cleft individuals from Germany, Iran, and India. Two speech pathologists independently rated audio recordings of the tests and found significant differences in hypernasality, nasal emissions, and consonant errors between cleft patients and non-cleft controls from the same language group. While inter-rater agreement was poor, the test was able to distinguish speech characteristics between cleft and non-cleft individuals across different languages and cultures.
This study evaluated the use of vascularised fatty tissue flaps to replace excised parotid tissue and prevent Frey's syndrome in 37 patients who underwent parotidectomy between 2008-2017. The fatty flaps took an average of 17 minutes to dissect and were stable for up to 9 years of follow up. None of the patients reported symptoms of Frey's syndrome such as flushing or sweating when eating. The flaps were an easy technique that avoided donor site morbidity compared to other options and successfully prevented Frey's syndrome in all patients.
1) The study compared the effects of dexamethasone, tranexamic acid, and a combination of both on post-rhinoplasty edema and ecchymosis in 60 patients who underwent primary open rhinoplasty.
2) Patients were divided into 4 groups: dexamethasone only, tranexamic acid only, combination, and placebo. Medications were given intravenously before and after surgery.
3) Edema and ecchymosis were evaluated on a scale of 0-4 on postoperative days 1, 3, and 7. The dexamethasone, tranexamic acid, and combination groups had significantly lower edema and ecchymosis ratings compared to the placebo
This study compared information obtained from standard computed tomographic angiography (s-CTA) scans and modified CTA (m-CTA) scans of the deep circumflex iliac artery (DCIA) flap to cadaver dissections. The m-CTA scans showed longer visible DCIA lengths, better visualization of branching patterns, and more detail on vessel course compared to s-CTA scans. However, s-CTA scans allowed bilateral evaluation while m-CTA only showed the injected side. Both CTA methods provided more information than cadaver dissections for preoperative planning of DCIA flaps.
This document describes a new minimally invasive technique for harvesting a deep circumflex iliac artery (DCIA) flap for jaw reconstruction using virtual surgical planning and 3D printed surgical guides. Virtual planning based on CT scans allows for precise preoperative design of the bone flap and surgical guide. The guide enables a medial approach to the pelvis to harvest the flap, preserving important anatomical structures and muscles to reduce donor site morbidity. Initial results found the new technique allowed for shorter recovery times and less complaints about walking or hip profile changes compared to standard approaches.
This study analyzed the three-dimensional morphology of ears in 240 Caucasian volunteers aged 21-65. 3D scans were taken and distances, angles, and proportions between landmarks on the ears were measured. The results showed that the distance between the subaurale and superaurale, as well as the width of the ear, significantly increased with age. The lower quadrant of the ear extended the most with increasing age. The ear continues changing shape in adulthood even after body growth stops. These measurements can help surgeons plan operations to achieve aesthetic outcomes for patients of different ages.
This study assessed parental risk factors for cleft lip and palate (CL/P) in 187 children with CL/P and 190 non-cleft children. The study found that family history of clefts, lack of folic acid consumption during pregnancy, and consanguineous marriage were strongly associated with increased risk of a child being born with CL/P. Children with CL/P also had significantly higher rates of other congenital abnormalities and physical problems compared to non-cleft children. The findings suggest expecting mothers with a family history of CL/P or who engage in consanguineous marriages should take extra precautions to prevent CL/P in their children.
2016 wahl-immunotherapy with imiquimod and interferon alfa for metastasized m...Klinikum Lippe GmbH
1) The document describes the case of a 90-year-old woman with metastatic Merkel cell carcinoma (MCC) that was treated with a combination of local and systemic immunotherapy.
2) Treatment included weekly intralesional injections of interferon alfa-2a along with topical imiquimod cream 3 times per week, as well as subcutaneous injections of pegylated interferon alfa-2b.
3) This combination led to the regression of all cutaneous metastases and lymph node metastases within 4 months, and the patient remained alive 30 months after starting immunotherapy, suggesting locally metastasized MCC can be controlled with local and systemic immunotherapy.
1) The study examined the effect of using acellular dermal grafts in combination with Z-plasty technique for secondary cleft lip deformities.
2) 18 patients underwent scar revision, submucosal tunneling, Z-plasty, and placement of an acellular dermal graft.
3) Quantitative measurements before and after surgery found significant improvements in symmetry, defect height, and lip thickness, indicating acellular dermal grafts with Z-plasty can effectively treat secondary cleft lip deformities.
This document describes a technique for reconstructing full-thickness defects of the lower third of the nose using a three-layer approach. A reversed nasolabial flap is used to reconstruct the nasal lining, an auricular cartilage graft provides structural support, and a forehead flap provides skin coverage. The technique was used in 21 patients and resulted in satisfactory aesthetic and functional outcomes in most cases. Combined flaps from local and distant sites incorporating cartilage can effectively reconstruct large nasal defects while restoring the three anatomical layers.
2016 heinz-two-step reconstruction of non-marginal auricular defectsKlinikum Lippe GmbH
This document describes a two-step surgical technique for reconstructing non-marginal full-thickness defects of the auricle. In the first step, tissue from the preauricular and retroauricular regions is used to reconstruct the anterior and posterior surfaces of the auricle defect. In the second step, performed two weeks later, the tissue pedicles are separated and adjusted. Thirteen patients underwent this procedure with excellent esthetic outcomes, low morbidity, and patient satisfaction. Vertical and horizontal dimensions of the reconstructed auricles changed minimally. The two-step technique provides an improved method for reconstructing central auricle defects.
This study retrospectively evaluated 34 patients with class III dentofacial deformities who underwent either maxillary advancement or mandibular setback surgery. Pre- and post-operative lateral cephalograms were analyzed to compare changes in 14 soft tissue parameters between the two surgical approaches. Statistically significant differences were found for cervical length, which increased after maxillary advancement but decreased after mandibular setback. Some other aesthetic parameters were found to be superior after maxillary advancement compared to mandibular setback. The study aims to help determine the best surgical approach for correcting class III deformities while optimizing aesthetic outcomes.
This study compared the clinically usable bone regions of the ilium and fibula for mandible reconstruction. Measurements were taken of 241 ilia, 91 mandibles, and 60 fibulas. The ilium offered a similar total usable bone length to the fibula but maintained a more constant bone thickness throughout, whereas the fibula's dimensions varied significantly. In some fibulas, only a small portion of the total bone length could actually be used. The study suggests the ilium may be a better donor site than the fibula, especially for women requiring occlusal rehabilitation after mandible reconstruction.
This study compared outcomes of 86 patients who underwent reconstruction of facial soft tissue defects following tumor excision using various surgical techniques, including non-vascularised skin grafts, local flaps, a modified face-lift technique, and microvascular free flaps. The face-lift technique resulted in shorter hospital stays and lower rates of ectropion than other methods for defects under 60 cm2. It provided the best aesthetic outcomes but was limited to smaller defects. Microvascular free flaps were necessary for the largest defects over 60 cm2 due to the amount of tissue needed.
2015 heinz-repairing a non-marginal full-thickness auricular defect using a r...Klinikum Lippe GmbH
This document describes a surgical technique using an anterior pedicled retroauricular flap (APRF) to reconstruct full-thickness defects of the central non-marginal area of the ear. The APRF is harvested from the postauricular skin in two stages and used to reconstruct both the posterior and anterior surfaces of the defect. The procedure was performed successfully in 11 patients to repair conchal defects, with good aesthetic outcomes, minimal donor site morbidity, and high patient satisfaction. The APRF provides an effective method to reconstruct central ear defects while maintaining ear size and shape with minimal stress on the flap.
This document discusses the use of techniques from aesthetic rhinoplasty in reconstructive nasal surgery after tumor resection. The authors used osteotomy and tip shaping techniques in 17 patients to reshape the nasal framework after removing underlying bone or cartilage. This increased the margin of safety and reduced the size of the defect, allowing tension-free primary closure with local tissue flaps. Patients were satisfied with the aesthetic and functional outcomes. The techniques require knowledge of procedures from aesthetic rhinoplasty but can improve reconstruction results.
4. ... Ende August 2014
• Freitagabend ungefähr 22:00 Uhr
• Unterkunft in der Adenauerstraße, Detmold
• 2 Busse aus ZAB Dortmund-Unna
• ca. 100 Flüchtlinge
• 3 Flüchtlinge am Ende ihrer Kräfte
25.11.2015 Medizinische Versorgung von Flüchtlingen 4
5. Mitternacht in der Notaufnahme
• Anruf aus der Unterkunft Detmold
• 3 Flüchtlinge zur notfallmäßigen Versorgung
• kein Dolmetscher verfügbar
• Nach „notdürftiger“ Untersuchung:
• Junge Mutter – Kreislaufkollaps, 2 kleine Kinder
• Westafrikaner – Fieber
• Hochbetagter - Erschöpfung
25.11.2015 Medizinische Versorgung von Flüchtlingen 5
6. Am nächsten Morgen ...
Was war denn das ???
Passiert so etwas demnächst öfters?
Wie können wir vorsorgen?
25.11.2015 Medizinische Versorgung von Flüchtlingen 6
7. Stabssitzung – Versorgung der Flüchtlinge
Hausärztliche Versorgung in den Einrichtungen
• Niedergelassene/pensionierte Ärzte
Medizinische Eingangsuntersuchungen
• Mitarbeiter des Klinikums
Notfallversorgung
• Rettungsdienst des Kreises
• Zentrale Notaufnahmen der Klinikums
25.11.2015 Medizinische Versorgung von Flüchtlingen 7
16. Die weiteren Schritte ...
• Erstellung von Freiwilligen-Dienstplänen
• Einrichtung von mobilen Materialwägen
• Einrichtung einer mobilen EDV-Einheit
• Vorhaltung von Lagerkapazitäten
• Materialnachbestellungen
25.11.2015 Medizinische Versorgung von Flüchtlingen 16
17. ... und nebenher !
Außerhalb der Erstuntersuchungszeiten:
• Ablesen von „Tuberkulin“-Ergebnissen
• Auswertung der „Quantiferon“-Befunde
• Durchsicht der Laufzettel und Röntgenbefunde
• Erstellung von Untersuchungs-Zertifikaten
• Planung des weiteren Prozedere
• Tuberkulose-Verdacht
• Abnorme Befunde
25.11.2015 Medizinische Versorgung von Flüchtlingen 17
18. Tipps & Tricks
• Dienstpläne weit im Voraus planen
• Abendliche Nachmeldungen vermeiden
• Blutabnahmen und Röntgen vorher planen
• Lieferengpässe für „Tuberkulin“ bedenken
• Gute Kommunikation im Team
• Enger Kontakt mit den Einrichtungen
• Ansprechpartner bestimmen und kommunizieren
25.11.2015 Medizinische Versorgung von Flüchtlingen 18
19. Ein wesentlicher Erfolgsfaktor …
Mitarbeiter/innen mit Migrationshintergrund:
• Kulturelles Verständnis
• Fremdsprachliche Ressource
• Hohe Eigenmotivation
25.11.2015 Medizinische Versorgung von Flüchtlingen 19
31. Turmbau zu Babel ...
Flüchtlingsambulanz
• „Kompetenz-Zentrum“
• Eigene Räumlichkeiten
• Feste Strukturen
• Klare Prozessabläufe
• Geregelte Zuständigkeiten
• Integrativer Versorgungsansatz
• Positiver Beitrag für Gesellschaft
25.11.2015 Medizinische Versorgung von Flüchtlingen 31
32. Die Räumlichkeiten ...
Anforderungen und Erfahrungen:
• Kurze Anfahrtswege für Busse/Taxis
• Kurze und klare Wegeführung zum Röntgen
• Großzügige und familienfreundliche Räume
• Sitzplätze vor den Untersuchungsräumen
• „Sammelbereich“ vor der Ambulanz
• Kreuzen von Wegen vermeiden
25.11.2015 Medizinische Versorgung von Flüchtlingen 32
33. Technische Ausstattung
• Zentrale Anmeldung mit Büro
• Drei große Untersuchungsräume
• Computerarbeitsplatz und Telefonanschluss
• Untersuchungsliege
• Verbrauchsmaterialien
• Kinderuntersuchungsraum
• wie oben
• Materialien zur Blutprobenentnahme
• Tuberkulin-Testbestecke
25.11.2015 Medizinische Versorgung von Flüchtlingen 33
34. Die Zukunft ... (ab 2016)
Mehrmals wöchentlich Untersuchungstermine
• Durchführung von Erstuntersuchungen
• Abklärung von auffälligen Screening-Befunden
• Medizinische Beratung von Einrichtungen
• Flüchtlingsambulanz-Hotline
25.11.2015 Medizinische Versorgung von Flüchtlingen 34
35. ... und am Ende ?
25.11.2015 Medizinische Versorgung von Flüchtlingen 35
Klinikum Lippe GmbH | Röntgenstraße 18 | 32756 Detmold Akademisches Lehrkrankenhaus
der Medizinischen
Hochschule Hannover
Sparkasse Detmold Konto 299 | BLZ 476 501 30 | IBAN: DE 02 4765 0130 0000 0002 99 | SWIFT-BIC: WELADE3LXXX
Sparkasse Lemgo Konto 190 | BLZ 482 501 10 | IBAN: DE 96 4825 0110 0000 0001 90 | SWIFT-BIC: WELADE1LEM
Flüchtlingsambulanz
Chefarzt
Dr. med. Patrick D. Dißmann
MSc PgD FRCEM FFSEM FEBEM
Klinikum Lippe GmbH
Röntgenstraße 18
32756 Detmold
Telefon 05231 72-1740
Telefax 05231 72-1749
Email patrick.dissmann
@klinikum-lippe.de
www.klinikum-lippe.de
Klinikum Lippe GmbH
Hauptgeschäftsführer:
Ingo Breitmeier
Medizinischer Geschäftsführer:
Dr. Helmut Middeke
Aufsichtsratsvorsitzender:
Landrat Dr. Axel Lehmann
Sitz der Gesellschaft: Detmold
Registergericht Lemgo
HRB 4066
Bezirksregierung Arnsberg
Dezernat 20
Seibertzstr. 1
59821 Arnsberg
Medizinische Eingangsuntersuchung für Ausländerinnen und Ausländer
Hiermit wird bestätigt, dass
Nachname: ABED
Vorname: Nour
geboren am: 28.01.1983
Herkunftsland: Syrien
Wohnhaft: Zentrale Unterbringungseinrichtung Detmold, Adenauerstraße
2-4, 32756 Detmold
sich im Klinikum Lippe, Röntgenstraße 18, 32756 Detmold einer Eingangsuntersu-
chung gemäß §62 Abs. 1 Satz 1 AsylVfG unterzogen hat.
Hierbei wurden nach erfolgter Selbstauskunft, körperlicher Inaugenscheinnahme
unter anderem folgende Erkrankungen festgestellt:
Probleme mit intrauteriner Spirale?, frauenärztliche Kontrolle empfohlen
Die Durchführung eines Tuberkulosescreenings mittels:
Röntgen
ergab:
keinen Hinweis auf Tuberkulose
Mit freundlichen Grüßen,
Dr. Patrick D. Dißmann
Chefarzt – Zentrale Notaufnahmen KLG
Ihre Nachricht vom Ihr Zeichen Unser Zeichen Datum
AsylVfG/ZNA 19.11.2015
36. 36
Vielen Dank für Ihr Interesse!
Zentrale Flüchtlingsambulanz
Tel. 05231 / 72-1470, Fax -1749
Ein Unternehmen im Konzern Kreis Lippe25.11.2015