Christian G Stief

University Hospital München, München, Bavaria, Germany

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Publications (991)2066.45 Total impact

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    ABSTRACT: Palpable scrotal masses are common scenarios in any clinical practice. These tumors can be painful or painless, can be intratesticular or extratesticular and be cystic or solid. The distinction between benign and malignant tumors is of utmost importance to enable an adequate and differentiated therapy of patients. In clinical diagnostics besides the medical history, examination of the inguinoscrotal region, laboratory diagnostics and ultrasound examination of the inguinoscrotal area play a decisive role. During the last few years the increased use of contrast-enhanced ultrasound has helped clinicians in differentiating scrotal tumors. Malignant tumors are of particular importance because this entity is the most frequent malignant disease among younger men and according to the Robert Koch Institute there are approximately 3900 new patients in Germany each year (Robert Koch Institute, Krebs in Deutschland 2007/2008 and 2012).
    Der Urologe. Ausg. A. 08/2014;
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    ABSTRACT: High-dose local stereotactic radiosurgery (SRS) has been performed in selected patients to improve local tumor control and overall survival. Here we report on patients with renal tumors who were treated with single-fraction robotic SRS.
    The Journal of urology. 08/2014;
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    ABSTRACT: Primary urethral carcinomas are rare tumors that can occur both in men and women. Histological patterns of these tumors are mixed, urothelial tumors occur as well as squamous cell tumors or adenocarcinomas.There are different clinical factors that define clinical prognosis, and the 1- and 5-year cancer-free survival is 75% and 54%. Therapy of locally limited disease is surgical resection, and organ-preserving treatment is possible if negative frozen sections prove complete surgical resection. However, in men a perineal urethrostomy might be necessary, and in women there is a high risk of urinary incontinence if more than 2 cm of the distal urethra is resected.In case of locally advanced tumors or tumors of the proximal urethra, a radical urethrectomy with supravesical urinrary diversion is necessary. In some cases neoadjuvant (radio-)chemotherapy may be an option.
    Der Urologe. Ausg. A. 08/2014;
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    ABSTRACT: To analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC)≥80 years of age in comparison with patients between the ages of 60 and 70 years.
    Urologic oncology. 08/2014;
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    ABSTRACT: Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations.
    BMC Urology 08/2014; 14(1):62. · 1.69 Impact Factor
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    ABSTRACT: Smooth muscle contraction may be critical for lower urinary tract symptoms (LUTS) in patients with benign prostate hyperplasia (BPH), and requires stable anchorage of the cytoskeleton to the cell membrane. These connections are regulated by focal adhesion kinase (FAK). Here, we addressed involvement of FAK in regulation of smooth muscle contraction in hyperplastic human prostate tissues. Prostate tissues were obtained from radical prostatectomy. Expression of FAK and focal adhesion proteins was assessed by western blot analysis and immunohistochemical stainings. Effects of the FAK inhibitors, PF573228 and Y11 on contraction of prostate strips were examined in the organ bath. Expression of FAK and focal adhesion proteins (integrin 5α, paxilin, c-src) was detected by western blot analysis prostate samples. By double immunofluorescence staining with calponin and pan-cytokeratin, expression of FAK was observed in stromal and epithelial cells. Immunoreactivity for FAK colocalized with integrin 5α, paxilin, talin, and c-src. Stimulation of prostate tissues with the α1-adrenergic agonist, phenylephrine, increased the phosphorylation state of FAK at tyrosines 397 and 925 with different kinetics, which was blocked by the α1-adrenoceptor antagonist tamsulosin. Noradrenaline and phenylephrine induced concentration-dependent contractions of prostate strips. Both FAK inhibitors, PF573228 and Y11, significantly inhibited noradrenaline- and phenylephrine-induced contractions. Finally, PF573228 and Y11 inhibited contractions induced by electric field stimulation (EFS), which was significant at the highest frequency. In conclusion, α1-adrenergic smooth muscle contraction or its regulation involves FAK in the human prostate. Consequently, FAK may be involved in pathophysiology of LUTS, and in current or future LUTS therapies.
    American journal of physiology. Renal physiology 07/2014; · 3.61 Impact Factor
  • Journal of Biophotonics 07/2014; 9999. · 3.10 Impact Factor
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    ABSTRACT: Transrectal ultrasound-guided prostate biopsy is considered the gold standard in the primary investigation of a suspicious prostate-related finding. The procedure can be carried out with ten probes or more on the lateral side of the prostate, after administering antibiotic prophylaxis and applying local anesthesia. The indication for a biopsy depends on the results of the digitorectal examination, on the serum prostate-specific antigen level, on the individual patient's wish and on his comorbidities. Whether multiparametric imaging should be used before or during the course of a primary or repeated biopsy in order to identify suspicious prostate lesions is the subject of current investigations. Extended biopsy protocols require further clinical investigations before they can become the new standard in the diagnostic work-up. This review delivers an update on the indication for, and technique of, prostate biopsies.
    Der Urologe. Ausg. A. 07/2014; 53(7):1046-51.
  • C G Stief, A Roosen
    Der Urologe. Ausg. A. 07/2014; 53(7):1030.
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    ABSTRACT: In Europe prostate cancer is one of the most common cancers among men. The diagnostics always include a control of the prostate-specific antigen (PSA) level and examination of a representative tissue sample from the prostate. With these findings it is possible to evaluate the degree of progression of the cancer and its prognosis. Several treatment options for localized prostate cancer are given by national and international guidelines including radical prostatectomy, percutaneous radiation therapy, or brachytherapy and surveillance of the cancer with optional treatment at a later stage. For the latter treatment option, known as active surveillance, strict criteria have to be met. The advantage of active surveillance is that only patients with progressive cancer are subjected to radical therapy. Patients with very slow or non-progressing cancer do not have to undergo therapy and thus do not have to suffer from the side effects. The basic idea behind active surveillance is that some cancers will not progress to a stage that requires treatment within the lifetime of the patient and therefore do not require treatment at all. Unfortunately the criteria for active surveillance are not definitive enough at the current time leading only to a delay in effective treatment for many patients. The surveillance strategy has without doubt a high significance among the treatment options for prostate cancer; however, at the current time it lacks reliable indicators for a certain prognosis. Therefore, patients must be informed in detail about the advantages and disadvantages of active surveillance.
    Der Urologe. Ausg. A. 06/2014;
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    ABSTRACT: Introduction: The purpose of this study was to evaluate and compare complications after radical cystectomy in patients aged ≥75 years. Materials and Methods: 251 patients aged 75-95 years (median 79) underwent radical cystectomy between 2000 and 2012 at four institutions. The patients were divided into two groups: ≥75-84 years of age (group 1) versus ≥85 years of age (group 2). Comorbidities, body mass index, and complications were obtained retrospectively, except at the Central Hospital of Bolzano and Weill Cornell Medical Center, which collected data prospectively. Cancer-specific survival, overall mortality, hospital stay, clinical outcome and complications were assessed. Complications were categorized using the Clavien-Dindo classification reporting system. The mean follow-up was 21 months. Results: The median hospital stay was 17 (2-91) days. Perioperative Clavien-Dindo grade ≥III complications were seen in 24.1% (48/199) of group 1 patients and 19.2% (10/52) of group 2 patients (p = 0.045). 30- and 90-day mortality was 4.5 and 13.5% in group 1 and 6.5 and 32.3% in group 2, respectively. Only the 90-day mortality rate was statistically significant (p < 0.05) between the two groups. The 3-year overall survival was 40% in group 1 and 34% in group 2. The 3-year cancer-specific survival was 52% in group 1 and 50% in group 2. Conclusions: We evaluated a large series of elderly (≥75 years) patients undergoing radical cystectomy at four institutions. Comparing patients aged ≥75-84 and ≥85 years revealed no significant difference in complications, 30-day mortality, overall and cancer-specific survival rates. Only 90-day mortality rates were significantly higher in the ≥85-year-old patients. © 2014 S. Karger AG, Basel.
    Urologia Internationalis 06/2014; · 1.07 Impact Factor
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    ABSTRACT: To evaluate the prognostic value of concomitant seminal vesicle invasion (cSVI) in patients with urothelial carcinoma of the bladder (UCB) and contiguous prostatic stromal infiltration in a large cystectomy series.
    Annals of Surgical Oncology 06/2014; · 4.12 Impact Factor
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    ABSTRACT: The aim of this study was to compare single-slice and 3-dimensional (3D) analysis for magnetic resonance renography (plasma flow [FP], plasma volume [VP], and glomerular filtration rate [GFR]) and for dynamic contrast-enhanced magnetic resonance imaging (MRI) of renal tumors (FP, VP, permeability-surface area product), respectively.
    Investigative radiology. 06/2014;
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    ABSTRACT: To evaluate for the first time the prognostic significance of female invasive patterns in stage pT4a urothelial carcinoma of the bladder in a large series of women undergoing anterior pelvic exenteration. Our series comprised of 92 female patients in total of whom 87 with known invasion patterns were eligible for final analysis. Median follow-up for evaluation of cancer-specific mortality (CSM) was 38 months (interquartile ranges, 21-82 months). The impact on CSM was evaluated using multivariable Cox proportional-hazards regression analysis; predictive accuracy (PA) was assessed by receiver operating characteristic analysis. Vaginal invasion was noted in 33 patients (37.9 %; group VAG), uterine invasion in 20 patients (23 %; group UT), and infiltration of both vagina and uterus in 34 patients (39.1 %; group VAG + UT). Groups VAG and UT significantly differed from group VAG + UT with regard to the presence of positive soft tissue margins (STM) only. Five-year-cancer-specific survival probabilities in the groups VAG, UT, and VAG + UT were 21, 20, and 21 %, respectively (p = 0.955). On multivariable analysis, only STM status (HR = 2.02, p = 0.023) independently influenced CSM. C-indices of multivariable models for CSM with and without integration of invasive patterns were 0.570 and 0.567, respectively (PA gain 0.3 %, p = 0.526). Infiltration of the vagina, the uterus or both is associated with poor 5-year survival rates. With regard to CSM, no difference was detectable between patients with different invasion patterns, thus justifying further collectively including these invasive patterns as stage pT4a.
    World Journal of Urology 05/2014; · 2.89 Impact Factor
  • Christian Gratzke, Jutta Engel, Christian G Stief
    European Urology 05/2014; · 10.48 Impact Factor
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    ABSTRACT: To report effect of different nerve sparing techniques (NS) during radical prostatectomy (RP) (intrafascial-RP vs. interfascial-RP) on post-RP incontinence outcomes (UI) in impotent/erectile dysfunction (ED) men. A total of 420 impotent/ED patients (International Index of Erectile Function-score <15) with organ-confined prostate cancer were treated with bilateral-NS [intrafascial-RP (239) or interfascial-RP (181)] in our institution. Intrafascial-RP was indicated for biopsy Gleason score ≤6 and PSA ≤10 ng/ml while interfascial-RP for Gleason score ≤7 and higher serum PSA. Seventy-seven patients with bilateral non-NS-RP were taken for comparison. No patient received pre-/postoperative radiation/hormonal therapy or had prostatic enlargement surgery. UI was assessed 3, 12 and 36 months postoperatively by third party. Continence was defined as no pads/day, safety 1 pad/day as separate group, 1-2 pads/day as "mild-incontinence" and >2 pads/day as "incontinence". All groups had comparable perioperative criteria without significant preoperative morbidities. International Prostate Symptom Score showed severe symptoms in 5 % of patients without correlation to UI. UI-recovery increased until 36 months. Full continence was reported from 56 versus 62 and 53 % patients after intrafascial-RP versus interfascial-RP and wide excision at 3 months, respectively (p = 0.521). Corresponding figures at 12 months were 70 versus 61 versus 51 % (p = 0.114) and at 36 months 85 versus 75 versus 65 % (p = 0.135), respectively. After 12 and 36 months, there was tendency to better UI-results in advantage of NS-technique; best results were achieved in intrafascial-RP group. UI-recovery was age-dependant. Advantage was found in NS-group compared with non-NS-group in older patients (>70 years, p = 0.052). Impotent/ED patients have higher chances of recovering full continence after NS-RP. NS should be planned independently of preoperative potencystatus whenever technically and oncologically feasible. Age and lower urinary symptoms are not restrictions. Current data should be considered in preoperative patient counselling.
    World Journal of Urology 04/2014; · 2.89 Impact Factor
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    ABSTRACT: Measurement of prostate-specific antigen (PSA) is not only used as a screening instrument by urologists, but also by general practitioners and internal specialists (GP-IS). Until now, there are neither data on the approach of German GP-IS in practicing this nor have data been classified in the context of available international literature on this topic. Between May and December 2012, a questionnaire containing 16 items was sent to 600 GP-IS in Brandenburg and Berlin. The response rate was 65 % (392/600). Six indicator questions (IQ1-6) were selected and results were set in the context of available international data. The quality of present studies was evaluated by the Harden criteria. Of the 392 responding physicians, 317 (81 %) declared that they would use PSA testing for early detection of PCA (IQ1) and, thus, formed the study group. Of these GP-IS, 38 % consider an age between 41 and 50 years as suitable for testing begin (IQ2), while 53 % and 14 % of the GP-IS perform early detection until the age of 80 and 90 years, respectively (IQ3). A rigid PSA cut-off of 4 ng/ml is considered to be reasonable by 47 % of the involved GP-IS, whereas 16 % prefer an age-adjusted PSA cut-off (IQ4). Patients with pathological PSA levels were immediately referred to a board-certified urologist by 69 % of the GP-IS. On the other hand, 10 % first would independently control elevated PSA levels themselves after 3-12 months (IQ5). Furthermore, 14 % of the interviewed physicians consider a decrease of PCA-specific mortality by PSA screening as being proven (IQ6). Knowledge regarding PCA diagnostics is mainly based on continuous medical education for GP-IS (33 %), personal contact with urologists (6 %), and guideline studies (4 %). While 53 % indicated more than one education source, 4 % did not obtain any PCA-specific training. The results provided by this questionnaire evaluating response of German GP-IS to six selected indicator questions fit well into the international context; however, further studies with sufficient methodical quality are required. Despite current findings and controversial recommendations of the two large PCA screening studies on this issue, German GP-IS still frequently use PCA screening by PSA measurement. Primary strategies of early detection as well as follow-up after assessment of pathologically elevated PSA levels poorly follow international recommendations. Thus, an intensification of specific education is justified.
    Der Urologe 04/2014; · 0.46 Impact Factor
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    ABSTRACT: To examine the outcomes with the AdVance XP and AdVance slings in the management of post-prostatectomy incontinence (PPI). Eighty patients were treated with the AdVance resp. AdVance XP at one tertiary reference centre. The initial patients were implanted with the AdVance male sling with no associated surgery. Following the introduction of the AdVance XP sling, subsequent patients were implanted with the AdVance XP slings. Measurements included: daily pad usage, 24-h pad weight test, International Quality of Life Questionnaire, International Consultation on Incontinence Questionnaire Short Form and the Patient Global Impression of Improvement. Adverse events were recorded. Follow-up was available for 39 and 41 patients treated with the AdVance and AdVance XP slings, respectively. At a median follow-up of 24.7 months, 69.3 % of patients could be classified as cured or improved in the AdVance group and at a median follow-up of 11.9 months, 90.3 % of AdVance XP-treated patients. At 3-month follow-up, 96.8 and 97.3 % of patients could be classed as cured or improved in the AdVance and AdVance XP groups, respectively (not significant). There were no perioperative complications. Two AdVance and three AdVance XP serious post-operative complications were reported, which were resolved following treatment. QOL was improved in both treatment groups. Both the AdVance and the AdVance XP slings are effective and safe for the treatment of PPI.
    World Journal of Urology 04/2014; · 2.89 Impact Factor
  • Martin Hennenberg, Christian G Stief, Christian Gratzke
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    ABSTRACT: Pharmacology of the lower urinary tract provides the basis for medical treatment of lower urinary tract symptoms (LUTS). Therapy of LUTS addresses obstructive symptoms (frequently explained by increased prostate smooth muscle tone and prostate enlargement) in patients with benign prostate hyperplasia (BPH) and storage symptoms in patients with overactive bladder (OAB). Targets for medical treatment include G protein-coupled receptors (α1-adrenoceptors, muscarinic acetylcholine receptors, β3-adrenoceptors) or intracellular enzymes (5α-reductase; phosphodiesterase-5, PDE5). Established therapies of obstructive symptoms aim to induce prostate smooth muscle relaxation by α1-blockers or PDE5 inhibitors, or to reduce prostate growth and volume with 5α-reductase inhibitors. Available options for treatment of OAB comprise anitmuscarinics, β3-adrenoceptor agonists, and botulinum toxin A, which improve storage symptoms by inhibition of bladder smooth muscle contraction. With the recent approval of β3-antagonists, PDE inhibitors, and silodosin for therapy of LUTS, progress from basic research of lower urinary tract pharmacology was translated into new clinical applications. Further targets are in preclinical stages of examination, including modulators of the endocannabinoid system and transient receptor potential (TRP) channels.
    Indian Journal of Urology 04/2014; 30(2):181-8.
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    ABSTRACT: Prostate cancer (PCa) patients with isolated clinical lymph node (LN) relapse, limited to the regional and/or retroperitoneal LNs, may represent a distinct group of patients who have a more favorable outcome than men with progression to the bone or to other visceral organs. Some data indirectly denote a beneficial impact of pelvic LN dissection on survival in these patients. To provide an overview of the currently available literature regarding salvage LN dissection (SLND) in PCa patients with clinical relapse limited to LNs after radical prostatectomy (RP). A systematic literature search was conducted using the Medline, Embase, and Web of Science databases to identify original articles, review articles, and editorials regarding SLND. Articles published between 2000 and 2012 were reviewed and selected with the consensus of all the authors. Contemporary imaging techniques, such as 11C-choline positron emission tomography and diffusion-weighted magnetic resonance imaging, appear to enhance the accuracy in identifying LN relapse in patients with biochemical recurrence (BCR) and after RP. In these individuals, SLND can be considered as a treatment option. The currently available data suggest that SLND can delay clinical progression and postpone hormonal therapy in almost one-third of the patients, although the majority will have BCR. An accurate and attentive preoperative patient selection may help improve these outcomes. The most frequent complication after SLND was lymphorrhea (15.3%), followed by fever (14.5%) and ileus (11.2%). It is noteworthy that all examined cohorts originated from retrospective single-institution series, with limited sample size and short follow-up. Consequently, the current findings cannot be generalized and warrant further investigation in future prospective trials. The current data suggest that SLND represents an option in patients with disease relapse limited to the LNs after RP; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population. Salvage lymph node dissection (SLND) represents a treatment option in for patients with prostate cancer relapse limited to the lymph nodes; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population.
    European Urology 03/2014; · 10.48 Impact Factor

Publication Stats

8k Citations
2,066.45 Total Impact Points

Institutions

  • 2007–2014
    • University Hospital München
      München, Bavaria, Germany
    • Wake Forest School of Medicine
      Winston-Salem, North Carolina, United States
  • 2004–2014
    • Ludwig-Maximilian-University of Munich
      • • Department of Urology
      • • Department of Oral and Maxillofacial Surgery
      München, Bavaria, Germany
  • 2013
    • University of Rostock
      Rostock, Mecklenburg-Vorpommern, Germany
    • University of Tuebingen
      • Department of Urology
      Tübingen, Baden-Württemberg, Germany
  • 2011–2013
    • University of Bonn
      • • Neurologische Klinik
      • • Klinik und Poliklinik für Urologie und Kinderurologie
      Bonn, North Rhine-Westphalia, Germany
    • Baylor College of Medicine
      Houston, Texas, United States
    • Weill Cornell Medical College
      • Department of Urology
      New York City, New York, United States
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
    • Sankt Elisabeth Hospital
      Bielefeld, North Rhine-Westphalia, Germany
    • Cyberknife Center Munich
      Münchenbernsdorf, Thuringia, Germany
  • 2010–2013
    • Klinikum St. Elisabeth Straubing GmbH
      Straubing, Bavaria, Germany
  • 2006–2013
    • Universität Regensburg
      • Department of Urology
      Regensburg, Bavaria, Germany
    • University of Amsterdam
      • Department of Urology
      Amsterdam, North Holland, Netherlands
  • 1991–2013
    • Lund University
      • • Department of Clinical Pharmacology
      • • Division of Clinical Chemistry and Pharmacology
      Lund, Skåne, Sweden
    • Universitätsklinikum Jena
      • Division of Anesthesiology
      Jena, Thuringia, Germany
  • 2012
    • Memorial Sloan-Kettering Cancer Center
      • Department of Pathology
      New York City, NY, United States
  • 2007–2012
    • Technische Universität München
      • • Urologische Klinik und Poliklinik
      • • Institute of Radiology
      München, Bavaria, Germany
  • 2003–2012
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
  • 2010–2011
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 2005–2011
    • Universitätsspital Basel
      • Klinik für Urologie
      Basel, BS, Switzerland
  • 1991–2011
    • Hannover Medical School
      • • Department of Nuclear Medicine
      • • Clinic for Urology
      • • Institute for Clinical Pharmacology
      Hannover, Lower Saxony, Germany
  • 2008–2010
    • University Hospital Essen
      • • Institut für Anatomie
      • • Clinic for Urology
      Essen, North Rhine-Westphalia, Germany
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Department of Urology
      Erlangen, Bavaria, Germany
  • 2006–2010
    • University of Hamburg
      • • Department of Urology
      • • Department of Anatomy and Experimental Morphology
      Hamburg, Hamburg, Germany
  • 1998
    • Lower Saxony Institute for Historical Coastal Research
      Wilhelmshaven, Lower Saxony, Germany
  • 1993
    • Universität Heidelberg
      • Department of Urology
      Heidelberg, Baden-Wuerttemberg, Germany
  • 1991–1993
    • Hanover Hospital
      Hanover, Pennsylvania, United States
  • 1989–1993
    • University of California, San Francisco
      • • Department of Urology
      • • Division of Hospital Medicine
      San Francisco, CA, United States
    • Universitätsklinikum Freiburg
      • Department of Urology
      Freiburg, Lower Saxony, Germany
  • 1989–1990
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
  • 1988–1990
    • Universität Ulm
      Ulm, Baden-Württemberg, Germany
  • 1987–1988
    • Bundeswehrkrankenhaus Ulm
      Ulm, Baden-Württemberg, Germany