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Accidental sharp injuries among the health-care workers are frequent, especially in the surgical disciplines. Because there are only limited data available about accidental sharp injuries in small surgical disciplines, we investigated the occurrence of sharp injuries among ophthalmosurgeons in Switzerland.An anonymous questionnaire was sent to all 500 members of the Swiss Ophthalmological Association. We asked how often the surgeons or any member of the surgical team suffered injury during an ophthalmic surgery within the last 2 years and which instrument had caused the injury. Using linear regression we analysed the connection between the occurrence of injuries and various factors, e.g., the age or experience of the surgeon, whether any actions in the case of an injury were taken, whether the event was documented and whether actual guidelines were followed.In the 117 analysed questionnaires we counted 193 injuries. 42.7 % of the surgeons (n = 50, 95 % CI 33.7 % - 51.8 %) had injured themselves at least once during the past two years and 59.8 % of the surgeons (n = 70, 95 % CI 50.9 % - 68.7 %) reported injuries among the rest of the surgical team. On average, surgeons were injured 0.66 times in two years (range 0-4 injuries per person). Most injuries were caused by hollow needles [28.2 % of self injuries (95 % CI 18.2 % - 38.2 %)], 24.3 % of injuries of team members (95 % CI 16.5 % - 32.1 %). 53.0 % of the surgeons (n = 63, 95 % CI 44.0 % - 62.0 %) reported the case whereas 18.8 % (n = 22, 95 % CI 11.7 % - 25.9 %) never reported them. Some questionnaires did not contain the answers to those last questions. Using chi-square, we could observe more injuries in the middle-age section and in surgeons with 11-30 years of surgical experience (p0.05). The regression did not show any dependence on the rate of injuries on the surgeon's experience and the number of performed surgeries.We conclude that in ophthalmosurgery sharp injuries to surgeons or their surgical team happen frequently and only about 50 % of the cases are reported. This study shows that there is room for improvement concerning the documentation and the actions taken after an injury. Thereby potential sources of danger could be better monitored.

The neighbouring cantons Basel-Stadt and Basel-Landschaft had introduced different fluoridation schemes for caries prevention: Basel-Stadt provided drinking water fluoridated at 0.8-1 ppm F since 1962, while Basel-Landschaft introduced fluoridated domestic salt (250 ppm F since 1983). Representative samples of 12-year-old schoolchildren (6th-graders) were studied to evaluate the prevalence of (I) dental fluorosis (FOP) using the Thylstrup-Fejerskov (TF) index, (II) non fluoride-associated enamel opacities (non-FOP), and (III) hypoplasia of the incisors. Standardised frontal colour photographs were taken and assessed by four examiners after projection. Of 373 schoolchildren studied in 1999 in Basel-Stadt 119 (31.9%) showed fluoride-associated enamel opacities, i. e. 66 (17.7%) a very mild form (TF score 1), 47 (12.6%) a mild form (TF score 2), five scored TF3 and one TF5. In addition, non-FOP were diagnosed in 115 (30.8%) and hypoplasia in 47 (12.6%) children. Among the 448 children evaluated in 2001 in Basel-Landschaft 143 (31.9%) showed FOP, namely 74 (16.5%) scored TF1, 54 (12.2%) scored TF2, 12 (2.7%) scored TF3, and three (0.7%) scored TF5. Non-FOP were found among 93 (20.8%) and hypoplasia among 56 (12.5%) children. Thus, in spite of different fluoridation schemes in the two cantons, the prevalences of FOP were identical. Most fluoride-associated enamel opacities were mild or very mild. They did not represent an aesthetic problem and certainly not a public health concern.

Background/Aims: The impact of aging on esophageal motility is not completely understood. This study aims at assessing 1) whether degeneration of esophageal body motility occurs with age and 2) whether this development is influenced by gastroesophageal reflux disease (GERD). Methods: 326 consecutive patients with symptoms of GERD underwent a diagnostic work-up including a water-perfused esophageal manometry. Patients were divided by age: 17–39 years (group 1, n=75), 40–49 years (group 2, n=79), 50–59 years (group 3, n=64), 60–69 years (group 4, n=74), and >70 years (group 5, n=34). GERD was diagnosed if patients had erosive esophagitis at endoscopy, a positive pH-metry, or both. The amplitude of esophageal contraction waves 3 cm and 8 cm above the lower esophageal sphincter and the percentage of peristaltic contraction waves of the tubular esophagus were analyzed and correlated to GERD. Results: A normal esophageal manometry was found in 86.7%, 73.4%, 67.2%, 58.1%, and 55.9% (p, GMS German Medical Science; 9:Doc22; ISSN 1612-3174

Although dental injuries are common occurrences at swimming pools, there are very few publications about them. The purpose of this study was to interview pool attendants at public swimming pools/bathing resorts in Switzerland on lip and dental injuries in 2007. The questions focussed on their knowledge of first aid, the frequency and accident site of lip and tooth trauma, as well as the storage medium for avulsed teeth. Questions were also asked about the presence of a "dental first-aid kit" and the poster on dental first aid. 606 public pools were contacted, and one pool attendant per pool was interviewed by telephone. 553 individuals participated; 53 declined to take part. The results show that in 2007, 40% of the interviewed pool attendants (n = 221) had witnessed at least one lip injury, and 36.9% (n = 204) at least one tooth trauma. At pools with slides, accidents were more frequent (p0.001), and the waterslide was the most common accident site. The pool attendants provided satisfactory answers on their actions after lip and dental injuries. However, 68.7% could not adequately answer the questions on storage of avulsed teeth. Only 74 pool attendants had a dental first-aid kit. Of these, only 68 used the kits as the storage medium for avulsed teeth. 59 pool attendants were in possession of the poster on dental first aid. Overall, it was shown that pool attendants who had a dental first-aid kit and a dental first aid poster gave better answers on how to handle tooth trauma.

We hypothesized that pool swimming has a low risk for acute injuries; however overuse injuries are predominant, depending on exposure time and swimming discipline.341 elite swimmers (19 +/- 11 years, BMI 20.3 +/- 3) were enrolled. Swimming was performed at mean since 10.1 +/- 8 years with 3.8 units every week during 43 weeks every year.The overall pool swimming injury rate was 0.39 / 1000 h. Overuse injuries (0.22 / 1000 h) were more frequent than acute injuries (0.17 / 1000 h). The upper extremity was involved more frequently (0.11 / 1000 h) than the trunk (0.067 / 1000 h) or the lower extremity (0.085 / 1000 h). Knee pain was predominant (0.17 / 1000 h) followed by shoulder overuse injuries (0.11 / 1000 h). Especially the 200 - 400 m breaststroke event had a fivefold higher risk for knee pain (relative risk, RR 5.1, p = 0.001). Freestyle had a reduced relative risk for knee pain (RR 0.5, p = 0.03), where shoulder overuse syndromes were predominant. Butterfly increased acute shoulder injury with RR 4.4 (p = 0.004), cervical spine injuries (RR 4.0, p = 0.03) and lower back pain (RR 2.5, p = 0.011). Swimming for more than four times a week had a higher risk for knee injuries (RR 2.1) and shoulder injuries (RR 4.0). We found that stretching was associated with a fivefold reduced risk for overuse knee injuries.Competitive swimming is a reasonable safe sport, where overuse injuries are predominant. 200 - 400 m breaststroke events increase the risk for knee overuse injuries more than other disciplines. Training for more than four times a week increases the risk twofold for knee and fourfold for shoulder overuse injuries.

Communication between patient and physician remains a central step of interaction.15 min after receiving the results of their coronary angiography via a standard verbal report, a total of 288 patients were asked the following questions: (1) Were the results of coronary angiography explained to you? (2) Who performed your procedure? (3) Were there any narrowings in your coronary arteries? (4) Was your left ventricular ejection fraction normal? (5) What kind of therapy was recommended to you?98.6% of the patients were informed about the results of their coronary angiography. 31.2% were able to recall the name of the interventionalist. 52.8% knew about their coronary arteries, 36.8% knew their left ventricular function, and 92.7% were able to recall the recommendations for therapy (mean 53.4% correct answers). In 14.6%, the causes of incorrect answers were related to the patient, in 85.4% to the doctor. The number of incorrect answers increased significantly in patients with complex angiographic results, cultural discordance between physician and patient, and presentation of the results by noncardiologists (p0.001 for all).Communication of coronary angiography results to patients via standard verbal reports leads to frequent misunderstanding. To resolve communication problems in the cathlab as effective as possible, communication skills of physicians should be improved.

Population-based data on smoking behavior in Germany of women before or during pregnancy have been lacking. Smoking rates of these women have now been recorded over a period of 3 years against the background of growing tobacco control activities in Germany.The study was conducted between 4/2003 and 3/2006 in the context of a prospective population-based survey about perinatal morbidity and mortality (Survey of Neonates in Pomerania - SNiP). This survey registers all newborns and their mothers in one defined region. Of the women eligible for the study 2 297 (68.1%) participated after delivery by giving data about their smoking behavior before and during pregnancy.61.2% of the women had smoked at some time, 46.6% had smoked before, 24.2% into the 4. month and 20.5% into the last 4 weeks of pregnancy. Smoking rates remained unchanged over the 3 years that were studied. The rates of smokers who had quit by the time of delivery varied according to the length of school education: (10 years: 30%; 10 y: 59%;10 y: 84%) and age (24 years: 45%; 25-30 y: 65%;30 y: 77%).This study for the first time provides population-based data about the prevalence of smoking before and during pregnancy among women in Germany. The data show extremely high numbers of smokers, especially younger women and women of only 10 years or less of school education. Despite growing tobacco control activities no changes in smoking rates were observed over three years. These findings underline the need to develop effective interventions to prevent smoking of women before and during pregnancy.

With the development and refinement of digital imaging, conventional fluoroscopic units are increasingly being replaced by state-of-the-art digital units for the practice of gastrointestinal imaging. The purpose of this study was to compare digital and conventional methods of gastrointestinal imaging by enteroclysis based on radiation exposure to the patient and fluoroscopy time.The medical records of 241 patients who underwent enteroclysis by the conventional technique in 1990 and 309 patients who underwent enteroclysis by digital technique between 2000 and 2004 were reviewed. The radiation exposure of the patient and the fluoroscopy time were evaluated.The mean radiation exposure was significantly lower (por = 0.05) for patients examined by the digital technique (4945.07 cGy x cm (2)) than for patients examined by the conventional technique (7513.6 cGy x cm (2)). The fluoroscopy time was significantly lower with the conventional technique (mean fluoroscopy time 9 min 43 sec) than with the digital technique (17 min 10 sec).We conclude that radiation exposure does not correlate directly with fluoroscopy time. Technical refinements of the digital technique such as Last Image Hold frames, which allow images to be stored with no increase in radiation dose and help to reduce digital fluorography exposures and pulsed fluoroscopy, result in significant dose reduction.

Despite advances in operative technique long-term survival of curatively operated gastric cancer patients still remains poor with 5-year-survival of 25 %. Gender differences have been recognized in patients with colorectal carcinoma with a higher 5-year-survival of women. The long time-survival of the individual patient is closely dependent on his immunofunction. If a splenectomy has to be carried out, the postoperative immunofunction will be affected considerably. Thus, the question arises as to how far gender and splenectomy influence the long time-survival after curative gastric cancer surgery.In a retrospective analysis of 505 patients with gastric cancer who had been treated between the years 1992 and 2002, a curative resection, i. e. R0, could be performed in 243 patients (48.1 %) with a definite classified tumour stadium according to the UICC (1997). The sociodemographic, operative, histomorphologic and postoperative data of each patient were collected, stratified by gender and compared using log-rank-test (survival) and chi-square-test (distribution). Multivariate analysis was performed by cox regression. The level of significance was set at p0.05.The sociodemographic, histopathologic and operative data between the two genders were comparable. The morbidity between men and women was not significant. However the rate of postoperative sepsis was higher in men (p0.05). With regard to the long-term survival, no difference could be shown between the two groups. However, splenectomy had a significant effect on long time-survival. Women with preserved spleen had a significantly improved five-year-survival rate as compared to women undergoing splencetomy and men with preserved spleen (p0.05). Multivariate analysis revealed only the tumour stage as a predictor for long time-survival in men, whereas in women the extend of lymphadenectomy and sepsis also influenced long time-survival.Long time-survival of curatively operated gastric cancer patients is gender dependent in terms of splenectomy. Therefore, gender differences should be taken into account in analysing long-term data of oncological patients.

To evaluate the impact of the configuration of the stent on the patency rate after transjugular intrahepatic portosystemic shunt with a self-expanding stent.In total, 80 patients (60 male, 20 female; mean age 56 +/- 9.6, range 37 - 81) with a transjugular intrahepatic portosystemic shunt were evaluated. The primary technical success rate, interventional revision rate, and mean patency rate according to Kaplan-Meier were calculated. The angle of deviation of the blood flow at the portal venous inflow and central venous outflow were measured on projected angiograms (valid cases, n = 78). The following five angle groups were established: 1. portal venous inflow, 2. central venous outflow, 3. maximum, angle, 4. minimum angle, and 5. sum of both angles in the shunt system. Within each group, the Mann-Whitney Test and after dichotomic partition using the median Pearson's Chi-Square Test and Fisher's Exact Test were carried out to prove the dependency of the patency on the stent's configuration.The primary technical success rate was 93 %, the interventional revision rate was 28 %, and the mean patency rate was 17.5 months. The mean/standard deviation/median angle were as follows: 1. portal venous inflow 66.5 degrees / 19.2 degrees / 65 degrees , 2. central venous outflow 43.7 degrees / 14.0 degrees / 40 degrees , 3. maximum angle 69.1 degrees / 16.3 degrees / 65 degrees , 4. minimum angle 40.6 degrees / 13.3 degrees / 40 degrees , and 5. sum of both angles 110.2 degrees / 21.8 degrees / 110 degrees . The 2-sided values of significance in the Mann-Whitney Test/Chi-Square Test/Exact-Fisher Test were as follows: 1. portal venous inflow 0.112 / 0.066 / 0.083, 2. central venous outflow 0.960 / 0.919 / 1.000, 3. maximum angle 0.151 / 0.042 / 0.056, 4. minimum angle 0.578 / 0.622 / 0.632, and 5. sum of both angles 0.104 / 0.111 / 0.140.The shunt's patency rate when using a self-expanding stent is not dependent on the stent's configuration regarding the deviation of the blood flow at the portal venous inflow and central venous outflow, and the maximum, minimum and total deviation in the shunt.

To evaluate and compare the expectations of patients and referring physicians (RPH) regarding the disclosure of radiological diagnostic procedure (RDP) results.A written survey was performed among 594 consecutive patients (47% male, 53% female; average age 49.6 y +/- 17.2 y) undergoing diagnostic cross-sectional imaging at three different ambulatories. A separate questionnaire was sent to 149 non-radiologist RPHs (rate of return 43.6%). The Chi-square test (Pearson's) (alphaor = 0.05) and the stepwise calculation of logistic regression were used for statistical evaluation.We found that 284 (47.8%) of the patients and 38 (58.5%) of the RPHs favored the radiologist disclosing RDP results. The patients' preference was significantly influenced by age, sex and geographical location (por = 0.05). 428 (72.1%) of the patients expected immediate therapeutic recommendations. Most patients (214, 75.1%) expected to be told the diagnosis within 30 minutes, RPHs (40/61.5%) within 48 hours.Patients have high expectations with respect to radiologists. Excellent organization is mandatory to fulfill these expectations. Unrealistic expectations should be corrected in advance by an improved information policy. Since only approximately half of the patients favored the radiologist disclosing the results of RDPs, radiologists should rethink their disclosure policy. The majority of RPHs preferred disclosure of the diagnosis by the radiologist. Timely reporting of RDP results is essential.

The purpose of this study was to evaluate the applicability of a port stapling device to simplify and improve port implantation in laparoscopic adjustable gastric banding (LAGB).From November 2005 to September 2006, a prospective study was conducted on 23 consecutive patients who underwent LAGB with Swedish adjustable gastric banding. Patients were randomized to either conventional titanium-port implantation or port stapling using the "Velocity" device.No differences in age, body weight, body mass index, fascia depth or incision length were reported between the groups. Port implantation time was significantly less using port stapling (90+/-24 s) compared to conventional port implantation (521+/-138 s). Port related complaints postoperatively and at follow-up were equal in both groups.Port stapling is an excellent tool to facilitate port implantation, particularly in massively obese patients with a thick abdominal wall.

Since 2004, several large randomized trials have provided important data about the comparison of carotid endarterectomy and carotid artery stenting of more than 2,000 patients with predominantly symptomatic carotid artery stenosis. None of these trials demonstrated clearly an equivalent periprocedural risk of both techniques. Long-term evaluation is also pending. Thus carotid endarterectomy remains the gold standard in treatment of symptomatic carotid artery stenosis. The frequently performed endovascular treatment of asymptomatic carotid stenosis is not supported by study data.

Distal radius fractures were investigated in a retrospective open multicenter cohort study to assess aetiology, fracture pattern and treatment modalities and their influence on subjective and objective outcome.Demographic data, fracture history, course of fracture healing, functional and radiological parameters and the DASH-questionnaire were collected from 18 Austrian hospitals and analysed statistically.n = 707, 465 (65.8 %) female, 242 (34.2 %) male. Mean age: 52 (19 - 86) years; age group 1 (19 - 39 years) 26 %, age group 2 (40 - 59 years) 41 %, age group 3 (60 years and elder) 33 %.mean 5.8 (3.9 - 17) years;fall 65.1 %, sports 17.4 %, traffic accidents 8.9 %, fall from great height 7.5 %; others 1.1 %. Most frequent fracture patterns according to AO: A2 (26.6 %), C2 (22.2 %), A3 (16.1 %), C1 (12.7 %); according to PE: I-2 (44.8 %), I-1 (40.0 %), III-2 (4.4 %), II-2B (4 %). There was no significant correlation between fracture pattern and age groups for both fracture classifications.57.9 % surgical, 42.1 % conservative. Radiological results: Depending on treatment, there were significant differences between the radial tilt and the palmar radial inclination, the dorsal and palmar ulnar variance and the width of the DRU-joint. DASH-questionnaire: Median 6.03 (90 - 0). There was a significant, minor positive correlation of bad results in the elderly and a minor positive correlation of bad results correlated to the palmar radial inclination as well as a minor negative correlation to the palmar DRUJ-value and the ulnar variance.The incidence of distal radius fractures was increased in females and in patients with the age between 40 - 59 years. The most frequent cause to sustain a distal radius fracture was a simple fall. 85 % of the fractures were dislocated dorsally. The most frequent fracture type was the dorsal intraarticular. There was no specific fracture type observed to be typical for one of the age groups and surgical treatment was almost as frequent as conservative. Surgical treatment improved reconstruction of the radial tilt, palmar inclination and the DRU-joint. Subjective outcome was worse in elderly patients. The radiological changes in the DRU-joint correlated to minor DASH values.

Collaboration between the Intensive Care Unit (ICU) and nephrology nurses is needed to ensure adequate care of critically ill patients with acute renal failure (ARF). To improve this collaboration a questionnaire was circulated to the 122 ICU nurses in the hospital to appraise their knowledge on ARF. A Refresher Course to update on ARF was then organised. Colleagues' interest in the initiative was elevated: 66% of questionnaires were completed which included 88% of nurses attending the course. The experience showed, through measurable results, that team work is essential to collaborative nursing plans. The initiative allowed improvement in the quality of nurses' communication and was accompanied with a significant reduction in short-term mortality rate of dialyzed ARF patients (45 versus 50%; p = 0.045, chi-square test). Despite the limitations of this short period of observation one year) the results are judged as useful. Collaboration ensures support for colleagues on a daily basis and during critical moments and can encourage appreciation of the nursing profession.

The prevalence of sleep-disordered breathing (SDB) in patients with chronic heart failure seems to be remarkably high, but existing studies are based on small cohorts of patients who were not receiving guideline-based drug treatment for heart failure. The aim of this study was to investigate the prevalence of SDB in patients with ischemic (ICM) or non-ischemic (DCM) cardiomyopathy.A total of 647 consecutive patients (130 females, 517 males; mean age 63.23 10.4 years) in stable, symptomatic chronic heart failure (NYHA class at least II) and with impaired systolic left ventricular function (ejection fractionor = 40%) were screened by cardiorespiratory polygraphy for the presence and type of SDB. Sleep apnea was classified as obstructive (OSA) or central (CSA) according to the majority of events, and as ICM or DCM according to the results of current left heart catheterization. SDB was defined according to the apnea-hypopnea index (AHI) as: no SDB:or = 5/h, mild: 6 -14/h, moderate: 15-29/h, and severeor = 30/h.Prevalence of SDB was 70% among DCM and 82% among ICM patients (p0.05). Central sleep apnea was found in 32% of DCM and 46% of ICM patients, obstructive sleep apnea in 38% of DCM and 36% of ICM patients. Moderate (15.7% vs. 9.9%, p0.05) and severe central sleep apnea (24.4% vs. 15.5%, p0.05) was documented more often in ICM than DCM patients. Severity of obstructive sleep apnea was similar in ICM and DCM patients. ICM patients were older than DCM patients (66.4 11 years vs. 66.0 9.0 years, p0.01) and in general presented with a greater impairment of cardiopulmonary function.There is a high prevalence of SDB in patients in chronic heart failure. Central sleep apnea can be documented particularly in ICM patients and seems to be a marker for the severity of heart failure. Because of their prognostic implications, risk stratification and identification of patients eligible for specific SDB treatment, screening for such disorders should be part of every heart failure work-up.

Determination of the amount of variation in conventional acetabular cup positioning (radiological inclination and anteversion) in view of different factors that could influence the measured angles.The intended acetabular cup position of 45 degrees inclination and 20 degrees anteversion was checked radiologically in 950 patients who received a cementless total hip replacement. The qualifications of the surgeon, operated side and implant model were recorded and analyzed with respect to a possible correlation with the results. Since a "safe angle" cannot be defined without consideration of other variables, a tolerable deviation of the target position was investigated.The mean inclination angle was 48.7 degrees (SD 7 degrees, minimum 28 degrees, maximum 75 degrees ). Anteversion was measured with a mean of 18.6 degrees (SD 9 degrees, minimum -9 degrees, maximum 50 degrees ). Assuming an acceptable deviation of +/- 5 degrees from the target position (45 degrees inclination and 20 degrees anteversion), only 22.7 % of the acetabular cups were in this range. In the case of an acceptable deviation of +/- 10 degrees, 34.5 % of the cups were still outside of the acceptable range. The qualifications of the surgeon, the implanted model, as well as the operated side did not have a significant influence on the results.The common implantation technique yielded significant variation with respect to anteversion and inclination. The application of computer-aided navigation in the placement of acetabular cups would help to improve accuracy and reproducibility considerably in total hip arthroplasty.

The purpose of this study was to establish a reliable and simple parameter for alignment evaluation and the evaluation and optimization of state-of-the-art contrast-enhanced examination protocols for (18)F FDG-PET/CT.44 consecutive patients were referred to 4 examination protocols. Group A and B underwent single-phase, contrast-enhanced CT (90 s delay) performed either during free shallow breathing (FA; group A) or normal expiration (NormExp; group B). Groups C and D underwent arterial and portal venous multiphase examinations performed during FA (group C) or during NormExp (group D) followed by a low-dose CT scan for attenuation correction. Organ displacement in the cranio-caudal direction was correlated with a 3D-vectorial shift. For alignment evaluation discrepancies with respect to size and liver location, the spleen and kidneys were calculated. Additionally, the groups were compared with regard to the presence of CT artifacts.Cranio-caudal organ shift and 3D-vectorial shift showed a high correlation (r0.8). Single-phase CT scans performed during NormExp yielded better image quality (p0.001) and alignment (p0.01 for liver, spleen and right kidney) than those performed during FA. Differences in organ size did not differ during FA and NormExp. Depending on the evaluated organ, breathing and contrast protocol misalignment was in the cranio-caudal direction 0-27 mm (mean: 6.8; standard deviation: +/- 4.9) in multiphase CT compared to 0 - 11 mm (mean: 4.5 +/- 2.3) in single-phase examinations.1. Organ shift in the cranio-caudal direction is a good and simple parameter for alignment evaluation. 2. Alignment and CT quality are best in expiration protocols. 3. Despite comparatively low alignment quality, integrated multiphase CT examinations show acceptable quality and alignment.

The diagnostic value of 3D ultrasound (US) was evaluated in comparison to 2D US on the basis of a set of pre-defined criteria for breast lesions. The individual criteria were correlated with the histological findings and they were ranked according to their significance for lesion characterization in both 3D US and 2D US.A total of 92 breast lesions were examined of which 61 were malignant and 31 were benign, as confirmed by histology of core biopsy specimens (Aplio 80, Toshiba, Otawara, Japan). The 2D and 3D data sets were stored digitally. The vascular tree was stored separately using 3D fusion. In addition, a power Doppler (PD) examination was performed. A total of 644 individual images were evaluated by two independent readers. The lesions were evaluated using established criteria (BI-RADS classification). For statistical evaluation, the individual US measurements were classified according to the following two groups: those suggesting malignant lesions and those suggestive of benign lesions. Pearsons's chi-square test was performed for both groups. The 2D and 3D techniques were compared directly using kappa (kappa) statistics. Odds ratios (OR) were determined for the purpose of weighting the individual criteria. The sensitivities and specificities of 2D and 3D US were calculated.The diagnostic value of 3D US was comparable to that of 2D US, with only slight differences observed for specific measurements. Analysis of 2D US data indicated that there was a strong correlation between malignant tumor growth and two specific 2D criteria: lesion margin and effect of the lesion on adjacent breast tissue (r (2) = 0.632, p0.001). Analysis of 3D images indicated that the significant measurements for tumor malignancy were shape and lesion margin in sagittal, transverse (r (2) = 0741, p0.001), and frontal views (r (2) = 0.592, p0.001) as well as retraction and lesion demarcation in the frontal views (r (2) = 0.649, p0.001). The comparison of 2D and 3D yielded primarily moderate (kappa = 0.412) to good (kappa = 0.789) agreement between the individual criteria. Crucial criteria for lesion characterization were the effect of the lesion on adjacent breast tissue (OR 47.8 [16.0-143.3]) in 2D US and the lesion margin (OR 36.4 [15.3-86.6]) and the 3 additional criteria of the frontal plane (OR 21.9-32.9) in 3D US. The two US techniques had comparable sensitivities (2D/3D 95-97 %/92-95 %) and specificities (2D/3D 54-58 %/61-67 %). The reconstructed 3D view of the vascular tree was subjectively considered to be helpful by both readers. A higher degree of vascularization was observed with 3D US.The diagnostic role of 3D ultrasound in the diagnostic evaluation of breast cancer is comparable to that of 2D US. Our findings illustrate the significance of the evaluation of frontal views in lesion characterization.

The aim of the study was to find to find out which factors are able to predict the disease-specific knowledge of in-patient diabetic patients and to characterize this group of patients.The disease-specific knowledge of diabetic patients of a Hospital in Munich, Germany (department of diabetology) was tested using a general questionnaire and a specific diabetes knowledge test. All data manipulation and statistical calculations were conducted with the statistical software package SAS (version 9.1).On average type-1-diabetics achieved 73% of the possible points in the knowledge test, type-2-diabetics achieved 68% of total points. In bivariate analyses, using logistic regression, existence of diabetes related complications was a significant predictor of poor knowledge (OR = 4.36; 95%-KI: 1.38-13.77) in type-1-diabetics. Other factors, e. g. lack of diabetes education were associated with low test results but reached no statistical significance (OR = 6.13; 95%-KI: 0.67-56.42). In multivariate logistic regression (female) gender was a significant risk factor for low test results (OR = 7.66; 95%-KI: 1.18-49.8). In type-2-diabetics lack of diabetes education (OR = 3.86; 95%-KI: 1.51-9.84), low self-assessment of information about diabetes (OR = 3.90; 95%-KI: 1.36-11.21) and lack of knowledge about diabetes diet (OR = 4.06; 95%-KI: 1.60-10.28) were predictors of poor test results. The existence of diabetes related complications was associated with poor test results but showed no statistical significance in multivariate analysis (OR = 2.99; 95%-KI: 0.85-10.43).There is a group of diabetic inward-patients that is less informed about diabetes and shows knowledge deficits in testing. These patients often lack diabetes education and show an unfavourable course of the disease, already having diabetes related complications. Type-2-diabetes patients who feel that they have poor information about their disease actually achieve lower results in knowledge testing. Efforts to assure diabetes education for these patients are essentially necessary.

The study aimed at investigating out-patient treatment of patients with depressive disorders referred to a psychiatric hospital by general practitioners (GP) and psychiatrists in private practice (PP). Data of the German psychiatric basic documentation system (DGPPN-BADO) of all depressive inpatients admitted to a psychiatric hospital in 2003 were analysed (n = 360). GP-patients had significantly less often a psychopharmalogical treatment before admission than PP-patients (59.4% vs. 89.7%). GP give significantly less often antidepressive drugs than PP do (53.1% vs. 87.9%). 4,7% of GP-patients and 17.9% of PP-patients received supportive psychotherapy, special psychotherapeutic treatment regimes were seldom in use during outpatient care (4,7% vs. 5,4%).

Eighteen months after completion of long-term treatment of 98 extremely overweight juveniles in the rehabilitation center Insula, this study revealed an improvement in the age-specific body mass index (BMI-SDS) in 55.1% of the cases, when all the non-responders (approx. 22%) were evaluated as failures. An improvement of at least 0.2 or 0.5 BMI SDS points was achieved in 41.8% and 21.4%, respectively.

The lifetime prevalence of bronchial asthma in adults is approximately 5%. Recommended drug therapy of this condition depends largely on its severity and varies from the on demand use of bronchodilators as a single measure up to the additional and sometimes permanent use of inhaled and/or systemic glucocorticoids. In this study, the prevalence and drug therapy of bronchial asthma were analysed in a representative sample of the resident population in Germany aged 18-79 years. We also report about health care utilization, like hospital stay, emergency treatments and use of ambulant medical care, and its associations with asthma medication. Of those study participants who affirmed a medical diagnosis of asthma, 17.3% used corticoid drugs continuously, 19.1% occasionally and 61.8% never. Use of medical services after an asthma attack was reported most often by those who took corticoid drugs regularly. Older people with asthma mostly used glucocorticoids regularly, while in very young patients the occasional use of corticoids was reported more often. When looking at the actual drug use (7 days before the examination) according to the drug usage questionnaire, anti-asthma drugs were mentioned as follows: 47.8% of persons with asthma, diagnosed during the last 4 weeks, used inhaled adrenergic drugs, 34.8% inhaled glucocorticoids, 2.1% systemic adrenergic drugs and 19.3% systemic theophyllines. The measured serum concentrations of theophylline were below 5 mg/l in 34.4%, between 5 and 8 mg/l in 28.1%, between 8 and 20 mg/l in 35.9% and somewhat over 20 mg/l in 1.6%. Our data suggest that especially young asthmatics may not be sufficiently treated with anti-inflammatory therapy, but further studies are needed. If such a deficit can be confirmed, measures for better adherence of therapy to existing guidelines should be considered. Our results, especially on serum concentrations of theophylline, suggest that therapeutic drug monitoring (TDM) of serum samples is not only an important tool in health surveys, but also suitable for increasing the safety and quality of drug treatment in asthmatics.

Prior to implantation of a chronic sacral neurostimulator, it is important to establish which patients might profit from this kind of therapy in order to ensure, by means of a PNE (peripheral nerve evaluation) test, that the implantation of a permanent stimulating device is effective. In this study we compared the two different techniques used in our department (implantation of the permanent neurostimulation electrodes, the so-called "two-stage-implantation" vs. conventional PNE).We performed a sacral nerve stimulation in 53 patients (mean age: 49.7 years, range: 14 - 75 years) over a minimum of 5 days. In 42 patients we performed a conventional PNE, 11 patients underwent "two-stage implantation" with implantation of the permanent electrodes.52 of 53 patients received bilateral test stimulation (9 % at S2, 91 % at S3). One patient underwent unilateral PNE (S3) because of an anatomic deformity of the os sacrum. In 20 cases the conventional PNE-test (cPNE) was successful according to standard criteria (47.6 % of all cPNE). The response rate of "two-stage implantation" with implantation of the permanent electrodes was 81.8 % (9 of 11 patients).The success rate of implantation of permanent neurostimulation electrodes in selecting patients for the permanent implant is significantly higher than the conventional PNE. In this group patients with neurogenic and overactive bladder dysfunctions showed the highest response rates to sacral nerve stimulation and are the most likely to benefit from sacral neuromodulation.

The Elo is a recently established dog breed in which the eye anomaly distichiasis has been frequently observed. Out of a total of 234 Elo dogs ophthalmologically examined over four years, 27.8% of the dogs showed between 1 and 31 distichia. There were twice as many distichia in the upper than in the lower eyelid. Litter size, the number of examinations of Elo dogs per ophthalmologist and the proportion of genes of the Eurasian dog had a significant influence on the prevalence of distichiasis. The error probability for the inbreeding coefficient and the proportion of genes of the Old English Sheepdog were just above the significance limit of p = 0.05. No significance was found for the remaining effects. Heritability for distichiasis was estimated using a linear animal model. After transformation of the linear observed estimate onto the underlying liability scale the heritability estimate was h2 = 0.43.

In the present cross-sectional study the results of three tests to assess the risk of falling were examined for a correlation with advancing age of the participants. Each of the 188 community dwelling active participants aged 40 years or older with a history of knee pain performed the Timed Up and Go (TUG), the Performance Oriented Mobility Assessment (POMA, "Tinetti Test") and a less established simple test of dynamic balance, the Four Square Step Test (FSST). Age-related differences in performance in the Timed Up and Go and the Performance Oriented Mobility Assessment have been shown in previous studies and are also present in this sample. For the Four Square Step Test an association of test performance and age has been shown for the first time in this study. Further investigation is required to determine the quality of these three tests regarding their ability to assess the risk of falling in patients with knee pain.

Several tests have been developed to probe phoneme discrimination. However, little is known about the reliability and validity of discrimination abilities in preschool children as assessed by these tests. Based on previous results we now developed a test material based on minimal pair presentation.Prospective study; 30 preschool children (5;1 to 6;3 years old, 17 boys, 13 girls); descriptive statistics and correlational analysis; items: 60 minimal pairs consisting of real words and nonsense words.Empirical testing confirmed prediction of normal distributed phoneme discrimination errors. No gender specific effects were found. Results correlated with the degree of phoneme opposition and with phonological loop capacity.These results indicate that the test material developed is suitable for testing phoneme discrimination in preschool children. However other normative assessments using larger test populations are warranted. Phoneme discrimination tasks appear to include testing of sensory as well as linguistic-cognitive functioning.

The concurrent occurrence of chronic pain syndromes and depressive symptoms is a commonly observed phenomenon.The aim of the present study was to illuminate the mediating role of specific cognitive pain coping strategies as a connective link between pain and depression.A total of 122 chronic and chronic recurrent simple back pain patients were examined in view of the connection between pain, cognitive pain coping strategies, and depression.The results of the path analysis support the assumption of a mediating effect of cognitive coping strategies between pain and depression (GFI = 0.99; AGFI = 0.96). It could be shown, that cognitive coping mediates the link between pain and depression in back pain patients.The results give further support for the cognitive mediation hypothesis and enhance it by pointing out the role of specific pain-related cognitive appraisals.

Diabetes mellitus type 2 is a polygenic disease. Up to now, numerous candidate genes have been examined and tested for their association to metabolic parameters and late complications of diabetes. Between 2000 to 2004, polymorphisms of the following genes and their association to metabolic parameters and late complications of diabetes were examined in the authors' laboratory: PAI-1 (plasminogen activator inhibitor-1), PPARgamma2 (peroxisome proliferator-activated receptor gamma2), UCP-1 (uncoupling protein-1), and adiponectin. Based on this, the question was examined whether the combination of the respective rarely occurring genotypes results in an increased atherogenic risk and a higher prevalence of micro- and macrovascular late complications of diabetes.Subjects were enrolled from a cohort of 570 type 2 diabetic patients (246 female and 324 male, mean age 66.9+/-9.2 years) who had participated in a population-based study on diabetes and its complications in a mobile survey unit in 23 towns and villages in Bavaria (Germany). Retinopathy was diagnosed by nonmydriatic fundus photography (Canon CR4-45 NM). Photographs of the retina of both eyes (one photo per eye) were taken. Data on macrovascular complications of diabetes were obtained using a standardized questionnaire.A significant association between the number of rarely occurring genotype combinations and the following parameters could be described: diastolic blood pressure, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and grade of retinopathy.An accumulation of certain genotypes of candidate genes for diabetes mellitus type 2 is associated with the severity of dyslipidemia and microvascular late complications, e.g., grade of retinopathy. Therefore, screening for genotype combinations of these metabolic target genes might offer the opportunity to identify diabetic patients at a high risk for macro- and microvascular complications.

The aim of the study was to investigate socioeconomic differences in adolescent health in Germany.Findings are based on data from 5650 11- to 15-year-old German pupils participating in the cross-national study "Health Behaviour in School-age Children" in 2002.Extend and occurrence of health inequalities depended largely on the selected health out comes. Moreover, there were marked gender-specific differences in respect of socioeconomic differences in health. For both, boys and girls, results showed a strong effect of socioeconomic status (parental occupation and family affluence) on overweight. Allergies yielded comparable results in respect of socioeconomic differences. On the other hand, social inequalities had an influence on psychological health mainly in girls. This effect was found for the number as well as for the extent of socioeconomic health differences. No health inequalities were found in respect of injuries, life satisfaction and underweight, independent of gender.The influence of social inequalities on adolescents' health was considerably more complex and more stratified than expected. The analysis indicates that the special characteristics of adolescence need to be taken into account in the discussion of social inequalities in health. The fact that young people's health is probably less influenced by social inequality then it is during other parts of the life course points attention to adolescence as an important stage for preventive efforts.

Endoscopic stenting with self-expanding metal stents (SEMS) has proved to be an efficient palliative endoscopic therapy option in treating malignant dysphagia. Different types of SEMS have been examined previously in small randomized clinical trials.A total of 150 consecutive patients (from 1/1995-1/2004; 35 females, 115 males) with a median age of 66 years (range 43-94 years) were evaluated. Three different types of SEMS were examined: Group A: Gianturco Z Stent n = 59 pts.; Gruppe B: Ultraflex Stent n = 49 pts.; Gruppe C: Flamingo Wallstent n = 42 pts.). Dysphagia was categorized into grade 0 (no dysphagia) to grade 4 (total obstruction).Stent insertion was successfully evaluated in 55/59 (93 %) of the patients in group A, in 47/49 (96 %) of the patients in group B and in 40/42 (95 %) of the patients in group C (p = 0.78). After stent insertion, a reduction in the dysphagia score from 2.77 to 0.99 was observed in group A, from 2.58 to 0.72 in group B and from 2.62 to 0.81 in group C (p = 0.37). The median time to dysphagia recurrence was 78 days in group A, 90 days in group B and 70 days in group C (p = 0.45). The median overall survival time was 96 days in group A, 118 days in group B and 108 days in group C (p = 0.18). The incidence of high grade complications was 34 % in group A, 16 % in group B and 17 % in group C (p = 0.04).The 3 types of SEMS examined in this study showed similar efficacies in treating malignant dysphagia. However, the major complication rate of the Gianturco Z stent was significantly higher when compared to the complication rate of the Ultraflex stent and the Flamingo Wallstent.

Primary Raynaud's phenomenon (PRP) is provoked by digital vasospasm induced by cold and emotional strain. By use of established psychometric test instruments (Freiburger Aggressionsfragebogen (FAF), Fragebogen zur Abschätzung psychosomatischen Krankheitserlebens (FAPK), Stressverarbeitungsfragebogen (SVF 120)) we examined the patients' ways of dealing with aggression and distress as well as their experience of psychosomatic illness. In all psychometric tests performed there were no statistically significant differences between the patients and the controls, indicating that patients with PRP depict no specific ways of dealing with aggression and distress, and do not experience psychosomatic illness. The subgroup of patients with affective disorders and the subgroup of patients with impaired psychological well-being, displayed a 'depressive style' of dealing with life events. Patients with major physical complaints of symptoms of Raynaud's phenomenon showed either an inability or a propensity to deny aggression. Patients with impaired psychological well-being tended to complain more often about severe physical symptoms associated with Raynaud's phenomenon. Psychometric testing in patients with primary Raynaud's phenomenon cannot be recommended without additional psychiatric diagnostic. In patients with primary Raynaud's phenomenon and psychiatric comorbidity psychometric testing can additionally provide useful clinical information.

Colorectal cancer is the second main cause of cancer death in Germany, although several measures related to primary prevention are described, and the utilisation of existing diagnostic tools (faecal occult blood test = FOBT, colonoscopy) is known to significantly decrease incidence and mortality. However, screening rates remain low in Germany, and insufficient knowledge of prevention possibilities is assumed to be responsible. The aim of this study was to investigate the knowledge related to colorectal cancer prevention in a Bavarian population, in the context of a regional public awareness campaign ("Active against Colorectal Cancer").618 individuals between 50 and 90 ys of age participated in a telephone survey (m: 219, f: 399, 63.2 +/- 9.17 ys); the participants were inhabitants of two Bavarian districts. The questionnaire consisted of open-ended questions concerning preventive behaviour, colorectal cancer screening, risk factors, early warning signs and knowledge of colorectal cancer information.More than 80% of participants recalled healthy diet as a possible protective factor against colorectal cancer; a distinctly smaller percentage, however, could correctly define concrete dietary factors: e. g., fruit and vegetables were named by 54.5%. 66% of participants knew that unusual rectal bleeding might be a warning sign of cancer. Colonoscopy was the screening test that was most frequently recalled (61.5%); fewer participants named FOBT (32.8%) and rectal examination (11.5%). The results demonstrate that for many knowledge items, females proved to be significantly better informed than males. The most frequent sources of colorectal cancer information were newspapers, magazines, television and/or radio (named by 76.7%), as well as physicians and pharmacies (45.1%). 11.5% of participants attended the regional public awareness campaign "Action against colorectal cancer"; this subgroup had a better knowledge of some aspects related to colorectal cancer prevention.Evidently, the interviewed Bavarian population of 50 years or older lack knowledge of risk or protection factors for colorectal cancer. Knowledge of existing screening tests was also poor. These findings can serve as starting point for information campaigns tailored for target groups.

To evaluate the applicability of the Canadian CT Head Rule (CCHR) on head trauma patients in a German university hospital.122 patients (m = 74; f = 48; 40 +/- 19 years) were examined with cranial CT due to minor head trauma. The need for cranial CT according to the CCHR was evaluated retrospectively.With a sensitivity of 98.9 % and a specificity of 46.6 % all patients with the need for neurosurgical intervention were detected by applying the major criteria of the CCHR. Also, every patient with severe brain injury was detected by the extended criteria with a sensitivity of 99.6 % and a specificity of 34.1 %. This would have led to a reduction in the rate of cranial CT examinations by 45.1 % for the major and 22.1 % for the extended criteria. No patient with severe brain injury would have been missed by application of the criteria.The Canadian CT Head Rule for patients with minor head trauma is applicable with a very high sensitivity and the potential of significantly reducing the rate of cranial CT examinations in these patients.

To test whether contrast-enhanced low mechanical index (low MI) sonography is superior to non enhanced B-Mode sonography in differentiating synovitis and joint effusion.In a retrospective study, 22 patients with proven rheumatoid arthritis underwent B-Mode sonography and low-MI sonography of 25 symptomatic joints of the upper and lower limbs. For low-MI sonography, 5 ml Sonovue (Bracco Altana Pharma GmbH, Konstanz) were injected as an intravenous bolus followed by 10 ml of 0.9 % saline solution. Magnetic resonance imaging (MRI) was obtained additionally in 3 joints. With non-enhanced sonography, we diagnosed a synovitis in case of an echogenic and a joint effusion in case of an anechoic mass. With contrast-enhanced sonography, we diagnosed a synovitis in case of enhancement and a joint effusion in the absence of enhancement of the intraarticular mass.In 13 joints, synovitis and joint effusion were differentiated by both non-enhanced and enhanced sonography. In 12 joints, this differentiation was only possible with contrast-enhanced sonography. In 3 patients diagnosed by sonography as having a synovitis, this diagnosis was proven by MRI.Contrast-enhanced low-MI sonography is superior to non-enhanced B-Mode sonography in differentiating synovitis and joint effusion.

Left-sided diverticulitis is a common disease in Western countries, whereas right-sided diverticultitis is rare and symptoms are often similar to the clinical signs of an acute appendicitis. It was the aim of this study to analyse surgical experience in right-sided diverticulitis.All patients who underwent resectional surgery for both right-sided and sigmoid diverticular disease were entered prospectively in a registry database (8-year observation period, 1996-2003). For the current study, a retrospective analysis of all patients who underwent ileocolic resection or right colectomy for right-sided colonic diverticulitis was performed, specifically focussing on incidence, clinical symptoms, indication for surgery, type of procedure, and histopathological parameters including immunohistochemistry, and outcome in right-sided diverticulitis.Within eight years, 481 patients were treated surgically for chronically recurrent or acute complicated diverticular disease: 468 patients with sigmoid diverticulitis, 12 patients with right-sided diverticulitis, and 1 patient with combined right-sided and sigmoid diverticular disease. This corresponds to an incidence of right-sided diverticulitis of 2.5 % related to the total number of resections for diverticulitis, and an incidence of 1.3 % in relation to the appendectomies in our patients. In 4 patients, acute appendicitis was presumed preoperatively. Most common diagnostic tool was ultrasonography. Right colectomy was performed in 9 patients with complicated cecal diverticulitis, whereas ileocolic resection was performed in 2 patients and simultaneous ileocolic and sigmoid resection was carried out in one patient. Postoperatively, no morbidity occurred. Histopathological assessment showed local perforation in 75 % (9/12). Hypoganglionosis or aganglionosis was detected in 5 of 12 resected specimen.As right-sided diverticulitis is a rare colonic disease in Western countries, the differentiation from acute appendicitis can be difficult. In general, there is no difference in the treatment of right-sided diverticulitis compared to left-sided diverticulitis, and surgery is only indicated in complicated right-sided diverticulitis. Resection of the inflamed colon with primary anastomosis is safe and can be performed by laparoscopy in experienced centers. At present, it can only be speculated whether hypoganglionosis or aganglionosis are causative factors in the etiology of right-sided diverticulitis.

Literature provides ample evidence that tactile-kinesthetic responsiveness is of basic importance for a normal speech development. The purpose of this study was to examine tactile-kinesthetic functions in children with cleft lip palate as they are suspected to be at risk to develop disturbances in this respect because of their anatomic defect.Tactile-kinesthetic responsiveness was measured using the specific DEF-TK questionnaire as previously proposed by Kiese-Himmel. Twenty-seven children aged 1;3 to 7;11 years with cleft lip palate were examined. Forty-two children with an isolated speech development disorder served as age matched controls.The results of both the study and the control group did not differ on a statistically significant level (p0.05). Compared to the data taken from the test manual both groups exhibited a significant number of questionnaires which could not be analyzed because of too many unobservable (not missing!) items, yet, this number did not differ between the two groups. So a "best case" and a "worst case" were calculated but did not reveal significant differences either.Surprisingly and in contrast to the results reported in the literature the DEF-TK questionnaire exhibited methodical shortcomings with a significant number of cases in which it could not be analyzed due to too many unobservable items. So, the results obtained can only be discussed under reserve: They indicate that children with cleft lip palate do not exhibit more tactile-kinesthetic problems than children with an isolated speech development disorder and thus do not require specific therapy in this field.

Gastroesophageal reflux (GER) is the main risk factor for the development of adenocarcinoma of the esophagus (AC). The aim of our study was to evaluate symptoms of patients with AC to identify those patients with a high risk for this tumour.117 consecutive patients with known AC were included. Prospectively all patients were interviewed with a standardised questionnaire comprising 120 items: social status, other diseases, risk factors, therapy of the GERD and, as a main part: current symptoms and those experienced at earlier times.85 % of the patients had often or sometimes reflux symptoms. 46 % of the patients with reflux symptoms had such symptoms daily. The median time span for this symptom was 20 years with a range from 1 year to 50 years. In 21 % of the patients the reflux symptoms stopped (median) three years (range two months -- 30 years) before the diagnosis of the carcinoma. Only 55 % of all patients had one or more esophago-gastroscopy examinations before the diagnosis of AC. These patients showed significantly more often earlier tumour stages than those patients without an endoscopy before diagnosis. Heartburn was treated with medication in 78 % of the patients (67 % of all patients). No patient had previously undergone antireflux surgery.15 % of the patients with adenocarcinoma of the esophagus show no, and in addition 25 % only discrete, heartburn; 1. an endoscopy due to heartburn was done in half of all cases, and 2. the medications do not fulfil the therapeutic standard; 3.patients with endoscopy had significantly more frequently an earlier tumour stage.

To compare virtual with flexible bronchoscopy for the detection of bronchial stenoses.In a retrospective study, we compared the results of 26 patients, who had clinical suspected pathologies of the tracheobronchial airways and underwent both flexible bronchoscopy and multislice CT with 3D surface rendering of the airways. Flexible bronchoscopy and virtual bronchoscopy were compared as to the rate of detecting bronchial stenoses. For statistical analysis, we divided the tracheobronchial tree in the following sections: trachea, 2 main bronchi, 6 lobar bronchi, 18 segmental bronchi and 36 subsegmental bronchi, corresponding to 63 bronchial sections for each patient (on average) and a total of 1638 bronchial sections for all 26 patients. We graded the bronchial stenosis as less than 50 %, as 50 to 95 % and as complete obstruction.Virtual bronchoscopy detected 25 bronchial stenoses, while flexible bronchoscopy only revealed 17 stenoses. Stenoses with a diameter less than 50 % were found with virtual bronchoscopy 14 times and with flexible bronchoscopy 10 times. Stenoses with a diameter between 50 and 95 % were detected 7 and 4 times, respectively, and complete obstructions 4 and 3 times, respectively. Tracheobronchial stenoses were well recognized with virtual bronchoscopy. Moreover, the virtual method enabled the visualization of high-grade stenoses and post-stenotic areas that could not be passed by the fiberoptic bronchoscope. Virtual bronchoscopy detected stenoses at a higher rate but the difference was not statistically significant (stenoses50 %: p = 0.352, 50 - 95 %: p = 0.339, complete obstruction: p = 0.696).Virtual bronchoscopy is a useful non-invasive method for the diagnostic evaluation of the tracheobronchial tree. In comparison with flexible bronchoscopy, virtual bronchoscopy is superior in revealing high-grade stenoses and visualizing post-stenotic areas.

Group A Streptococci have remained sensitive to penicillins and other betalactam antibiotics, e. g. cephalosporins. Since the beginning of the 1950s oral penicillin V given three times daily in a dose of 50,000 IU daily has been the drug of choice against Group A streptococcal infection. The German Society for Pediatric Infectious Diseases (DGPI) undertook a large scale multicenter randomized study of culture-proven A-streptococcal tonsillopharyngitis to compare the efficacy and safety of a five day regimen of ceftibuten (9 mg/kg KG, once daily) with 10 days of penicillin V (50,000 I.E./kg KG, divided in three doses), testing for equivalence of clinical and bacteriological efficacy. A one year follow-up served to assess poststreptococcal sequelae like rheumatic fever or glomerulonephritis.The clinical efficacy at the clinical end-point 7-9 days after end of treatment was 86.9% (419/482) for ceftibuten and 88.6% (1,198/1,352) for penicillin V. This result is statistically equivalent (P = 0.0152). Resolution of clinical symptoms was significantly faster in the ceftibuten group (P = 0.043/Fisher-Test) and compliance was significantly superior as well (P (0.001). Eradication of group A streptococci at an early control 2-4 days after end of treatment was not equivalent, 78.49% for ceftibuten and 84.42% for penicillin V (P = 0.5713). Both eradication rates were comparable 7-8 weeks after end of treatment (84.65%, 375/443 ceftibuten vs. 86.82%, 1,067/1,229 penicillin V), the difference not being significant. No cases of poststreptococcal sequelae, e.g. rheumatic fever or glomerulonephritis, attributable to either ceftibuten or penicillin were observed in the course of the study.

To report our clinical experience in calcium scoring and coronary angiography with multislice computer tomography (MSCT).Cardiac four-row MSCT (Siemens, Volume Zoom, Erlangen, Germany) was performed in 60 patients, comprising 45 patients without known coronary vessel disease (CVD) and falling in an intermediate risk (group I) by calcium scoring, and 15 patients with multivessel disease by the combination of calcium scoring and MSCT coronary angiography (group II). Group I underwent analysis of risk factors as well as patient management in the form of risk profile modulation, indication for invasive selective coronary angiography (SCA) and supplemental myocardial diagnostic evaluation (e. g., SPECT). Agatston and volume scores (Virtuoso, Siemens, Erlangen, Germany) were calculated for calcium scoring. Group II had the calcium scoring and diagnostic accuracy of MSCT in detecting coronary artery stenosis evaluated according to established American Heart Association (AHA) criteria. SCA was used as gold standard.In group I, calcium scoring was positive in 27/45 (60 %) patients, with 14/27 (52 %) consecutively referred to SCA and 2/27 (7 %) to SPECT. SCA revealed significant coronary stenosis (60 %) in 5/27 (19 %) patients and SPECT detected myocardial ischemia in 0/2 patients. Patients with obstructive coronary vessel disease showed a significantly increased calcium score of300 together with a high risk profile. Patients with negative calcium score showed significantly less risk factors (p0.05). The use of calcium scoring in therapeutic procedures in the form of increased modulation of risk factors was documented in 21/45 (47 %) patients. In group II, sensitivity, specificity and diagnostic accuracy for the detection of high grade coronary artery stenosis were 64 %, 99 % and 96 %, and the Agatston and Volume scores were 333 +/- 123 and 334 +/- 136, respectively.MSCT can be applied as risk profile module for coronary screening of patients with intermediate risk. As non-invasive alternative for the evaluation of coronary vessel disease, it can be useful in some cases by providing additional information.

To analyse drug therapy knowledge of prescribed drugs and self-administered medicinal products we interviewed 222 ambulatory cardiovascular patients. Spontaneous mentions of drugs (at least 3 preparations on average) were completed later on specific questioning. 40% of patients once interrupted their therapy due to adverse drug reactions. Most patients knew the labels of their medicaments but the effects and indications only in 50%. Nevertheless 70% were satisfied with the informations of the physician. Drugs available over the counter were consumed in many of the respondents: 50% consumed analgetics, and--mainly female patients--25% sedatives and 15% laxatives or diuretics. We conclude that specific questioning on self-administation of OTC preparations or formerly prescribed drugs results in an improved overview of medication and a better handling of polymedication and drug compliance.

The (dis-)advantages of preoperative chemoradiation in patients with esophageal cancer (EC) are still controversial as data are lacking showing a clear cut benefit. Therefore, data of neoadjuvant therapy of our hospital have been analyzed. Since 1994 102 patients with an EC (33 % adenocarcinoma, 67 % squamous cell cancer, scc) were operated after receiving preoperative chemoradiation (36 Gy radiation, 1.8 Gy/day for 4 weeks, 500 mg/m (2) 5-FU for 4 weeks and 20 mg/m (2) Cisplatin, day 1-5, week 1 and 4). Operation was performed usually 8-10 weeks after treatment start. In 11.7 % of patients with an adenocarcinoma a complete pathological response (CR, pT0N0M0) was observed and a pT0 stage in 20.6 %. 38.2 % of these patients were staged as pN0. Postoperative morbidity was observed in 66 % (anastomotic leakage in 20 %, recurrent nerve palsy in 23 %). In-hospital mortality was 5.9 %. 5-year survival was calculated as 30.5 %, in patients wit a CR 66 %.26.5 % of patients with a scc revealed a CR. However no effect at all was observed in 32 % of these patients. 56 % were staged as pN0. Postoperative morbidity was observed in 87 % (anastomotic leakage in 16 %, recurrent nerve palsy in 32 %). In-hospital mortality was 11.8 %. 5-year survival was calculated as 19.2 %, in patients with a CR 45 %. The impact of pN stage was significant (p = 0.0052). These results underline the benefit of neoadjuvant therapy in patients with a CR. Further on, a pN0 stage is an important prognostic indicator. However, it remains open, whether neoadjuvant therapy leads to a downstaging of lymph node involvement, as histological confirmation in clinically positive lymph node is seldom performed prospectively.

Fall-related injuries in nursing homes for the aged are frequent and cost-intensive. Their iatrogenic causes are well known and avoided in modern geriatric institutions. We examined all falls in an institution during the period of 19 months. Patients who carry out daily tasks on a semi-independent level were most at risk. The main risk-factor was dementia. Medication did not prove a major risk-factor. At 37% p. a. the risk of falling was lower than in previous studies. This was due to a restriction on benzodiazepines with short term effects, minimising of neuroleptics, diuretics and other types of antihypertensives as well as avoidance of polypharmacy. Unavoidable risks need to be identified and should result in use of a hip protector.

Today the most common application in the field of computer-assisted surgery is navigated total knee arthroplasty. During the last 5 years the imageless kinematic navigation systems have gained wide acceptance. As several prospective randomized studies could show, the standard deviation of the mechanical axis is reduced significantly by these techniques. However, the direction of the mechanical axis is only one factor which influences the long-term results of total knee arthroplasty. Further important factors are ligament balancing and position of the femoral and tibial components in all three planes. Up to now no studies have been able to show a significantly better functional result, a more rapid recovery, or a decreased complication rate. Drawbacks of the navigation systems are the additional costs and the additional operation time between 15 and 20 min. Therefore, navigated total knee arthroplasty is not yet a standard procedure, but this technique is well on the way to becoming the gold standard in the future.

Due to the severity of their clinical picture and their shattered sense of physical inviolability that almost always is associated with their condition as well as their changed physical appearance, inpatients being treated at the clinic for technical orthopedics frequently exhibit comorbid mental disorders. This article examines these mental health comorbidities. The proportion of adjustment disorders in this group was shown to be noticeably higher than in a comparative group of outpatients attending a psychosomatic/psychotherapeutic clinic. Furthermore, diabetes mellitus proved to be another statistically significant organic comorbidity in the patients treated at the clinic for technical orthopedics. This article discusses the extent to which the chronicity of this disease affects the psychosomatic diagnoses but also the course of the treatment in the clinic for technical orthopedics. In conclusion, this article emphasizes the need for close interdisciplinary management for this highly selected patient group because of the high rates of comorbidity.

Primary hyperparathyroidism (pHPT) occurs in about 90% of patients with multiple endocrine neoplasia type 1 (MEN1). In contrast to sporadic pHPT, multiple gland disease is most common in MEN1. The appropriate surgical approach is still controversial. The aim of this study was to analyze the results of surgical therapy of pHPT in patients with genetically confirmed MEN1. In an observational study, preoperative data, operative procedures, long-term results, and a possible genotype-phenotype correlation were analyzed in patients with pHPT and genetically confirmed MEN1. According to our results, tPTX+T (total parathyroidectomy+thymectomy+autotransplantation) seems to be a more favorable surgical approach in patients with MEN1 pHPT than sDE (selective gland exstirpation) and stPTX (subtotal parathyroidectromy) without cervical thymectomy, because recurrences or persistence of the disease are rare. A prospective randomized trial is needed to compare stPTX including cervical thymectomy vs tPTX+T. A genotype-phenotype correlation could not be identified.

To evaluate magnetic field interactions of commonly used biomedical implants at 3.0 Tesla.Fourteen aneurysm clips designed for permanent placement in intracranial aneurysms, 19 coronary artery stents and 20 iliac artery stents were evaluated in an actively shielded compact 3.0 T MR system (Intera, Philips Medical Systems, Best, The Netherlands, length of magnet 1.57 m). The magnetic deflection forces (translational movement) were evaluated as follows: The implants were suspended by a fine string and placed in the magnet bore at the location of the maximum magnetic field gradient. The translational forces F (z) were calculated from the measured angle of deflection from the vertical axis. The magnetic field-induced torque (rotational forces) was evaluated as follows: Each implant was placed in the center of the magnetic bore parallel to the static magnetic field B0 (position 0 degrees ). Any possible displacement of the implant was noted on a millimeter scale and any torque qualitatively evaluated using a 5 point grading scale (0: no torque; + 4: very strong torque). The implant was turned in steps of 45 degrees, and the procedure was repeated to encompass a full 360 degrees rotation.In 52 of the 53 devices tested, the deflection force (deflection angle: range 0-21 degrees, translational force: range 0-3.8 mN) was less than the gravitational force (i.e., the implant's weight). These devices (n = 52/53) did not show any alignment to or rotation in the magnetic field at any of the various 45 degrees -increment positions corresponding to a qualitative torque evaluation of grade 0/4. One device (n = 1/53), an iliac artery stent made of stainless steel (Zenith, Cook, Mönchengladbach, BRD), was found to have deflection forces (deflection angle 88 degrees translational force 299 mN) greatly exceeding the gravitational force as well as a pronounced torque (grade 4/4).Out of 53 biomedical implants evaluated for magnetic field interactions at 3.0 T, one iliac artery stent made of stainless steel was found to be potentially unsafe based on ASTM criteria. MR imaging at 3.0 Tesla may be performed safely in patients with any of the other 52 different implants evaluated in this study with respect to magnetic field translational attraction and torque.