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Context Nest predation is a leading cause of nest failure for most ground-nesting birds. Methods that allow for accurate classification of fate and identification of predators are important for understanding productivity and conservation strategies. Past studies have used a visual inspection of nest remains to determine nest fate and predict predator identity. Most formal assessments of these methods have addressed small-bodied birds nesting in trees or shrubs, and have revealed that use of evidence at nests can be relatively accurate for determining nest fate but may lead to incorrect conclusions regarding predator identity. However, few have tested the latter hypothesis for larger ground-nesting birds with precocial young. Aim We aimed to evaluate a classification system developed for determining nest fate and identifying predators of waterfowl nests, at both the scale of individual nests and across the study area. Methods From 2016 to 2020, we located 989 blue-winged teal (Spatula discors), mallard (Anas platyrhynchos) and gadwall (Mareca strepera) nests in central North Dakota. We placed cameras at a subset of 249 nests and recorded evidence of nest remains at depredated nests. Key results The most common predators were American badgers (Taxidea taxus), followed by striped skunks (Mephitis mephitis), raccoons (Procyon lotor) and red foxes (Vulpes vulpes). Using evidence of nest remains, we determined nest fates with high accuracy (98.0%). However, evidence of nest remains was only sufficient for identifying predators at 50% of nests, and the classification system was correct only 69.7% of the time. The predicted proportion of predators across the study area differed between the classification system and our video evidence as well. Conclusions The accuracy of predator identifications based upon the classification system that we evaluated was not supported at any scale. Implications Our results suggest that evidence of nest remains can be used to determine nest fate for large-bodied precocial, ground-nesting birds, but accurate identification of nest predators will require alternative methods such as nest cameras.

Intracranial aneurysms (IA) occur in 3–5% of the general population and may require surgical or endovascular obliteration if the patient is symptomatic or has an increased risk of rupture. These procedures carry an inherent risk of neurological complications, and the outcome can be influenced by the physiological and pharmacological effects of the administered anesthetics. Despite the critical role of anesthetic agents, however, there are no current studies to systematically assess the intraoperative anesthetic risks, benefits, and outcome effects in this population. In this systematic review of the literature, we carefully examine the existing evidence on the risks and benefits of common anesthetic agents during IA obliteration, their physiological and clinical characteristics, and effects on neurological outcome. The initial search strategy captured a total of 287 published studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 28 studies were included in the final report. Our data showed that both volatile and intravenous anesthetics are commonly employed, without evidence that either is superior. Although no specific anesthetic regimens are promoted, their unique neurological, cardiovascular, and physiological properties may be critical to the outcome in vulnerable patients. In particular, patients at risk for perioperative ischemia may benefit from timely administration of anesthetic agents with neuroprotective properties and optimization of their physiological parameters. Further studies are warranted to examine if these anesthetic regimens can reduce the risk of neurological injury and improve the overall outcome in these patients.

Intraoperative neuromonitoring was introduced in the second half of the 20th century with the goal of preventing patient morbidity for patients undergoing complex operations of the central and peripheral nervous system. Since its early use for scoliosis surgery, the growth and utilization of IOM techniques expanded dramatically over the past 50 years to include spinal tumor resection and evaluation of cerebral ischemia. The importance of IOM has been broadly acknowledged, and in 1989, the American Academy of Neurology (AAN) released a statement that the use of SSEPs should be standard-of-care during spine surgery. In 2012, both the AAN and the American Clinical Neurophysiology Society (ACNS) recommended that: “Intraoperative monitoring (IOM) using SSEPs and transcranial MEPs be established as an effective means of predicting an increased risk of adverse outcomes, such as paraparesis, paraplegia, and quadriplegia, in spinal surgery.” With a multimodal approach that combines SSEPs, MEPs, and sEMG with tEMG and D waves, as appropriate, sensitivity and specificity can be maximized for the diagnosis of reversible insults to the spinal cord, nerve roots, and peripheral nerves. As with most patient safety efforts in the operating room, IOM requires contributions from and communication between a number of different teams. This comprehensive review of neuromonitoring techniques for surgery on the central and peripheral nervous system will highlight the technical, surgical and anesthesia factors required to optimize outcomes. In addition, this review will discuss important trouble shooting measures to be considered when managing ION changes concerning for potential injury.

Introduction Long-term study evidence about the BioBall® adapter system is limited, especially in highly morbid elderly patients. Thus, we analysed the long-term outcome of revision hip arthroplasty using this system in highly morbid elderly patients. Materials and methods We included 19 patients undergoing revision hip arthroplasty after primary or secondary total hip arthroplasty dislocations between July 2002 and August 2004 and followed up their long-term outcome until 2015. Results The patients achieved a median of 17 points in the Merle d'Aubigne hip score in 2004 and a median of 18 points in 2011, and the 4 surviving patients in 2015 achieved 18 points. For the four 12-year survivors, the Merle d'Aubigne score was virtually stable over the complete observation period. The Harris Hip Score showed comparable results. The patients had a median Barthel index of 90 in 2004 and 100 in 2011, and the 4 survivors in 2015 had Barthel indices of 65, 95, 100, and 100, respectively, in 2015. Conclusions In multimorbid patients, using the BioBall® adapter system for total hip arthroplasty, revision due to dislocation results in good long-term outcome without impairment of quality of life. Translational potential Our study provides long-term evidence in a vulnerable patient population. It shows how the therapeutic concept of revision hip replacement with an adapter device translates into long-term outcome and quality of life in these patients. Thus, it adds important information for evaluation of therapeutic options in this field.

High quality feedback on resident clinical performance is pivotal to growth and development. Therefore, a reliable means of assessing faculty feedback is necessary. A feedback assessment instrument would also allow for appropriate focus of interventions to improve faculty feedback. We piloted an assessment of the interrater reliability of a seven-item feedback rating instrument on faculty educators trained via a three-workshop frame-of-reference training regimen. The rating instrument's items assessed for the presence or absence of six feedback traits: actionable, behavior focused, detailed, negative feedback, professionalism / communication, and specific; as well as for overall utility of feedback with regard to devising a resident performance improvement plan on an ordinal scale from 1 to 5. Participants completed three cycles consisting of one-hour-long workshops where an instructor led a review of the feedback rating instrument on deidentified feedback comments, followed by participants independently rating a set of 20 deidentified feedback comments, and the study team reviewing the interrater reliability for each feedback rating category to guide future workshops. Comments came from four different anesthesia residency programs in the United States; each set of feedback comments was balanced with respect to utility scores to promote participants’ ability to discriminate between high and low utility comments. On the third and final independent rating exercise, participants achieved moderate or greater interrater reliability on all seven rating categories of a feedback rating instrument using Gwet's agreement coefficient 1 for the six feedback traits and using intraclass correlation for utility score. This illustrates that when this instrument is utilized by trained, expert educators, reliable assessments of faculty-provided feedback can be made. This rating instrument, with further validity evidence, has the potential to help programs reliably assess both the quality and utility of their feedback, as well as the impact of any educational interventions designed to improve feedback.

Background The Accreditation Council for Graduate Medical Education (ACGME) mandates minimum numbers of cases in many specialties, including anesthesiology, but resident scheduling is often done on the basis of time spent on each rotation rather the number of opportunities for specific cases, risking uneven case distribution, particularly for low-volume cases. We used the neuroanesthesia rotation as a model to evaluate a system to more evenly distribute ACGME-mandated cases among residents and assessed the effects on their perceptions of their experience on the rotation. Methods In November 2018, we instituted a targeted operating room scheduling system at our institution by making specific daily assignment requests for anesthesia residents on the neuroanesthesia rotation. We used Shewhart control charts to analyze the variation in case distribution among all resident rotations (N = 91) from January 2018 to October 2019. We then surveyed residents who had experienced both systems (n = 15) and those who had experienced only the old system (n = 16). Results Shewhart p-charts of the proportion of ACGME-mandated cases assigned to each resident showed wide variation under the old scheduling system and a more even distribution under the new system. Residents reported significantly greater perceived fairness of case distribution and balance between their education and service obligations under the new system (response rates: 10/16 [62.5%] and 13/15 [86.7%]). Conclusions Targeted resident scheduling based on ACGME-mandated case numbers rather than solely time spent on a rotation is feasible and can improve resident perceptions of fairness and balance between education and service, a top priority of the ACGME.

Background Much has been written on initial airway management in patients undergoing cervical spine procedures, but comparatively less is known about extubation criteria. High cervical and occipital fusion procedures pose a particular risk for extubation given the potential for a reduced range of motion at the occiput-C1 and C1-C2 joints should reintubation be necessary. Materials and methods We performed a retrospective cohort analysis of posterior high cervical and occipital fusion cases to identify factors related to delayed extubation and postoperative airway and pulmonary complications. Using a convenience sample of all cases operated between January 2009 and April 2018, we reviewed anesthesia records and discharge summaries to compare patient characteristics, airway management, surgical factors, and postoperative complications between patients who underwent delayed extubation and those who did not. Results A total of 135 patients met our inclusion criteria. Overall, 92 (68.1%) patients were extubated in the operating room (OR), and 43 (31.9%) underwent delayed extubation. Multivariate logistic regression analysis identified age, procedure length, C2 as the highest level fused, and percentage colloid administered as predictors of delayed extubation. We did not find a difference in the rate of postoperative pulmonary complications between groups (6/92 [6.5%] for OR extubation; 2/43 [4.7%] for delayed extubation). Two patients had serious airway complications, and both were extubated in the OR (2/92, 2.2%). Conclusions The decision to extubate immediately postoperatively after high cervical and occipital fusion should be considered carefully as the morbidity associated with airway obstruction can be severe in this population, while negative effects of delayed extubation were not evident in our analysis.

The black cloud that hovers over newly minted attendings is the stuff of legend. After graduation from residency and fellowship, everyone warns you that the worst complications and most complex cas...

Bacterial RNA has emerged as an important activator of innate immune responses by stimulating Toll-like receptors TLR7 and TLR8 in humans. Guanosine 2′-O-methylation at position 18 (Gm18) in bacterial tRNA was shown to antagonize tRNA-induced TLR7/8 activation, suggesting a potential role of Gm18 as an immune escape mechanism. This modification also occurs in eukaryotic tRNA, yet a physiological immune function remained to be tested. We therefore set out to investigate the immune modulatory role of Gm18 in both prokaryotic and eukaryotic microorganisms, Escherichia coli and Saccharomyces cerevisiae, and in human cells. Using RiboMethSeq analysis we show that mutation of trmH in E. coli, trm3 in S. cereviase, and CRISPR/Cas9-induced knockout of TARBP1 in H. sapiens results in loss of Gm18 within tRNA. Lack of Gm18 across the kingdoms resulted in increased immunostimulation of peripheral blood mononuclear cells when activated by tRNA preparations. In E. coli, lack of 2′-O-methyltransferase trmH also enhanced immune stimulatory properties by whole cellular RNA. In contrast, lack of Gm18 in yeasts and human cells did not affect immunostimulation by whole RNA preparations. When using live E. coli bacteria, lack of trmH did not affect overall immune stimulation although we detected a defined TLR8/RNA-dependent gene expression signature upon E. coli infection. Together, these results demonstrate that Gm18 is a global immune inhibitory tRNA modification across the kingdoms and contributes to tRNA recognition by innate immune cells, but as an individual modification has insufficient potency to modulate recognition of the investigated microorganisms.

Structural remodeling of synapses in response to growth signals leads to long-lasting alterations in neuronal function in many systems. Synaptic growth factor receptors alter their signaling properties during transit through the endocytic pathway, but the mechanisms controlling cargo traffic between endocytic compartments remain unclear. Nwk (Nervous Wreck) is a presynaptic F-BAR/SH3 protein that regulates synaptic growth signaling in Drosophila melanogaster. In this paper, we show that Nwk acts through a physical interaction with sorting nexin 16 (SNX16). SNX16 promotes synaptic growth signaling by activated bone morphogenic protein receptors, and live imaging in neurons reveals that SNX16-positive early endosomes undergo transient interactions with Nwk-containing recycling endosomes. We identify an alternative signal termination pathway in the absence of Snx16 that is controlled by endosomal sorting complex required for transport (ESCRT)–mediated internalization of receptors into the endosomal lumen. Our results define a presynaptic trafficking pathway mediated by SNX16, NWK, and the ESCRT complex that functions to control synaptic growth signaling at the interface between endosomal compartments., Damon Runyon Cancer Research Foundation (Postdoctoral grant), Charles A. King Trust Postdoctoral Fellowship Program, National Institute of Neurological Disorders and Stroke (U.S.) (K99/R00 award, K99NS060947), National Institutes of Health (U.S.) (award NS43244)

Genetic studies in Drosophila have revealed two separable long-term memory pathways defined as anesthesia-resistant memory (ARM) and long-lasting long-term memory (LLTM). ARM is disrupted in radish (rsh) mutants, whereas LLTM requires CREB-dependent protein synthesis. Although the downstream effectors of ARM and LLTM are distinct, pathways leading to these forms of memory may share the cAMP cascade critical for associative learning. Dunce, which encodes a cAMP-specific phosphodiesterase, and rutabaga, which encodes an adenylyl cyclase, both disrupt short-term memory. Amnesiac encodes a pituitary adenylyl cyclase-activating peptide homolog and is required for middle-term memory. Here, we demonstrate that the Radish protein localizes to the cytoplasm and nucleus and is a PKA phosphorylation target in vitro. To characterize how these plasticity pathways may manifest at the synaptic level, we assayed synaptic connectivity and performed an expression analysis to detect altered transcriptional networks in rutabaga, dunce, amnesiac, and radish mutants. All four mutants disrupt specific aspects of synaptic connectivity at larval neuromuscular junctions (NMJs). Genome-wide DNA microarray analysis revealed ∼375 transcripts that are altered in these mutants, suggesting defects in multiple neuronal signaling pathways. In particular, the transcriptional target Lapsyn, which encodes a leucine-rich repeat cell adhesion protein, localizes to synapses and regulates synaptic growth. This analysis provides insights into the Radish-dependent ARM pathway and novel transcriptional targets that may contribute to memory processing in Drosophila., National Institutes of Health (U.S.) (Grant no. NS43244)

The objective of this study was to analyze factors leading to explantation of totally implanted access ports (TIAPs) and to assess its occurrence and clinical relevance. Of 438 patient consecutive patients with a port explantation, 385 were eligible for this retrospective cohort study. Reasons for explantation as well as demographic, clinical, and surgical characteristics were analyzed by univariate and multivariate models. The diagnoses leading to TIAP implantation were hematological malignancies in 142 patients (36.8%), breast cancer in 103 patients (26.8%), gastrointestinal cancer in 76 patients (19.8%), nonmalignant diseases in 46 patients (11.9%), and other malignant diseases in 18 patients (4.7%). The reasons for TIAP explantation were infection in 178 patients (46.2%), end of treatment in 129 patients (33.5%), thrombosis in 44 patients (11.4%), TIAP dysfunction in 22 patients (5.7%), and other reasons in 12 patients (3.2%). At the time of TIAP explantation, 115 patients (29.9%) were receiving chemotherapy, and 49 patients (12.7%) were considered immunocompromised. In case of TIAP explantation due to infection, the median length of TIAP in situ time was 303.3 days, whereas the cumulative 10-day and 30-day explantation rates were 2.8% and 10.6%, respectively. By multivariate models, TIAP explantation due to infection is statistically significantly decreased in patients with breast cancer (P

Synaptic plasticity is a fundamental feature of the nervous system that allows adaptation to changing behavioral environments. Most studies of synaptic plasticity have examined the regulated trafficking of postsynaptic glutamate receptors that generates alterations in synaptic transmission. Whether and how changes in the presynaptic release machinery contribute to neuronal plasticity is less clear. The SNARE complex mediates neurotransmitter release in response to presynaptic Ca[superscript 2+] entry. Here we show that the SNARE fusion clamp Complexin undergoes activity-dependent phosphorylation that alters the basic properties of neurotransmission in Drosophila. Retrograde signaling following stimulation activates PKA-dependent phosphorylation of the Complexin Cterminus that selectively and transiently enhances spontaneous release. Enhanced spontaneous release is required for activity-dependent synaptic growth. These data indicate that SNAREdependent fusion mechanisms can be regulated in an activity-dependent manner and highlight the key role of spontaneous neurotransmitter release as a mediator of functional and structural plasticity., JPB Foundation, National Institutes of Health (U.S.) (Grants NS064750, NS40296 and MH104536) JPB Foundation

Uber den Zeitraum 2001 bis 2003 wurden alle in der allgemein-chirurgischen Hochschulambulanz der Universitatsklinik Heidelberg anfallenden Behandlungsfalle, Diagnosen und Prozeduren, sowie Daten zu Patientenherkunft und Zuweisercharakteristik, differenziert nach viszeral-, gefaschirurgischen und traumatologischen Bereichen prospektiv aufgezeichnet. Weiterer Fokus wurde auf die Quantifizierung von zeitphasenabhangigen Variabilitaten der Leistungsvolumina und der resultierenden Belastungsschwankungen gesetzt. Zusatzlich wurde retrospektiv eine Aufwandsabschatzung in den Bereichen Forschung, Lehre und Krankenversorgung mittels strukturierten Fragebogen und Interviews durchgefuhrt. Die Daten verdeutlichen die dominierend medizinische Versorgungsfunktion einer allgemein-chirurgischen Hochschulambulanz mit Uberlauffunktion fur den ambulanten Sektor. Forschung und Lehre treten in der Bedeutung zuruck und werden uberwiegend in nachgeschalteten Spezialambulanzen realisiert. Allgemein-chirurgische Ambulanzen, konnen damit fur integrierte medizinische Versorgungsmodelle eine gute Basis darstellen. Die Leistungsvergutung muss allerdings wegen der hohen Versorgungsvolumina und hohen Leistungsvorhaltungserfordernis durch immense Belastungsschwankungen zukunftig kostendeckender gestaltet werden.

Objectives: To assess the use of Holter monitoring for evaluating the incidence of post-anaesthetic cardiac arrhythmias and associated anaesthetic risk for two different anaesthetic protocols. Methods: Patients undergoing orthopaedic surgery were randomly divided into two groups with different anaesthetic regimens (group A, isoflurane n=30; group B, propofol n=30). Two 24-hour Holter recordings were performed for each patient: the first directly following anaesthesia and the second, as a comparison, on the fifth postoperative day. Results: Although all dogs were healthy on pre-anaesthetic cardiac evaluation, 56 dogs showed arrhythmias in the two 24-hour (Holter) electrocardiograms performed. However, the number of arrhythmias recorded was low in most cases (less than 10 supraventricular extrasystoles and less than 100 ventricular extrasystoles). One patient in group A showed 94 supraventricular extrasystoles during the second monitoring period. Three patients in each group developed more than 100 ventricular extrasystoles during both Holter recordings. There were no statistically significant differences between the two anaesthetic regimens or between the two recordings in both groups. Clinical Significance: The two anaesthetic protocols investigated in this study did not induce an increased incidence of severe arrhythmias in healthy dogs in the post-anaesthetic phase.

Background: It has long been suspected that mechanical influences may enhance the release of viable colorectal cancer cells into the circulation. The objective of this study was to determine the extent of hematogenous tumor cell spread in colorectal cancer patients during colonoscopy. Methods: Peripheral venous blood samples were taken before and after colonoscopy from 44 patients with colorectal cancer. Blood samples were examined using a reverse-transcriptase polymerase chain reaction assay to amplify cytokeratin 20 transcripts. Results: Eleven patients with colorectal cancer displayed circulating tumor cells before and after colonoscopy (25%), whereas tumor cells were detected in six of 44 patients (14%) only after the procedure (p = 0.03, McNemar’s test: tumor cell detection before after colonoscopy). All control samples consistently tested negative. Conclusions: Mechanical forces may result in enhanced release of viable colorectal cancer cells into the circulation; however, the clinical significance of these results needs to be clarified.

Wetland basins in the Prairie Pothole Region of the U.S. are commonly modified by excavation (e.g., roadside ditches, stock dugouts), partial drainage (ditching), and diking. Differences in the distribution of modified wetlands may affect the predictive accuracy of waterfowl survey data if such wetlands are not distributed randomly in the landscape and if waterfowl are not distributed equally among them. We used data collected on thirty-eight 40-km2 plots in North Dakota to examine the distribution of modified basins relative to roadside transects and their use by five species of dabbling ducks in 1995. The 800-m-wide transects were subdivided into an inner 400-m transect, centered on the road, and the remaining outer transect area. We compared the distribution of modified and natural wetland basins among three sample areas: 1) the inner 400-m-wide roadside transect area, 2) the outer transect area, and 3) the remaining area within the 40-km2 plot that was outside of the transects (outer plot). Duck use was compared between the two transect areas. The plots contained 20,582 basins, of which 88.5% were unmodified, 7.5% were excavated, 3.7% were partially drained, and 0.2% were diked. Nearly all excavated temporary (89%) and seasonal (90%) basins occurred in the inner transect area, reflecting the high proportion of basins that would be defined as roadside ditches. Excavated semipermanent basins were more evenly distributed among the outer plot and two transect widths; these basins often were dugouts but also included roadside ditches. Partially drained and diked basins also were fairly evenly distributed among the three sample areas. Semipermanent basins had greater use by mallards (Anas platyrhynchos) and northern pintails (A. acuta) when they were partially drained than when they were excavated or unmodified; pintails also had greater use of partially drained seasonal basins. Use of wetland basins by gadwall (A. strepera), blue-winged teal (A. discors), and northern shovelers (A. clypeata) did not differ among water regimes or modification. We found no evidence to indicate that duck numbers determined from standard 400-m-wide roadside transects were biased relative to the larger landscape. However, pond counts derived from such transects were biased. Correlations of duck numbers to pond counts that exclude ditches or temporary basins would poorly reflect the response of ducks to available water.

Endoscopy between Gastroenterology and Visceral Surgery – Point of View of a University Department for Visceral Surgery with Own Endoscopic Unit Historically the major steps in the

Background Peritoneal seeding or liver metastases found at laparotomy usually preclude curative treatment in patients with gastric adenocarcinoma. Such exploratory laparotomies may be avoided by diagnostic laparoscopy. However, routine diagnostic laparoscopy does not benefit those patients who proceed to laparotomy after negative laparoscopy. The aim of this study was to evaluate prospectively the selective use of laparoscopy in uncertain situations. Methods One hundred and twenty consecutive patients with primary gastric adenocarcinoma were studied prospectively. Diagnostic laparoscopy was performed in patients with clinical T4 tumours or suspected metastases, unless laparotomy was required for symptomatic disease. Results Ninety-six of 120 patients were selected for immediate laparotomy with curative intent (n = 81) or for palliation (n = 15). In two of the 81 patients gastrectomy was abandoned because of unexpected peritoneal carcinomatosis. Fifteen patients underwent diagnostic laparoscopy, which identified intra-abdominal metastases in six; the other nine patients proceeded to laparotomy, which revealed peritoneal metastases not detected at laparoscopy in four patients. The remaining nine patients had overt metastases and were referred for systemic chemotherapy without abdominal exploration. Conclusion Diagnostic laparoscopy in selected patients effectively limits the number of unnecessary invasive staging procedures. Routine use of diagnostic laparoscopy in all patients with gastric adenocarcinoma is not warranted.

The coronoid processus of the ulna ist responsible for the stability of the humero-ulnar joint during flexion but especially in extension. In patients with lesions of the processus an instability of this joint is the result depending on the size of the fragment with the possibility of luxation and insufficient carrying capacity of the extended arm. The classification of the bony lesions of the processus coronoideus according to Regan and Morrey in Type I avulsion of the tip of the process; Type II a fragment involving 50 per cent of the process or less; and Type III a fragment involving more than 50 per cent of the process presents a clear overview of the kind of lesion, its indication for a conservative or operative treatment and its outcome. A conservative treatment is recommended for Type I lesions as well as for Type II fracture without dislocation or instability, prooven by an examination in general anaesthesia, otherwise this fracture has to be treated operatively like Type III lesions. The incisions - anterior, radial or ulnar - are performed in respect of further bony and/or ligamentous injuries. The prognosis correlates well with the type of lesions: Type I fracture will have a satisfactory result - recovery of form and function - in generally, Type III fracture in the mean not - even after operative treatment according to the rules. Causes of bad results seem to be an immobilisation for more than four weeks and an instability of the elbow joint after conservative or any operative treatment. The use of an articulated external fixator may help to achieve a better outcome of these uncommon severe instable fractures.

The Prairie Pothole Region of the northern Great Plains is an important region for wa- terfowl production because of the abundance of shallow wetlands. The ecological significance of the region and impacts from intensive agriculture prompted the U.S. Environmental Protection Agency to select it as one of the first areas for developing and evaluating ecological indicators of wetland condition. We examined hypothesized relations between indicators of landscape and wetland condi- tions and waterfowl abundance on 45 40 km 2 study sites in North Dakota for 1995-1996. Landscape condition was defined ap riorias the ratio of cropland area to total upland area surrounding wetlands. Measures of waterfowl abundance included estimated numbers of breeding pairs (by species and total numbers) and , a species-specific correction factor which effectively adjusts breeding pair estimates for annual or area-related differences in pond size. Landscape indicators and waterfowl measures varied among regions. Results indicated that most areas in the Coteau region are of much higher quality for ducks than those in the Drift Plain, and areas in the Red River Valley are of the poorest quality for ducks. Regression models demonstrated the impact of agricultural development on breeding duck populations in the Prairie Pothole Region. The most consistent landscape indicators of waterfowl abundance were percent of cropland and grassland. Models were inconsistent among years and species. The potential biotic indicators of landscape and wetland condition examined here would be appropriate for temporal trend analyses, but because of inherent geographic variability would not be appropriate for single-year geographic trend analyses without more extensive evaluations to improve explanatory models.

Introduction Perforation represents a severe complication of gastric cancer. Because it is rare, only few data are available regarding treatment and prognosis. Methods Patients with perforated gastric cancer were identified from two prospective registers of gastric cancer and of gastroduodenal ulcer. Results Between February 1982 and June 1999 23 patients with perforated gastric cancer were treated surgically. This corresponds to only 1.8% of 1273 patients presenting with gastric cancer, but to 14% of 161 patients presenting with gastric perforation during this time period. Overall, post-operative mortality was 13% (3/23). Initially, 21 patients had palliative operations. Two patients had a potentially curative procedure at the emergency operation and one of the two died post-operatively. Another six patients had potentially curative gastrectomy at a second stage and no patient died post-operatively. The 5-year overall survival was estimated at 50% for all eight curatively-treated patients. Median survival of palliatively treated patients was 6 months. Conclusions Perforation of the stomach should raise suspicion of malignancy, particularly in elderly patients. At the time of perforation radical gastrectomy with lymphadenectomy is mostly not advised, either because a diagnosis of gastric cancer is not confirmed or because the patient's condition does not allow extended surgery. In this situation it is suggested to consider a two-stage procedure and direct the primary operation at the treatment of perforation and peritonitis. Tumour staging can be completed when the patient has recovered and a radical operation with curative intent can be planned without compromising long-term prognosis. Our observations and a review of the literature confirm that perforation of gastric cancer does not preclude long-term survival per se in a substantial number of patients.

Strip transects located along roads are commonly used to estimate waterfowl populations and characterize associated wetland habitat. We used data collected in May and early June, 1995, on forty-five 40-km2 plots in North Dakota to evaluate bias of 800-m and 400-m wide roadside transects for sampling wetlands relative to a larger (40-km2) scale and to compare duck abundance at the two widths. Densities of all basins combined and of seasonal basins considered alone were biased high for both transect widths, but mean bias did not differ from zero for temporary or semipermanent basins. Biases did not occur when excavated seasonal and temporary basins (i.e., road ditches) were excluded from the sample. Mean basin density was higher for the inner (400-m) transect width than for the outer transect width (area remaining of the 800-m transect, outside of center 400-m width) for all basins combined and for seasonal and temporary basins. We detected an area-related bias in the occurrence of basins in transects: smaller basins (0.08–1.6 ha) were over-represented in transect samples by 2.9–6.5%, and larger basins (≥11 ha) were under-represented in 800-m transects by 7.3% and in 400-m transects by 16.3%. We compared the distribution of ducks relative to water conditions in the inner and outer transect widths to evaluate whether they were affected by proximity to the road. Mallards (Anas platyrhynchos L.), northern pintails (A. acuta L.), and gadwall (A. strepera L.) responded to water conditions equally in the inner and outer transect widths, but northern shovelers (A. clypeata L.) and blue-winged teal (A. discors L.) responded more strongly to wetlands on the inner than the outer transect width, indicating that estimates of these species would be higher from a 400-m wide transect than from an 800-m wide transect. Differences in an adjustment index, used to account for the portion of basin obscured from view, were highly variable between inner and outer transect widths but did not indicate that use of wider transects was hampered by visibility. Biases of transect sampling need to be carefully considered when extrapolating wetland basin or duck densities from transects to larger landscape scales.

In einer prospektiven Untersuchung wird die transabdominelle Sonographie in Hydrotechnik (Hydrosonographie) mit der Endosonographie zum locoregionaren Staging des Adenocarcinoms des Magens verglichen. Dazu wurden 52 konsekutive Patienten sowohl endosonographisch (7,5 und 12 MHz) als auch hydrosonographisch (3,75 MHz) untersucht. 49 der 52 Tumoren konnten endosonographisch, 41 hydrosonographisch untersucht werden. Die Genauigkeit der Endosonographie zur T-Klassifizierung betrug 74 %, die der Hydrosonographie 46 %. Kardiacarcinome wurden oft aufgrund des subserosen Fettgewebes praoperativ als uT3 oder hT3, postoperativ als pT2 klassifiziert. Die Genauigkeit der Endosonographie in der Lymphknotendiagnostik betrug 86 %, die der Hydrosonographie 61 %. Aufgrund dieser Ergebnisse kann die transabdominelle Sonographie in Hydrotechnik die Endosonographie nicht ersetzen. Die Hydrosonographie kann jedoch im Rahmen der allgemeinen abdominellen Sonographie eine Erweiterung der orientierenden Untersuchung darstellen und in besonderen Fallen (z. B. stenosierende Tumoren) kann sie ohne Strahlenbelastung wichtige Informationen uber das lokale Tumorstadium liefern.

Die Therapie der pigmentierten villonodularen Synovitis (PVNS), insbesondere der diffusen Form, wird weiterhin unterschiedlich beurteilt aufgrund der geringen Incidenz dieser Erkrankung. Die wichtigsten operativen Verfahren stellen die arthroskopische oder offene Synovektomie dar. Zur Vermeidung von Gelenkdestruktionen und funktionellen Einschrankungen ist die fruhe Erkennung der PVNS entscheidend. In den Jahren 1994 und 1995 haben wir 4 Falle operativ behandelt und in einem Zeitraum von mehr als 12 Monaten nachuntersucht. In 2 Fallen wurde die komplette Synovektomie, in einem Fall die partielle Resektion der Synovia und in einem weiteren Fall die Gelenkresektion und Arthrodese als offene Verfahren durchgefuhrt. Anhand unserer Ergebnisse lies sich zeigen, das das MRT unverzichtbar in der Diagnostik und der operativen Therapieplanung ist. Liegt ein lokaler Befall der Synovia vor, so scheint die partielle Synovektomie ausreichend. Bestehen aber Zweifel in der Einschatzung oder zeigt sich klar das Bild eines diffusen Befalls, sollte die komplette Synovektomie, aufgrund der hohen Rezidivrate der diffusen PVNS, bevorzugt werden. Es zeigte sich weiterhin, das bei allen unseren Patienten sekundare ossare Lasionen auftraten bis hin zur Gelenkdestruktion bei einem Patienten. Daher ist die fruhzeitige operative Therapie als z. Z. einzig kausale Behandlung zu empfehlen. Inwieweit arthroskopisch oder als offenes Verfahren vorgegangen werden kann, ist abhangig von der Form der PVNS, dem Ausmas des Tumorbefalls und sekundaren Gelenkveranderungen.

Background and Study Aims: Based on the positive results of endorectal ultrasound we evaluated flexible colonic endosonography for colonic tumors. At present there are no generally accepted indications for this procedure. Moreover, it is unclear whether the results are valid enough to warrant specific therapeutic interventions. Patients and Methods: Over a one-year period we performed flexible colonic endosonography (12 MHz rotating scanner) on 31 patients with colonic tumors. The examination was only performed when therapeutic implications were expected (e.g. endoscopic procedure when there was no sign of malignancy; oncological resection when there were signs of malignancy in ulcerative colitis or familial polyposis). Results: Of 40 tumors examined, 36 were correctly staged by endosonography, compared to postoperative histology as the gold standard (16 of 17 adenomas, 5 of 5 pT1 carcinomas, 8 of 8 pT3 carcinomas). In two cases pT4 carcinomas were wrongly classified endosonographically as uT3 carcinomas, because the infiltration of the visceral peritoneum was technically not recognizable. Overall the accuracy rate of staging was 85 %. Lymph node staging was correct in 36 of 40 patients, amounting to an accuracy rate of 90 %. Conclusion: Because of its high accuracy rate flexible colonic endosonography has a place in the preoperative staging of colonic tumors in selected patients, especially those with ulcerative colitis, familial adenomatous polyposis or macroscopically suspicious adenomas. It helps to clarify the extent (oncological resection, lymphadenectomy) of resection required in conventional surgery and helps to avoid laparoscopic procedures in advanced colonic cancer.

We describe efforts to obtain access for research to 81 wetland basins on 69 farms in four zones of the Prairie Pothole Region of North Dakota, South Dakota, and Minnesota. Access was obtained to 54% of the farms in areas where land was intensively cropped and 87% of farms in areas of low cropping intensity. On average, 1.35 operators had to be contacted and 1.70 interviews were required to obtain a decision on access to a farm. On 77% of the farms, cooperators placed at least one restriction on access, most commonly requiring walking access only or notification before nighttime work. Cost of obtaining access averaged $265/ farm in wages and travel expenses. No cooperators were willing to sign written access agreements. Operators rescinded access to four farms and drained three wetland basins during the first year; six of the seven sites lost were in the intensively cropped portion of a low-wetland-density zone. The difficulty of obtaining and retaining research access to privately owned wetland basins in intensively cropped areas may be related to landowner attitudes towards wetlands. Researchers may have to rely on remote sensing or consider payment for access to secure representative research sites in such areas. Unwillingness of cooperators to sign access agreements may jeopardize research by the newly formed National Biological Service and other resource management agencies.

Complexins are small α-helical proteins that modulate neurotransmitter release by binding to SNARE complexes during synaptic vesicle exocytosis. They have been found to function as fusion clamps to inhibit spontaneous synaptic vesicle fusion in the absence of Ca[superscript 2+], while also promoting evoked neurotransmitter release following an action potential. Complexins consist of an N-terminal domain and an accessory α-helix that regulates the activating and inhibitory properties of the protein, respectively, and a central α-helix that binds the SNARE complex and is essential for both functions. In addition, complexins contain a largely unstructured C-terminal domain whose role in synaptic vesicle cycling is poorly defined. Here, we demonstrate that the C-terminus of Drosophila complexin (DmCpx) regulates localization to synapses and that alternative splicing of the C-terminus can differentially regulate spontaneous and evoked neurotransmitter release. Characterization of the single DmCpx gene by mRNA analysis revealed expression of two alternatively expressed isoforms, DmCpx7A and DmCpx7B, which encode proteins with different C-termini that contain or lack a membrane tethering prenylation domain. The predominant isoform, DmCpx7A, is further modified by RNA editing within this C-terminal region. Functional analysis of the splice isoforms showed that both are similarly localized to synaptic boutons at larval neuromuscular junctions, but have differential effects on the regulation of evoked and spontaneous fusion. These data indicate that the C-terminus of Drosophila complexin regulates both spontaneous and evoked release through separate mechanisms and that alternative splicing generates isoforms with distinct effects on the two major modes of synaptic vesicle fusion at synapses., Pew Charitable Trusts. Latin American Fellow Program in Biomedical Science, National Institutes of Health (U.S.) (Grant NS40296)

Male Wistar rats were treated concurrently with a combination of the carcinogen N-methyl-N'-nitro-N-nitrosoguanidine (MNNG; CAS 70-25-7) and the polyamine-synthesis inhibitor alpha-difluoromethylornithine (DFMO) at two different doses of 0.5% and 1.0% (w/v). Experimental groups were treated with (I) MNNG alone (n = 25), (II) MNNG plus 0.5% (w/v) DFMO (n = 25), (III) MNNG plus 1.0% (w/v) DFMO (n = 25), (IV) 1.0% (w/v) DFMO alone (n = 25). Group V represented untreated controls (n = 20). Both the carcinogen and DFMO were administered in drinking water. The treatment time with the carcinogen and DFMO was 35 weeks. After treatment was completed animals were followed for an additional 50 weeks to cover a total observation time of 85 weeks. Significantly fewer animals developed gastric adenocarcinoma in the two groups of animals that received a combined treatment of MNNG plus DFMO compared to animals treated with the carcinogen alone (P0.05 and 0.005). No benign or malignant neoplastic lesions were observed in the stomach or duodenum of animals treated with DFMO alone or in untreated controls. It is concluded that concurrent treatment with DFMO prevents the development of malignant gastric epithelial tumors induced by MNNG in rats.

Magnetic Resonance Imaging (MRI) is often used in modern day radiotherapy (RT) due to superior soft tissue contrast. However, treatment planning based solely on MRI is restricted due to e.g. the limitations of conducting online patient setup verification using MRI as reference. In this study 3D/3D MRI-Cone Beam CT (CBCT) automatching for online patient setup verification was investigated.Initially, a multi-modality phantom was constructed and used for a quantitative comparison of CT-CBCT and MRI-CBCT automatching. Following the phantom experiment three patients undergoing postoperative radiotherapy for malignant brain tumors received a weekly CBCT. In total 18 scans was matched with both CT and MRI as reference. The CBCT scans were acquired using a Clinac iX 2300 linear accelerator (Varian Medical Systems) with an On-Board Imager (OBI).For the phantom experiment CT-CBCT and MRI-CBCT automatching resulted in similar results. A significant difference was observed only in the longitudinal direction where MRI-CBCT resulted in the best match (mean and standard deviations of 1.85±2.68 mm for CT and -0.05±2.55 mm for MRI). For the clinical experiment the absolute difference in couch shift coordinates acquired from MRI-CBCT and CT-CBCT automatching, were ≤2 mm in the vertical direction and ≤3 mm in the longitudinal and lateral directions. For yaw rotation differences up to 3.3 degrees were observed. Mean values and standard deviations were 0.8±0.6 mm, 1.5±1.2 mm and 1.2±1.2 mm for the vertical, longitudinal and lateral directions, respectively and 1.95±1.12 degrees for the rotation (n=17).It is feasible to use MRI as reference when conducting 3D/3D CBCT automatching for online patient setup verification. For both the phantom and clinical experiment MRI-CBCT performed similar to CT-CBCT automatching and significantly better in the longitudinal direction for the phantom experiment.

Background: The lack of proven effects of postoperative adjuvant chemotherapy in gastric cancer stimulates new therapeutic approaches. In vitro studies applying different kinds of interferon to renal cell carcinomas, however, indicated (as did clinical studies) its antitumor activity, but there is no experience so far about the effects of interferon on gastric cancer. Methods: 44 patients following curative resection of advanced gastric cancer were included in this prospective-randomized phase III pilot trial. 23 patients were allocated to the therapy group and treated with 4×106 units beta-interferon and in addition with 2x500 mg acetylic salicylate over a period of 30 days. The postoperative course was compared with that of 21 patients who received acetylic salicylate only. Results: Therapy-related side effects were observed in 13/23 patients of the treatment group requiring premature termination of beta-interferon in six patients. No differences could be stated, neither concerning recurrence-free survival nor overall survival. In the treatment group, 5-year survival of patients with side effects was 62% compared to 30% of patients without side effects, but this difference was not significant. Conclusion: In gastric cancer patients no beneficial effects of adjuvant postoperative beta-interferon therapy could be demonstrated. Due to this fact this treatment and schedule cannot be recommended as a promising approach.

Phosphopeptides derived from casein may function as carriers for calcium and trace elements. In regard to such specific nutritive effects, the heat-induced changes in tryptic phosphopeptides liberated from bovine sodium caseinate as a model system were investigated. Both microwave and oven heating resulted in a marked loss of peptide-bound phosphorous (dephosphorylation) and a decrease of casein-phosphopeptides in the soluble part of the tryptic hydrolysate. It is concluded that hydrolysis of phosphoseryl to seryl residues was the prevailing degradation step to soluble proteolytic products, whereas lysinoalanyl-casein is claimed to be present almost exclusively in the pH 4.6-insoluble part of the tryptic digest.

Zwischen Oktober 1987 und August 1988 wurden 15 Malleolarfrakturen (13mal Typ B, zwei isolierte Innenknochelfrakturen) und sechs Flakefrakturen (viermal Femurrolle, zweimal Talus) mit resorbierbaren Stiften (Biofix©) ubungsstabil operativ versorgt und prospektiv dokumentiert. Es handelt sich um Polyglykolsaurefibrillen die mit einer Schmelztechnik zusammengeprest und mit Polydioxanon ummantelt sind, ihre Scherfestigkeit nimmt in zirka vier Wochen um die Halfte ab. Sie sind in verschiedenen Langen und Starken erhaltlich. Die Frakturen wurden mit einer Zuggurtungsosteosynthese unter Verwendung von PGS-Stiften und PDS-Kordel oder Maxon©-Faden (Starke 1) stabilisiert, die Abscherfragmente mit zwei bis drei Stiften aus PGS fixiert. Die Nachbehandlung erfolgte funktionell. Die Frakturen waren nach sechs Wochen bei zwolf Patienten verheilt, nach sieben Wochen bei zwei und lediglich bei einem Patienten erst nach neun Wochen. Die knocherne Ausheilung der Flakefrakturen dauerte langer, nach sechs Wochen waren erst eine, nach sieben Wochen zwei und nach neun Wochen drei Frakturen fest. Vollbelastung war bei den Malleolarfrakturen durchschnittlich nach 8,9 Wochen, bei den Flakefrakturen nach 10,8 Wochen erreicht. Die Dauer der Behandlung betrug 10,2 Wochen beziehungsweise 12,4 Wochen. Unseres Erachtens wurde mit dieser Studie der Nachweis erbracht, das Ausenknochelosteosynthesen mit resorbierbarem Material unter funktioneller Nachbehandlung moglich sind. Die Stifte eignen sich des weiteren aufgrund ihrer hohen Scherfestigkeit ideal zur Refixation von Flakefrakturen.

Detailed knowledge of the relationship between plant diversity and productivity is critical for advancing our understanding of ecosystem functioning and for achieving success in habitat restoration efforts. However, effects and interactions of diversity, succession and biotic invasions on productivity remain elusive. We studied newly established communities in relation to preexisting homogeneous vegetation invaded by exotic plants in the northern Great Plains, USA, at four study sites for 3 years. We observed variant diversity-productivity relationships for the seeded communities (generally positive monotonic at three sites and non-monotonic at the other site) but no relationships for the resident community or the seeded and resident communities combined at all sites and all years. Community richness was enhanced by seeding additional species but productivity was not. The optimal diversity (as indicated by maximum productivity) changed among sites and as the community developed. The findings shed new light on ecosystem functioning of biodiversity under different conditions and have important implications for restoration.

This paper summarizes applications of micro-optics and nano-optics for spatial and spectral beam control. Methods of fabrication will be summarized with specific examples in beam conditioning, imaging, and filtering.

During the observation period between 2001 and 2003, all outpatient surgical therapy, including degrees of urgency, surgical care volume, regional provenance of patients, diagnoses, and referral channels were prospectively analysed at the Surgical Department of the University of Heidelberg, Germany. The data gathered do not merely describe the volume and characteristics of care encountered at this academic surgical institution but also provide further insight into the variability of resource utilisation and associated patient flow. Additionally, a retrospective evaluation using structured interviews and questionnaires was performed to differentiate and quantify patient care, teaching, and research activities. This study illustrates the high relevance of academic outpatient institutions to regional provision of general surgical care in Germany. There is a clear dominance of medical support functions, while research and teaching activities are of only minor relevance and realised particularly in subspecialty clinics. These data should give important stimuli for the future planning of health care in Germany. Outpatient clinics for general surgery appear to be an excellent basis for regional models of integrated health care delivery in the future.

Background Jejunal pouch formation and restoration of duodenal transit have been suggested for reconstruction after total gastrectomy. Opinions about the clinical value vary. Methods The literature was searched for prospective randomized trials comparing reconstructive procedures after total gastrectomy for malignancy. Reports with at least an English or German abstract were included. Immediate results were evaluated in terms of postoperative deaths and complications. Long-term outcome was analysed using trends in bodyweight and quality of life. Results A total of 19 randomized trials including 866 patients was identified. The operative risk of total gastrectomy was low, with a median mortality rate of 0 (range 0–22) per cent, irrespective of the method of reconstruction. Neither gastric substitution nor restoration of duodenal transit was associated with significant procedure-related complications. Results for specific reconstructions varied considerably within and between individual trials. Jejunal pouch reconstruction, but not restoration of duodenal passage, was associated with improved food intake and a tendency for weight gain in the early postoperative months. A favourable perception of quality of life persisted in the long term in some studies. Conclusion Preservation of duodenal transit offers little clinical benefit. Construction of a small-bowel reservoir after total gastrectomy should be considered to improve early postoperative eating capacity, bodyweight and quality of life.

Post-anesthetic holter monitoring was performed in 2 patient groups in order to compare the incidence of cardiac arrhythmias as a result of different anesthetic protocols. The 2 groups differed in their anesthetic protocol. Both groups received levomethadone as pre-anesthetic. The dogs in group A (n = 30) additionally received diazepam, the dogs in group B (n = 30) received propofol instead. Anesthesia was maintained by isoflurane in group A and a propofol constant rate infusion in group B. In each patient 2 holter monitorings were performed. The first recording began directly after anesthesia. As a comparison a second recording was performed on the 5th post-operative day. The recorded number of arrhythmias was low and no statistical difference was demonstrated between the 2 patient groups.

The appearence of distant metastases or local recurrence is assumed to render gastric cancer incurable. However, experience with colorectal cancer has shown that patients with recurrent disease may have a chance for cure, if recurrent or metastatic disease can be completely resected. Since improved imaging allows detection of ever smaller tumour deposits, we have reviewed the pertinent literature to determine the current surgical options for recurrent or metastatic gastric cancer. Metastatic disease or local recurrence is rarely resectable. Tumour recurrence in the remnant stomach after partial gastrectomy can be treated by secondary total gastrectomy and may occasionally result in long-term survival. Other types of local recurrence are generally not amenable to complete resection. The same is true for distant metastases. If, however, distant metasases are technically resectable, 5 year survival of approximately 20% has been documented. Solitary and late appearing metachronous tumours are associated with an improved prognosis. As a consequence resection of distant metastases should be considered, because the risk of metastasectomy is generally low and there is no alternative treatment with a chance for cure.

Background: Local and multimodal therapeutic strategies for tumours of the oesophagus and gastric cardia, require precise preoperative staging. Endosonography is considered the most accurate staging method, while computed tomography (CT) has limitations especially in the evaluation of local infiltration. Macroscopic endoscopic evaluation was reported to be accurate in selected series, but no study has yet compared all three staging modalities. Methods: One hundred and seventeen unselected patients with tumours of the oesophagus and gastric cardia were prospectively staged first by the endoscopic macroscopic appearance and then by endosonography. All patients had preoperative CT scans, however, only the 36 patients receiving the scans at our institution were included in the study. The preoperative staging results were then compared to postoperative histology which was available as the gold standard in all included patients. Kappa statistics were used to exclude chance agreement of the clinical staging results with the pathohistological findings. Differences between the resulting ĸ values for the different staging modalities were analysed with a jack-knife test. Results: Endoscopic macroscopic staging and endosonography (accuracy 67 and 69%, weighted ĸ 0.78 and 0.84) were significantly more accurate than CT (accuracy 33%, weighted ĸ 0.44) for determination of the T category (p = 0.006 and p = 0.001). After exclusion of tumours of the cardia (n = 33), the accuracy of macroscopic and endosonographic staging (accuracy 72 and 75%, weighted ĸ 0.86 and 0.88) increased and remained more accurate than CT (accuracy 50%, weighted ĸ 0.62). The main pitfall in our series in staging the T category was the overestimation of T2 tumours in the cardia as T3 or even as T4 tumours due to the inability to visualise the serosa. The accuracy of predicting lymph node metastasis was 68% for macroscopic endoscopic, 79% for endosonographic, and 67% for CT staging. Only endosonographic staging was significantly different from chance agreement with histology (weighted ĸ = 0.56). Endosonographic staging was significantly more accurate than endoscopic macroscopic and CT staging (p = 0.03). Conclusions: Endosonography is the most accurate staging modality for overall preoperative staging of oesophageal and cardial tumours. Endoscopic macroscopic staging allows a reasonably accurate assessment of the T category.

Einleitung: Eine Laparotomie ist bei Patienten mit Magenkarzinom, wenn eine Peritonealkarzinose oder diffuse Lebermetastasierung vorliegt, nicht indiziert. Diese Befunde entgehen jedoch oft der praoperativen bildgebenden Diagnostik. Verbesserung der praoperativen Diagnostik durch den Einsatz der Laparoskopie konnte die explorative Laparotomie vermeiden. Die routinemasige Anwendung der Laparoskopie bei allen Patienten mit Magenkarzinom konnte zur unnotigen Erweiterung der invasiven Diagnostik und zum Anstieg der damit verbundenen Komplikationen fuhren. Patienten und Methode: Alle Patienten, die im Zeitraum von 6/99 bis 8/01 in der Chirurgischen Universitatsklinik Heidelberg mit einem primaren Magenkarzinom behandelt wurden, wurden prospektiv erfasst. Bei allen Patienten wurde praoperativ eine Gastroskopie, EUS, Sonographie des Abdomens und Rontgen-Thorax durchgefuhrt und ggf. durch CT und MRT erganzt. Die Indikation zur Laparoskopie wurde gestellt, wenn die bildgebenden Verfahren (EUS, CT, MRT) bei asymptomatischen Patienten eine lokale Infiltration, Peritonealkarzinose oder diffuser Lebermetastasierung nicht sicher ausschliesen konnten. Bei symptomatischen Patienten (Stenose, Perforation, Blutung) mit Indikation zu palliativen Masnahmen, wurde auf die diagnostische Laparoskopie verzichtet. Ergebnisse: Seit Juni 1999 bis September 2001 wurden in unserer Klinik 130 Patienten wg. eines primaren Magenkarzinoms behandelt. 105 Patienten (81%) wurden nach o.g. Kriterien primar laparotomiert: 77 mal mit kurativer Zielsetzung, 28 mal mit palliativer Zielsetzung. Bei 2 Patienten (1,5%), die mit kurativer Zielsetzung laparotomiert wurden, zeigte sich intraoperativ eine Peritonealkarzinose. Zehn weitere Patienten mit weit fortgeschrittenem, nicht resektablem Tumorleiden wurden direkt einer palliativen Chemotherapie zugefuhrt. 15 mal stellten wir die Indikation zur diagnostischen Laparoskopie. In 6 Fallen wurde nach der diagnostischen Laparoskopie die Operabilitat als gegeben angesehen und es konnte eine potentiell kurative Operation durchgefuhrt werden. Bei 6 Patienten (5%) haben wir bei der diagnostischen Laparoskopie eine Peritonealkarzinose bzw. Lebermetastasen nachweisen konnen, so dass auf eine Laparotomie verzichtet werden konnte. Bei 3 weiteren Fallen wurde laparoskopisch eine Peritonealkarzinose nicht erkannt, die erst bei der nachfolgenden explorativen Laparotomie gesichert werden konnte. Schlussfolgerung: Bei sorgfaltiger klinischer und bildgebender Diagnostik hat sich die selektive Indikationsstellung zur diagnostischen Laparoskopie bewahrt.

The Prairie Pothole Region of the northern Great Plains is an important region for waterfowl production because of the abundance of shallow wetlands. The ecological significance of the region and impacts from intensive agriculture prompted the U.S. Environmental Protection Agency to select it as one of the first areas for developing and evaluating ecological indicators of wetland condition. We examined hypothesized relations between indicators of landscape and wetland conditions and waterfowl abundance on 45 40 km2 study sites in North Dakota for 1995-1996. Landscape condition was defined a priori as the ratio of cropland area to total upland area surrounding wetlands. Measures of waterfowl abundance included estimated numbers of breeding pairs (by species and total numbers) and gamma, a species-specific correction factor which effectively adjusts breeding pair estimates for annual or area-related differences in pond size. Landscape indicators and waterfowl measures varied among regions. Results indicated that most areas in the Coteau region are of much higher quality for ducks than those in the Drift Plain, and areas in the Red River Valley are of the poorest quality for ducks. Regression models demonstrated the impact of agricultural development on breeding duck populations in the Prairie Pothole Region. The most consistent landscape indicators of waterfowl abundance were percent of cropland and grassland. Models were inconsistent among years and species. The potential biotic indicators of landscape and wetland condition examined here would be appropriate for temporal trend analyses, but because of inherent geographic variability would not be appropriate for single-year geographic trend analyses without more extensive evaluations to improve explanatory models.

In dieser prospektiven Studie wurde die endoskopisch makroskopische Einschatzung des Tumorstadiums beim O sophagus-, Barrett- und Kardiakarzinom mit dem Ergebnis der apparativen Diagnostik mittels Endosonographie und Computertomographie verglichen. Eingeschlossen wurden Patienten, die operativ exploriert wurden und bei denen eine postoperative Histologie als Goldstandard vorlag (n=110). Die accuracy fur das endosonographische und makroskopische T-Staging war vergleichbar, die accuracy fur das computertomographische Staging war signifikant schlechter und nicht unterschiedlich von der zu erwartenden zufalligen Ubereinstimmung. Beim N-Staging war nur die endosonographische Beurteilung unterschiedlich von der zu erwartenden zufalligen Ubereinstimmung und war signifikant besser als beide anderen Stagingmodalitaten. Die schlechtesten Ergebnisse wurden beim pT2-Kardiakarzinom erzielt, was durch die besondere anatomische Situation erklarbar ist.