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Perfectly secure protocols are often too inefficient performance wise to be used in a practical setting. On the other hand, an insecure (but faster) protocol might be deemed secure for a particular setting. Recent research has thus focused on precise leakage quantification of a security protocol. In this context, we first give precise leakage quantification of a basic cryptographic primitive, that of multiplicative hiding. We then show how the approach can be extended to compute worst case leakage bounds of arbitrary compositions of cryptographic operations. The composition results make our bounds applicable to a wide range of general security protocols.

Besides persisting high pulmonary arterial pressure and increased pulmonary vascular resistance, remodelling of pulmonary tissues and subsequently the right heart are the key pathomechanisms of pulmonary hypertension (PH). Extracellular matrix maintenance in this context plays a central role.We tested the hypothesis that plasma concentration of matrix metalloproteinase (MMP)-2, tissue inhibitor of matrix metalloproteinases (TIMP)-4 and tenascin C (TNC) might be useful as biomarkers for assessing the severity of PH. Therefore, the concentrations of MMP-2, TIMP-4, TNC and N-terminal b-type natriuretic peptide (NT-proBNP) of 36 PH patients were compared with those of 44 age- and gender-matched healthy volunteers. Additionally, lung function, 6-min walk distance and right heart function were assessed.In PH patients, significantly elevated plasma levels of MMP-2, TIMP-4, TNC and NT-proBNP were detected. In particular, TIMP-4 was significantly increased in patients with higher NYHA classification, and in patients with severe right ventricular hypertrophy.Monitoring of plasma TIMP-4 and to a lesser extent of MMP-2 and TNC levels in PH patients might help to assess the beneficial effects of PH pharmacotherapy on tissue remodelling.

Einleitung: Für die Colitis Ulcerosa (CU) steht eine große Bandbreite medik. Therapien zur Verfügung. Zumeist werden die Pat. erst nach Ausnutzung sämtl. konserv. Maßnahmen der Chirurgie zugewiesen. Dabei wird immer wieder diskutiert, welchen Einfluss die vorbestehende Immunsuppression[for full text, please go to the a.m. URL], 127. Kongress der Deutschen Gesellschaft für Chirurgie

Background: Increasing incidence rates of soft tissue sarcomas (STS) have been reported. In the present study, the authors have analyzed the incidence of STS in Austria in a population-based study for the period 1984–2004. Patients and methods: Age-adjusted incidence rates, gender and age predilection and geographic differences were analyzed, comprising data from the Austrian National Cancer Registry. Results: A total of 5333 cases were registered; male-to-female ratio was 0.8. The most common histotypes were sarcoma not otherwise specified (36%), leiomyosarcoma (24%), liposarcoma (12%), malignant fibrous histiocytoma (9%) and fibrosarcoma (5%). Age-adjusted incidence rate was 2.4 per 100 000 per year. Analysis of annual incidence rates and 3-year periods showed no increase (annual increasing gradient = -0.0025). Conclusions: This study has analyzed the most recent data from a European population in comparison with seven international studies. An increase, as postulated elsewhere, could not be confirmed. The incidence rate of STS in Austria ranges in the lower half of the international incidence rates (1.8–5.0 per 100 000 per year). Different inclusion criteria (Kaposi's sarcoma and dermatofibrosarcoma) and classifications in the various studies explain the increase of incidence in some studies rather than true increase of STS due to new or accumulated risk factors.

Osteosarcoma is the most common, non-haematopoietic, primary malignant bone tumour with an incidence of 0.3–0.5 per 100,000. There is some discrepancy in literature concerning the peaks of incidence of osteosarcoma. Some describe only one peak which arises in adolescence, whilst others report a bimodal age distribution with a second peak over the age of 60. In this retrospective study, we evaluated osteosarcoma patients over age 60 treated at our department and reviewed previous studies from the literature. Sixty-four patients (40 male, 24 female) with a mean age of 29 years (from 7 to 82) were treated for primary osteosarcomas. At the time of diagnosis, seven patients (two male and five female) were over 60 years of age with a mean follow-up of 46 months after definite diagnosis. Three out of seven osteosarcomas were primarily radiologically or histologically misdiagnosed, but only one was mistreated with intramedullary nailing at a trauma centre. At last follow-up, two patients had died from the disease, three were alive with disease, and two had no evidence of osteosarcoma. We did not find an increased incidence of primary osteosarcoma in the elderly; yet, older patients had a higher rate of misdiagnosis due to untypical radiological findings in combination with longer times from the onset of first symptoms to definite diagnosis. In cases of pathological fracture, it is essential to assess whether it is caused by mechanical stress or a primary or secondary tumour before leading into mistreatment, especially in older patients.

Einleitung: Die Behandlung der Colitis ulcerosa (CU) und der FAP durch eine Coloproktomucosektomie (CPM) gilt als etabliertes Verfahren. Neben dem standardisierten offenen Vorgehen wurden in den letzten Jahren zunehmend auch laparoskopisch assistierte Operationen für diese Patienten durchgeführt.[for full text, please go to the a.m. URL], 126. Kongress der Deutschen Gesellschaft für Chirurgie

Einleitung: Die Coloproktomukosektmoie (CPM) mit ileopouch-analer Anastomose (IPAA) hat sich zu einem kontinenzerhaltenden Standardverfahren in der Behandlung der therapierefraktären Pancolitis ulcerosa und der familiären adenomatösen Polypose des Colon entwickelt. Die dauerhafte Rückverlagerung[for full text, please go to the a.m. URL], 126. Kongress der Deutschen Gesellschaft für Chirurgie

Background: Pompe disease (Glycogen storage disorder type II) is an inherited disease because of a lack or reduced activity of the enzyme α-1,4-glucosidase (acid maltase). Since 2006, an intravenous enzyme replacement therapy (ERT) with Myozyme™ (Genzyme Corporation, Cambridge, MA, USA) is available. Methods: Four adult patients aged between 39 and 68 years received ERT over a period of 6 months. Clinical and functional parameters were registered longitudinally. Results: In three patients, a considerable improvement of symptoms could be noticed, patients with pre-existing respiratory insufficiency seemed to profit most. In all patients, a continuous decrease of initially raised laboratory parameters (creatine kinase, lactic dehydrogenase, transaminases) was striking. Conclusions: Enzyme replacement therapy seems to be a long-term effective therapy in adult patients with Pompe disease. Whether all patients will profit from an improvement of symptoms or at least a stabilisation of the otherwise progressive disease is currently not definitively clear.

Several studies have observed both higher mortality rates and lower utilization of endovascular aneurysm repair (EVAR) at low-volume centers. This article presents the results of elective abdominal aortic aneurysm (AAA) repair at a low-volume center in the endovascular era and investigates whether postprocedural mortality can be improved by extension of EVAR application also in this setting. This is an 11.6-year retrospective cohort study of 132 patients undergoing elective surgical or endovascular AAA repair at a tertiary care academic hospital between 1997 and July 2008, i.e., a median volume of 12 cases per year. The study was divided into two periods of time according to the respective indications and contraindications for EVAR, which substantially changed in 2005. During period 1, only aneurysms with necks > or =20 mm long and not involving the iliac arteries were treated endoluminally. Beginning in 2005, indication for EVAR was expanded to aortoiliac aneurysms with a minimum neck length of 15 mm. Preoperative risk was assessed by the SVS/AAVS comorbidity score. During the first period (1997-2004) 18.4% (16/87) of all patients received EVAR. By extending anatomical confines and indications for EVAR in 2005, the utilization rate of EVAR increased to 40.0% (18/45) during the second period (2005-July 2008; p = 0.007). Prevalence of preoperative risk factors did not change during the two observation periods. In contrast to period 1, high-risk patients were preferentially treated endoluminally during the second period, resulting in a significantly higher median SVS/AAVS score in the EVAR group (p < 0.001). A significant decrease in median length of stay at the intensive/intermediate care unit (5 vs. 2 days; p = 0.006) and length of in-hospital stay (20 vs. 12.5 days; p < 0.001) was observed during period 2. Overall perioperative mortality was reduced from 6.9% during the first period to 2.2% during the second period (p = 0.256). EVAR mortality was 0%, mortality after open repair was reduced from 8.5% to 3.7% (p = 0.414). In conclusion, by risk-adjusted selection of treatment and frequent application of EVAR, it is possible to improve perioperative outcome of elective AAA repair at a low-volume hospital. Mortality figures are similar to those of recent trials at high-volume centers, as reported in the literature.

In the treatment of ruptured abdominal aortic aneurysm (rAAA), the results of open graft replacement (OGR) have remained constant but discouraging for the last 4 decades. Provided suitable anatomy, elective endovascular abdominal aortic aneurysm repair (EVAR) is less invasive and leads to improved perioperative mortality. Thus, it is reasonable to assume that endovascular treatment should improve the results of rAAA therapy.To determine whether the use of both endovascular and open repair of rAAA leads to improved results.A single-center, retrospective analysis of 89 patients suffering from rAAA treated either by EVAR or OGR.From October 1999 until July 2006, a consecutive series of patients with rAAA were analyzed. Time was divided into 2 periods of 41 months. During the first period, 42 patients were treated by OGR exclusively. Period 2 started with the availability of an EVAR protocol to treat rAAA; 31 patients received open repair while 16 patients underwent EVAR.Kaplan-Meier survival estimates were calculated and compared.Survival estimates showed a statistically significant reduction in overall postoperative mortality following the introduction of EVAR (P.03). The 90-day overall mortality rate was reduced from 54.8% to 27.7% during the second period (P.01). Survival of patients older than 75.5 years was especially improved (75% vs 28.6%; P.01). There was a parallel pattern of significant reduction of the mortality rate after OGR to 29% (P.03).Offering both EVAR and OGR to patients with rAAA leads to significant improvements in postoperative survival.

Ziele: Ziel der Studie war die softwaregestutzte, semiautomatische Detektion eines Lungenemphysems in der Computertomographie des Thorax sowie die Korrelation mit dessen Schweregrad. Methode: Bei 474 Patienten (60±15 Jahre) wurde eine Computertomographie des Thorax (16-Detektorreihen) in Inspiration sowie Lungenfunktions-Tests durchgefuhrt. Die Bodyplethysmographie diente als Referenzmethode fur die Diagnose eines Emphysems nach den GOLD-Kriterien. Emphysemareale wurden in der Computertomographie softwaregestutzt semiautomatisch ermittelt (“Lung emphysema“, Extended Brilliance Workspace, Philips Medical Systems, Cleveland, Ohio). Das Lungenvolumen (LV) und Emphysemvolumen (EV) sowie der Emphysem-Index (EI=EV/LV) wurden in der Computertomographie bestimmt. Diese Ergebnisse wurde mit der totalen Lungenkapazitat (TLC), dem intrathorakalen Gasvolumen (ITGV), dem Residualvolumen (RV), der Vitalkapazitat (VCin) und der FEV1 korreliert. Eine Atemwegsobstruktion wurde definiert als FEV1/VC

Objectives The aim of this study was to investigate whether initial abdominal aortic aneurysm (AAA) diameter influences long-term survival after elective repair. Design Retrospective analysis of database. Material and Methods Between March 1995 and December 2006, a consecutive series of 895 patients underwent elective treatment of an AAA either by open surgical or endovascular repair. An AAA diameter of 5.5 cm was chosen as threshold to distinguish between small and large aneurysms, according to the definition given by the UK small aneurysm trial. Patient characteristics and distribution of basic risk factors were assessed. Survival estimates (Kaplan-Meier) and Cox proportional hazards regression results are reported. Results Patients with small aneurysms were more likely to survive the first 6 years after AAA repair, even after adjustment for treatment modality and baseline risk factors. After adjustment for age and sex aneurysms with smaller diameter were related to a lower risk of death (p Conclusions Patients with small aneurysms (≤5.5 cm) have an improved long-term survival than patients with larger aneurysms.

Pompe's disease, a rare, inherited deficiency of the enzyme alpha-1,4-glucosidase (GAA), is a lysosomal storage disorder. Early-onset (infantile) Pompe's disease is associated with cardiomegaly and severe myopathy and, if left untreated, will inevitably lead to death within the first 2 years of life. In juvenile Pompe's disease, progression of the disease is generally slower and involvement of the myocardium is less likely with onset at a later age. The adult form of Pompe's disease is frequently associated with a progressive proximal myopathy which is more marked in the lower limbs. Involvement of the respiratory system is common. A new treatment with intravenous enzyme replacement (Myozyme) is now available. At present, there is only limited data available regarding its efficacy in the treatment of the adult form of Pompe's disease.A 67-year-old lady with Pompe's disease and known severe respiratory compromise due to involvement of the respiratory muscles had had recurrent emergency admissions with respiratory failure. After only a few weeks of treatment with intravenous enzyme replacement with Myozyme, significant improvement in her respiratory function was noticed. Following a total length of treatment of 7 months, her arterial blood gas results on room air had almost returned to normal.A glycogen storage disorder (type II) should be excluded in all adult patients with a slowly progressive weakness involving pelvic and thigh muscles even when respiratory involvement is not present. In addition to supportive treatment, a new enzyme replacement therapy for patients with late-onset disease has now become available which shows promising results.

Purpose: To develop a machine learning-based automatic classification of Gleason Score (GS) 3+4=7 versus 4+3=7 prostate cancers (PCa) from multiparametric MRI (mpMRI) combined with first and second order texture features. Methods: 140 PCa were delineated in the peripheral and transition zones from patients undergoing mpMRI 6 months pre-prostatectomy. Lesions were contoured on T2-weighted MRI and apparent diffusion coefficient (ADC) maps by correlating the images with step-section pathology maps of the excised prostates. 114 tumors had a GS (3+4) and 26 had a GS (4+3). First order (mean, standard deviation, skewness, kurtosis) and second order texture features (energy, entropy, correlation, homogeneity, contrast) were analyzed. Due to large tumor class imbalance, we employed two different sample augmentation techniques: Gibbs and SMOTE oversampling. The samples in each class were oversampled to 200 samples. We evaluated the performance of three different classifiers, t-test support vector machine (t-test SVM), recursive feature elimination SVM (RFE-SVM), and adaptive boosting (AdaBoost), using 10-fold crossvalidation. Results: RFE-SVM achieved the best classification performance (accuracy: 97%; Youden Index: 0.93) when trained using samples generated by the SMOTE method, followed by t-test SVM (78%,0.56) and AdaBoost (73%,0.46). When trained using samples generated from Gibbs oversampling, the performance of the classifiers were: RFE-SVM (90%,0.80), t-test SVM(71%,0.41), and AdaBoost (76%,0.52). In comparison, the classification performance of the same methods without sample augmentation was RFE-SVM (83%,0.11), t-test SVM(81%,0.00), and AdaBoost(79%,0.41). Classification with only mean ADC and mean T2 resulted at best in an accuracy of (67%,0.34) using Gibbs sampling. Conclusion: We developed a fully automated method for classifying GS of PCa from multi-parametric images using texture features combined with sample augmentation. Our method enables to boost classifier performance despite highly unbalanced datasets. Furthermore, our results show that texture features enable the classifiers to achieve a much higher accuracy in comparison to not using any of them.

Let $I$ be an ideal of the polynomial ring $A[x]=A[x_1,...,x_n]$ over the commutative, noetherian ring $A$. Geometrically $I$ defines a family of affine schemes over $\Spec(A)$: For $\p\in\Spec(A)$, the fibre over $\p$ is the closed subscheme of affine space over the residue field $k(\p)$, which is determined by the extension of $I$ under the canonical map $\sigma_\p:A[x]\to k(\p)[x]$. If $I$ is homogeneous there is an analogous projective setting, but again the ideal defining the fibre is $\sigI$. For a chosen term order this ideal has a unique reduced Gr\"{o}bner basis which is known to contain considerable geometric information about the fibre. We study the behavior of this basis for varying $\p$ and prove the existence of a canonical decomposition of the base space $\Spec(A)$ into finitely many locally closed subsets over which the reduced Gr\"{o}bner bases of the fibres can be parametrized in a suitable way.

Erdheim-Chester disease is a rare non-Langerhans' cell histiocytosis of unknown etiology with typical osteosclerotic long-bone findings. However, clinical symptoms are mostly due to disease involvement of other tissues, particularly of the lung, heart and retroperitoneum.A 58-year-old man presented with fatigue, diffuse pain of the lower extremities, dyspnea, and a dry cough. Physical examination was unremarkable. Chest X-ray revealed an extensive bilateral pulmonary inter interstitial process. Computed tomography demonstrated pulmonary fibrosis, periaortic fibrosis of the thoracic aorta, and retroperitoneal fibrosis. The diagnosis of Erdheim-Chester disease was confirmed by minimally invasive lung biopsy. Steroid therapy was not tolerated. Following a stable interval of 18 months there was a disease progression, which could be stabilized after the initiation of cyclophosphamide therapy.In patients with extensive pulmonary fibrosis and coincidence of other organ manifestations such as periaortic or retroperitoneal fibrosis and particularly in case of symmetrical osteosclerotic bone lesions, Erdheim-Chester disease should be considered. Immunosuppressive therapy can lead to a stabilization or even improvement of the disease.

Background: Antipersonnel landmine protective footwear relies on blast deflection or on exaggerated standoff between the foot and the explosive. Neither design has been tested for clinical effectiveness. Methods: 4 cadaveric lower extremities - 3 fitted with a Koflach® boot incorporating TABRE® (Technology for Attenuating Blast Related Energy) were subjected to controlled blast with charges of up to 100 g trinitrotoluene (TNT). The blasts were recorded by a digital recording system. All legs were X-rayed and underwent computed tomography scanning before and after testing. Results: TABRE-protected limbs directly subjected to the blast hyperextended at the knee during firing. Injuries showed a pattern of open tibial fractures (Gustilo grade I, II), of multiple calcaneal (Sanders Type III, IV), and fibular fractures and of the tibial plateau, but showed no traumatic amputation. Conclusions: Development of protective footwear against landmine blast is feasible. From medium mines up to charges of 100 g TNT limb salvage may be possible.

PURPOSE To compare the volume of open graft replacements (OGR) for abdominal aortic aneurysm (AAA) versus endovascular aneurysm repairs (EVAR) over time and after modifying selection criteria. METHODS A review was conducted of 1021 consecutive patients who underwent AAA repair from 1989 through 2002: 496 elective OGRs for infrarenal AAAs (STANDARD), 289 elective EVARs for infrarenal AAAs, 59 complex OGRs for suprarenal AAAs, and 177 emergent OGRs for ruptured AAAs. Patients from 1995 to 2002 were divided into 2 groups based on shifting treatment strategies; 454 patients were treated by STANDARD or EVAR at the surgeon's discretion between 1995 and 2000 (post EVAR). The second group comprised 161 patients treated in 2001-2002 after the introduction of "high-risk" screening criteria (age > or = 72 years, diabetes mellitus, renal dysfunction, impaired pulmonary function, or ASA class IV) that dictated EVAR whenever anatomically feasible. For comparison, 170 STANDARD repairs performed in the 6 years prior to EVAR served as a control. RESULTS While surgery for ruptured AAAs remained fairly stable over the 14-year period, the number of patients undergoing elective repair increased due to the implementation of EVAR. During the 6 years after its introduction, EVAR averaged 34.3 patients per year; after 2001, the annual frequency of EVAR increased to 41.5 (p > 0.05). In like fashion, the rate of STANDARD repairs increased to 41.3 patients per year versus 28.3 before EVAR (p = 0.032). ASA class IV patients increased by almost 9 fold in the recent period versus pre EVAR (p = 0.006). The overall mortality after elective infrarenal AAA repair decreased between the pre and post EVAR periods (6.5% versus 3.7%, p > 0.05) and fell still further to 1.2% in the most recent period (p = 0.021 versus pre EVAR). CONCLUSIONS The implementation of an EVAR program increases the total volume of AAA repairs but does not reduce open surgical procedures. By allocating patients to EVAR or open repair based their risk factors, mortality was markedly reduced.