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Es wurden Checklisten zur anlagenspezifischen Identifizierung von Optimierungspotenzialen für Kläranlagen mit Faulung entwickelt. Wesentliche Ziele sind die energetische Optimierung der Anlagen, die Reduzierung der Schlammmengen für die Entsorgung und die Sicherstellung der Abwasserreinigung auf einem hohen Niveau. Ein Überblick über die Ansätze zur Optimierung bestehender Faulungsanlagen, die Checklisten sowie Ergebnisse bei deren Anwendung wird gegeben.

The purpose of the paper was to generate up-to-date, representative osteoarthritis prevalence data for individual population subgroups and to identify potential risk factors.A cross-sectional study, the "First National Health Survey", investigated the prevalence of osteoarthritis, comorbidity and health-relevant behaviours of the post-unification German population on the basis of interviews with physicians and medical evaluations conducted in the period from October 1997 to March 1990. The study was based on a net sample comprising 6205 subjects aged 18-79 years.The three main correlates for osteoarthritis are age, obesity and occupational stress factors. Osteoarthritis patients are more likely to have osteoporosis, thyroid disease, chronic bronchial disease, hypertension and elevated blood lipids, but do not tend to have a higher incidence of diabetes.Our data show the importance of preventive behavioural approaches such as weight management and workplaces designed to limit joint overuse.

The report describes a case of post-mortem scavenging by a songbird. A married couple had opened the cage of an astrild (finch) prior to their joint death. The body of the wife showed unusual patchy epidermal lesions on parts of the body not covered by the clothing, which were obviously caused by the songbird. According to the observations made by Roll and Rous they are attributable to "pecking and pulling". The behaviour of the bird was most probably due to lack of fluid.

The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia.One hundred and fifty-eight patients with stage IIA-IV breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. Radiation treatment consisted of an interstitial boost of 10 Gy 192Ir-afterloading therapy and a course of external beam radiotherapy of 50 Gy, using 5 x 2 Gy/week. Local hyperthermia with 43.5-44.5 degrees C over 60 minutes was delivered immediately before interstitial radiotherapy.One hundred and forty-two patients underwent salvage surgery. A breast-conserving approach was possible in 74 patients (52%). Fifty-three patients (37%) underwent flap-supported surgery. After a median follow-up of 20 months, one patient developed isolated local recurrence. In 14 cases, locoregional recurrences occurred in combination with distant metastases.In about 50%, breast conservation was achieved by chemotherapy, radiotherapy and hyperthermia. The low isolated local recurrence rate of 0.6% (1/158) has to be substantiated by further follow-up.

The stability of flunitrazepam, flurazepam, diazepam and some of their metabolites in spiked blood and plasma samples was studied bei GC-ECD analysis at defined time intervals up to 240 days. Validation data of the method are given. The blood or plasma samples were stored either at 22 degrees C or at 4 degrees C, and were exposed to global natural light irradiation or protected from light. All substances considerably decreased during the time interval studied. Flunitrazepam soon disappeared completely at room temperature (22 degrees C), while diazepam and flurazepam proved to be more stable, but a clear pattern of breakdown could not be established. The data obtained suggest a result from a long-term stored sample to be cautiously interpreted. Further investigation concerning the stability of drugs and the establishment of optimal storage conditions seem necessary.

A case of fatal sodium azide poisoning is reported. From the hospital staff, a 57 year old patient had obtained 1 g of sodium azide in order to put it as a preservative, in his 24 hour urinal. Probably due to an error, he swallowed the total dose. A cardiovascular collapse was cause of the death after five hours of intensive treatment and reanimation. Azide anions were found in blood (traces, less than 0.5 mg/L), vitreous (10 mg/L) and cerebrospinal fluid (20 mg/L). The use of sodium azide for disinfection of urine samples should be regarded as obsolete. Less toxic substances for disinfection are available. To avoid chemical disinfection, urine samples can be kept at 4-8 degrees C prior to rapid analysis.

The aforementioned case proves very convincingly that a very high dose of alcohol consumed within a short time span can be absorbed completely within 2 hours. Numerical models based on low to moderate alcohol consumption were lower than expected in cases of severe alcohol intake. The claim of alcohol consumption after an event can best be verified by means of a drinking experiment under intensive medical supervision.

Doctors of legal medicine often have to act as experts when it comes to determining the influence of alcohol or drugs. For this work it would be desirable to have many years of experience in dealing with alcoholics or occasional drinkers. Therefore, drinking experiments have always been part of the training of a doctor of legal medicine, as well as playing an important role in legal practice. It would be wrong if the experience in the legal sense were to be considered sufficient for standardising the judgement of legal responsibility. However, this is often attempted. Too much schematism should be avoided with the so called per mille graduation.

For that reason absorption of bile acids was investigated using the 75Se-homotaurocholate (SeHCAT) in 239 patients with diarrhoea. SeHCAT retention time was measured as 7 day retention time in a whole body counter. An intact bile acid absorption (negative SeHCAT test) was confirmed in 23 healthy volunteers within the range of 11 to 50% (mean +/- double standard deviation).In 135 patients with a possible type I bile salt malabsorption the SeHCAT test was positive in 78%, thus indicating bile salt malabsorption. The test is very sensitive detecting bile salt malabsorption in Crohn's disease, identifying ileal disease more precisely than radiology. The SeHCAT test ascertained type II primary bile salt malabsorption in 7 patients, as well as type III bile salt malabsorption in patients (9 out of 28) with cholecystectomy, vagotomy, partial gastrectomy and chronic pancreatitis. In addition, a positive SeHCAT test indicating bile acid malabsorption was found in 5 out of 11 patients with irritable syndrome, diarrhoeic form, and in 4 out of 12 patients with lactose intolerance.SeHCAT retention should be measured routinely in patients with chronic diarrhoea for which the cause is not obvious.

In-depth advice about contraception is important for type I diabetic women since special medical aspects have to be considered and because pregnancy should be planned. The actual contraceptive practice in diabetic women living in Germany had not been investigated before.In December 1992 type I diabetic women of 16 to 46 yrs of age who had consecutively participated in a diabetic treatment and teaching programme (n = 1028) were mailed a multiple-choice questionnaire about reproductive and contraceptive issues. 409 non-diabetic women were also questioned and served as a control group.808 diabetic women (age 32[7] yrs, duration of diabetes 14[8] yrs) returned the questionnaire. The percentage of women using a method of contraception was comparable between diabetic and control women (76 vs. 72%). Of these, fewer diabetic women used oral contraceptives (OC) (33 vs. 57%). The OC-using diabetic women were younger than those using other methods (27[5] vs. 33[7] yrs), however 63% had at least one of the contraindications for OC-use (smoking, hypertension, proteinuria, retinopathy, poor metabolic control) and 18% were using high-dose preparations. More diabetic than control women used IUDs (19 vs. 12%) and more diabetic women were sterilised (19 vs. 9%). Compared to controls diabetic women had had sterilisation at a younger age (31[5] vs. 36[4] yrs) and more sterilised women were childless (29 vs. 14%). Methods of lower efficacy (condom, diaphragma, spermatocides) were used by 26% of diabetic women (controls 20%), p0.05. Nearly half of the diabetic women had received contraceptive advice exclusively by gynaecologists. 22% of all pregnancies were unplanned (controls 17%); 00.05).More diabetic women should use methods of contraception with high efficacy. However, when prescribing OCs more attention must be payed to special contraindications. Sterilisation should be recommended more cautiously to diabetic women without advanced diabetic complications. Contraceptive advice to diabetic women must be given by gynaecologists and diabetologists.

The triage of victims after radiation injury is complicated by missing dose values and the fact that most tissues react after a latency period.We evaluated 63 patients undergoing total body irradiation as conditioning regime before bone marrow transplantation in order to find a relation between prodromal symptoms and dose.Emesis after radiation exposure hints to doses greater than 1.5 Gy. A rise of body temperature above 37 degrees C up to five hours after exposure is related to doses exceeding 2.5 Gy, while an acute onset of diarrhoea is an indicator of a severe accident with more than 9 Gy.Besides blood counts and chromosome analyses a careful evaluation of prodromal symptoms can help to classify the severity of radiation accidents.

The distribution of prothipendyl (Dominal) in two cases of fatal poisoning are reported. The highest concentration of prothipendyl were found in liver (1.2 g/kg to 1.8 g/kg) and kidney (0.6 g/kg). Prothipendyl concentrations in these organs far exceeded those in blood. In the first case we found a blood concentration 200 times over the therapeutic range. Prothipendyl was detected in all specimens tested including: lung, muscle and stomach. These results are in agreement with limited, previously reported data and indicate that more then 4 g of prothipendyl is fatal overdose. In this report the survival time and dose are discussed.

Between 1980 and 1988, 116 patients with invasive breast cancer were treated by limited surgery with axillary node dissection followed by radiation therapy. Radiotherapy was performed by individually computerized treatment planning. The target volume dose was 50 Gy to the whole breast followed by an electron boost of 10 Gy to the tumor bed. The median follow-up period was 59 months. The actuarial overall survival rate is 93%, and the disease-free survival 75.2%. Ten (8.6%) breast recurrences occurred. Analysis of clinical and pathological prognostic factors revealed that local control was impaired by young age, negative hormone receptors, G3-4 tumors and intraductal growth. The recurrence rate for T3- and T4-tumors was 12.5%.

After sniffing of glue solvents (mixture of aliphatic hydrocarbons: boiling fraction 60-90 degrees C, ethylacetate and toluene) a blood alcohol concentration of 1.96 permille was indicated with an instrument using the infrared wavelength of 3.4 micrometer for the spectrophotometrical determination of breath alcohol. Testing of the individual solvents with a simple manual procedure showed linear relationships between concentrations in breathing air and the false positive breath alcohol values. Aliphatic hydrocarbons predominantly are responsible for the false positive breath alcohol determination. With 500 micrograms/liter a value of nearly 1.5 permille can be produced (using the factor of 2100 for the calculation of the blood alcohol concentration from breath alcohol). With ethylacetate or toluene up to 1 milligram/liter 0.5 permille ethanol in the blood will erroneously be found. The problem of recognition of crossreactive other gases by the measurement at two wavelengths (3.4 and 9.2 micrometer) is discussed.

Report on suicide with chloroquine in combination with maprotiline and trimipramine. Chloroquine and his metabolite monodesethylchloroquine could be determined in organs and body fluids. The highest organ-concentrations of chloroquine were found in liver and kidney. The survival time and dose are discussed.

Among combined radiochemotherapy regimens of advanced head and neck tumors four modalities can be discriminated: 1. Induction chemotherapy, 2. simultaneous radiochemotherapy, 3. adjuvant chemotherapy, 4. accelerated hyperfractionated radiotherapy and chemotherapy. The results of the presently available randomized trials are as follows: 1. Induction chemotherapy has no influence on long-term recurrence-free survival. 2. With respect to simultaneous radiochemotherapy, recurrence-free survival has been unproved with 5-FU and Mitomycin C. 3. There is evidence that adjuvant cisplatin therapy improves recurrence-free survival. 4. No results are available to date using hyperfractionated accelerated radiotherapy regimens in combination with chemotherapy.

After preceding radiotherapy, chemotherapy and/or surgery the therapeutic options are limited in case of recurrence. In order to enhance the effect of a reduced radiation dose we have combined intravenous mitoxantrone and simultaneous irradiation. From 1988 to 1991 22 patients with recurrent head and neck carcinomas were treated with this combined regimen. 20 patients had already been irradiated with 50 to 70 Gy. The second treatment course was given with 19.8 to 56.0 Gy and simultaneous application of one to three courses of mitoxantrone. Eleven (50%) patients achieved a clinical complete remission. A partial remission was seen in nine patients.

For the precision testing of the gas-chromatographic and the ADH-enzymatic method respectively we used commercially available control sera. During one year of testing (1990) they were daily and routinely used together with the specimen analysed. With the automatized GC-method the precision required according to the jurisdiction of the Bundesgerichtshof was better than with the manual ADH-method. The precision of the ADH-method should be improved using an autoanalyzer. Systematical errors between the two different methods (GC and ADH) can be minimized by a double GC-determination. Our investigation also aimed at a possible lower threatening threshold of 0.5% (BAK) as a consequence of the german "Wiedervereinigung". The precision for this concentration is 0.02% for the GC- and the ADH-method.

A traumatic osseous bridge between lumbar transverse processes is a bone formation occurring after severe or even mild trauma of the back. However, only few of the patients with a contusion of the back or a fracture of a lumbar transverse process develop such an osseous bridge. The localisation of the haematoma plays an important role in this process, but myositis ossificans is a mandatory condition. Anamnesis will not lead to traumatic aetiology in all cases, because sometimes the patient is not aware of the fact that a transverse process has been fractured. The diagnosis finally depends on the recognition of the different shapes. The traumatic osseous bridge is characterised by the kind of trauma that causes the fracture of the transverse process. The shapes can be classified as "h", "H", "K", or "Z". Among 72 patients with inter-transverse osseous bridges, only 11 patients have congenital bridges. The congenital osseous bridge shows typical features that can be explained by means of embryogenic and functional dynamic considerations. These symptoms are the O-shape, concavity of the lumbar spine of a pathological nature and the absence of degenerative changes in the corresponding intervertebral space.

Multiple myeloma of IgG kappa type was diagnosed in a 42-year-old man with bone pains, dyspnoea on exertion and increasing drowsiness. Six chemotherapy cycles extending over 14 weeks and consisting of 15 mg/m2 melphalan intravenously on day 1 and 60 mg/m2 prednisolone orally on days 1-4 produced a partial remission. As the HLA-identical sister of the patient was willing to donate bone marrow, an allogeneic marrow transplantation was planned. After 7 days' conditioning treatment (hyperfractionated whole-body irradiation with 12 Gy, chemotherapy with 70 mg/m2 melphalan and 60 mg/kg cyclophosphamide), 4.2 x 10(8) nucleated cells of donor marrow were infused per kg recipient body-weight through a central venous catheter. Despite prophylaxis with short-course methotrexate and cyclosporin, an acute graft-versus-host reaction of grade II-III occurred on day 26, though it settled almost completely after treatment with daily 2 mg/kg prednisone and monoclonal interleukin-2 receptor antibodies (B-B10, daily 10 mg). On day 100 after the marrow transplantation, marrow puncture showed the picture of complete remission with normal regeneration of haemopoietic cells. Allogeneic marrow transplantation may therefore be considered as a new and promising mode of treatment for younger patients with multiple myelomas.

From 1979 to 1988 63 patients with cancer of the colon received postoperative adjuvant radiotherapy. The mean age was 62 years and the median follow-up period was 71 months. Pathologic staging showed a B1-tumour in nine cases, B2 in 25, C1 in three and a C2-tumour in 26 cases according to the Astler and Coller modification of the Duke's classification. 53 patients received doses between 41 and 50 Gy. 47 patients were treated with a 60Co megavoltage unit and 16 cases with 8 MV photons. The overall five years survival rate is 65%. There was no significant difference between the survival rates for all stages. Only four patients with primary positive lymph nodes experienced a local relapse. 16 developed metastatic disease. In twelve cases (19%) liver metastases appeared: four patients (6%) developed intraperitoneal metastases, one patient had a metastasis in the abdominal wall and another showed pulmonary carcinosis. Acute and transient side effects were seen in 35% of our patients. Three patients underwent a second operation for radiation induced bowel stenosis. Compared with the results of surgery adjuvant radiotherapy yields improved five-year survival data in patients with C2 and G4 tumours.

Acute skin lesions following radiotherapy are uncomfortable and unacceptable side effects. They are observed predominantly after high surface doses as in conventional roentgen or electron beam therapy. To accelerate the wound healing we tested a bandage consisting of hydrocolloids and polymers, which is permeable for gas and water. Handling, compatibility and effectiveness of this plaster were tested in this study. According to the RTOG scoring system 19 irradiated fields with grade II to IV lesions were treated. Densitometric measurements of verification films with and without Biofilm showed no energy absorption. The bandage was comfortable for the patients and easy to handle.

The processing of blood alcohol measurements by alcohol dehydrogenase method (ADH) was improved by using a tailored software program. The program is written in Turbo BASIC and requires an IBM Personal Computer (PC/XT/AT) or compatible with at least 640K memory and a graphic adapter (EGA or Hercules). All features of the program are available from the menu bar with pull down menus. The program stores on disk or harddisk the optical density values measured with an HITACHI spectrophotometer. After the measurement the calculation of alcohol concentration is accomplished by the program. The results can be transferred and further handled with database systems (e.g. DBASE III). Stored values are used to calculate the reproducibility of calibration and the precision of single determinations.

This is a short report of an erythema arising suddenly after implantation of a cardiac pacemaker on the right side of the thorax. The patient, the results of examination and histology, the thermophysiologic reactions are described and the diagnosis of cutaneous passive hyperemia offered, caused by the position of the pacemaker in connection with the multiple regional operation scars.

The results of treatment of the first 100 patients with uveal melanomas treated with 106-Ruthenium applicators in Essen are presented. The mean follow-up period was 2 years; 80 of the patients presented with choroidal melanomas and 20 with melanomas of the ciliary body. Five of the 100 patients had metastatic disease originating from the primary uveal melanoma. Compared to 60-cobalt therapy, therapeutic results are similar in terms of tumor regression, but the incidence of complications was significantly lower. In 16 patients the eye with the tumor had to be removed, because of tumor growth (12), neovascular glaucoma (3), and vitreous hemorrhage (1). Visual acuity did not decrease in 20% of the cases treated. In the light of our results 106-Ruthenium therapy seems to be a reliable method of tumor treatment in tumors with a maximum prominence not exceeding 8 mm.

From 1969 to 1981, 23 patients with tumors in the pons region were irradiated at the Department of Radiotherapy of the West German Tumor Center in Essen. The age of the patients ranged from 18 months to 50 years. Fifteen patients (65%) were younger than 18 years, one was 25 years old, and seven were between 40 and 50 years old. In two cases the histologic diagnosis of an astrocytoma I and astrocytoma II could be confirmed by exploratory excision and cyst punction, respectively. Nineteen patients received a shunt system (ventriculoatrial shunt) prior to radiotherapy in order to achieve a pressure reduction. After a follow-up period of 1.5 to 12 years, eleven patients are alive, and twelve patients died from a local recurrence or from progressive tumor growth. The five-year survival rate is 47%. Five of the surviving patients show no or only slight adverse effects on their general condition and are able to attend school or carry out their profession (in Karnofsky: 90 to 100%). Four other patients suffering from marked remaining neurologic symptoms are able to take care of themselves (Karnofsky: 70 to 80%). Two patients need permanent nursing (Karnofsky: 50 to 60%). Because of the local propagation tendency of pons tumors, radiotherapy should be locally restricted to the brain stem and the adjacent brain structures, e.g. cerebellum and proximal neck marrow. The authors recommend target volumes of 55 to 60 Gy, which must be applied within 6 to 8 weeks, taking into account the age of patients. This palliative therapy conception should be applied routinely in the hope of bringing about a curative treatment to this group of patients.

Ultrasound tomography provides true scale representation of body contours and organ structures. The image supplies substantial, individual geometrical data, essential for computerized radiation treatment planning. The mehtod is described. Typical planning examples for therapy are demonstrated. The value of follow up sonograms for radiation therapy is described. The limitations of the method are pointed out.

The effect of various doses of sodium perchlorate in several dose fractions on the extent and the time scale of displacement of radiopertechnetate, in dependence on application mode, was studied. An intravenous dose of 50 mg perchlorate was in respect of competitive suppression of organs actively concentrating pertechnetate as effective as intravenous 1000 mg ClO-4- simultaneously or 1000 mg orally 30 min before the injection of radiopertechnetate. An intravenous injection of perchlorate given later also produces a complete and immediately beginning depletion of pertechnetate already accumulated in the thyroid, within a period of 195 min after 99m-TcO-4-injection with a corresponding increase in blood levels. 20 mg result in incomplete depletion which becomes complete after a second additional dose. The intravenous application of perchlorate offers advantages in clinical use.

Recent data from the literature as well as our own treatment results of soft tissue sarcomas and primary bone tumours with the exception of osteosarcomas indicate, that: 1. A conservative, limb sparing therapy should be attempted in peripheral bone tumours and soft tissue sarcomas. This may be achieved in 85% to 97%. 2. The recurrence rate is in a range of 3% to 22%, which does not exceed the results of ablative surgery. 80% of possible recurrences can be controlled by consecutive surgery. 3. After the development of improved treatment techniques, the complication rate is less than 10%. 4. Conservative limb sparing treatment does not decrease the survival rate. However, these results are not derived from randomised studies. 5. Apart from osteosarcomas and Ewing sarcomas adjuvant chemotherapy is recommended for G3 tumours. The time interval for evidence of metastases may be doubled by this treatment modality. 6. There is some evidence that neutron-boost therapy may improve local control rates in T2 and T3 soft tissue sarcomas.

The proton relaxation times of muscles in the limbs of rats were measured after various types of experimental injury. Abnormalities of perfusion, the effect of histamine and of a non-specific myositis resulted in a significant prolongation of T1 and T2 in in-vitro experiments. It must be remembered that these were serious types of injury. It may be possible to demonstrate less extensive muscle changes by means of MR.

Samples of heart conducting system tissue and samples of ordinary heart muscle (left heart, right heart, and septum interventriculare) were taken from the hearts of 50 prime-conditioned bulls. The specific gravity of the heart conducting system was significantly higher than that of ordinary heart muscle. This is surprising because it cannot be explained by a difference in water content. The question arises whether or not there are differences in the composition of protein and in the content of glycogen.

Densitometric measurements were carried out on various types of glass, plastic and wood in order to determine the scope of computer tomography in detecting nonmetallic foreign bodies. CT was superior to conventional film techniques for localising glass when situated near bone. Densitometry of plastic materials showed wide variation of these substances and the results hae been tabulated. Heavy polymers exceeded +200 H, light synthetic materials were between 0 and -100 H. Computer tomographic absorption measurements of wood showed that the density depended on its water content. Measurements of different types of wood, with different degrees of hydration, showed that changes in density could be brought about by incorporation of fluid into the wood.

Twenty-six bone marrow transplantations were performed at the West Germany Tumour Centre at Essen between December 1975 and December 1981. Three patients had aplastic anaemia, 23 acute leukaemia. Of the leukaemia patients 13 had a recurrence and ten were in full remission at the time of the transplantation. Two of the patients with a recurrence received deep-frozen autologous marrow from the remission phase. One patient with aplastic anaemia had an identical twin as donour, while all other patients received allogeneic marrow from histocompatible family members. Eleven patients are still alive, all three of those with aplastic anaemia, one of those with leukaemia in a recurrence, and seven of those with acute leukaemia in full remission. Two of the survivors have a chronic graft-host reaction, but the others are symptom-free, after an observation period of up to four years. Main causes of death were leukemic recurrence (6), infection (5), and graft-host reaction (2). It would seem that at present bone marrow transplantation offers the best chance of a cure for severe aplastic anaemic and acute leukaemia in adults, but only if transplantation is undertaken early and not in the end-stage of the disease.

Postoperative radiotherapy reduces the local recurrence rate of rectal carcinoma. However, the recurrence free interval and survival time are not influenced. Postoperative radio- and chemotherapy reduce the local recurrence rate as well and prolongs the recurrence free interval. The survival rate is not significantly improved. Combined pre- and postoperative radiotherapy are presently being evaluated in prospective randomised trials. The actual results demonstrate a reduced local recurrence rate, a prolongation of the recurrence free interval and an improved survival time. Because of the relatively small numbers of patients in the different treatment groups a final evaluation is not yet possible.

The article presents two methods for the theoretical determination of CT values. These methods involve relatively little work and cost and enable at least an estimation of the CT value of any object to be examined. The results are compared with the experimental data, and possible sources of errors are shown. The article concludes with a discussion of a few examples from actual practice.