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Difficult fractures of the calcaneus are therapeutic problem today. From 1965 to 1977 147 patients were non-operative treated in the department of general surgery - including cases from department of orthopedic surgery. 67 patients with fractures of the os calcis were controlled between 3 and 15 years after accident. The various methods of conservative treatment are discussed. The early functional treatment had the better late results than other conservative methods i.e.: fewer pain and better flexibility of the talo-calcaneo-navicular and talo-calcanean joint, sooner taking up of the former occupation and lower decrease in performance.

Aim of this case-control study, performed on 412 male bladder cancer cases and 414 controls with benign prostatic hyperplasia in a former area of coal, iron and steel industries in Germany, was to identify occupations with an increased bladder cancer risk. In bladder cancer cases, smokers were overrepresented (58.3 %) compared to controls (35.2 %). The percentage of patients who had stopped smoking for at least 10 years did not differ in cases (10.2 %) and controls (9.7 %). Significantly elevated smoking-adjusted bladder cancer odds ratios (MH) were observed in painters and lacquers (MH 2.24, 95 % CI 1.07–5.13), chemistry-related occupations (MH 2.44, 95 % CI 1.05–5.67), coke plant workers (MH 2.89, 95 % CI 1.16–7.16) and hard coal miners (MH 2.33, 95 % CI 1.52–3.58). Significantly decreased smoking-adjusted bladder cancer odds ratios (MH) were observed in businessmen (MH 0.64, 95 % CI 0.45–0.92) and office personnel (MH 0.58, 95 % CI 0.41–0.81). In these two groups a relevant exposure to occupational bladder carcinogens is not likely.

Fire resistance of structures, systems and components (SSC) is widely identified as a fundamental issue for fire risk assessment at nuclear power plants (NPP). It is currently supported by several national or international ambitious experimental programs. Fire risk assessment at NPPs is performed under a series of hypothesis, e.g. the fire load. A problem will arise if tests used for conformity assessment do not appropriately represent the hypothesis selected during the fire risk analysis. In this case, SSCs may possibly be not meeting the expectations related to their fire resistance capacity supposed by the fire risk analysis. Ways of tackling this issue involve a regulatory approach and adapted requirements for components. While the widespread regulatory approach consists in seeking enveloping scenarios and conservative assumptions, a better knowledge of SSCs behaviour under for NPPs typical situations may be also desirable. The Institute for Energy of the European Commission's Joint Research Centre (JRC) at Petten (NL) launched a questionnaire with the aim of gathering opinions of regulatory bodies and their technical support organisations and manufacturers in Europe on this topic. Major goal was to estimate the relevance of the issue according to the perception of the specialists. The present paper collects the answers given by seven entities (AREVA, GRS, iBMB, IRSN, SJUB, SUEZ-TRACTEBEL, and VTT) and makes suggestions for addressing the issues identified by the participants.

Gallstone disease is a common disorder with a prevalence of approximately 20 % in industrialized countries. We performed a genome-wide disease association scan of over 500,000 single nucleotide polymorphisms (SNPs) using 280 cases with early onset gallstone disease and 360 sonographically stone-free controls from Germany. A total of 238 lead SNPs were identified, based upon their marker- and region-specific levels of statistical significance, and were subsequently followed-up in another 1100 symptomatic cases and 850 controls. The original disease association was replicated for only one marker, a SNP (Affymetrix id: A-1791411) in the ABCG8 gene (allelic p = 4.1 × 10−9). Fine-mapping of the ABCG5/ABCG8 locus, using both haplotype and logistic regression analysis, revealed that nonsynonymous SNP rs11887534 in the ABCG8 gene (encoding a D19H amino acid substitution) was found to represent the major source of gallstone risk at this locus. Its association with gallstone disease was further replicated in another 728 patients from Germany (p = 2.8 × 10−7) and in 167 patients from Chile (p = 0.02). The overall odds ratio (OR) for D19H carriership, as estimated from all German samples combined, was 2.2 (95 % CI 1.8–2.6). In a post-hoc logistic regression analysis, the genotypic effect was found to be independent of known risk factors such as BMI, age and sex. The association with D19H was strongest (OR = 3.3; 95 % CI: 2.5 – 4.3)) in the subgroup of patients with gallstones that contained cholesterol as a major constituent (> 30 %). The ABCG8 protein forms a heterodimer with ABCG5 that actively transports cholesterol into the bile. Since the His19 allele has been shown before to be associated with lower serum cholesterol levels, it appears likely to exert its gallstone predisposing effect by a more efficient transport of cholesterol into the biliary lumen and, therefore, a higher concentration of cholesterol in the bile.

A section of an actual power system was modelled on a Transient Network Analyzer for the purpose of defining high frequency transient voltages occuring during switching events. The variety of system switching events which were staged produced oscillatory voltages covering a broad band of frequencies. On a digital model of the system autotransformers it was demonstrated that such oscillatory voltages could excite internal natural frequencies, but none of the actual generated waves coincided closely with the particular transformer natural frequency. However, if the applied waveshapes were frequency-scaled to a closer match, internal response voltages of concern could be developed.

Injuries to the epiphysel plates without involvement of the epiphyses or metaphyses, such as crush fractures or pure epiphysiolysis may be difficult to diagnose radiologically. Thirteen bone scans after damage to the growth plate have been performed on eight children. These indicate that these scans are able to diagnose lesions of the epiphyseal plates at an early stage and with certainty. The scintigrams also provide information concerning the healing process of the plate; they indicate when healing has been completed and when the extremity can be used for weight-bearing again. Radiation exposure of the children during scintigraphy with 99mTc-polyphosphate is within acceptable limits.

Oberarmschaftbruche sind auch heute noch die Domane konservativer Frakturenbehandlung. In einigen Fallen ist bei exakter Indikationsstellung ein operatives Vorgehen angezeigt. Die nach den Richtlinien der AO durchgefuhrte Druckplattenosteosynthese gewahrt eine Ubungsstabilitat und verhindert Rotationsfehler und Distraktion. Alle an unserer Klinik nach den Richtlinien der AO mit Druckplattenosteosynthese versorgten Frakturen heilten knochern fest aus.

Energiereiche Strahlen konnen am Magen-Darm-Kanal Fruh- und Spatreaktionen auslosen. Zu den letzteren zahlen Ulcera, Blutungen, Stenosen und Fisteln. Haufigste Ursache einer Strahlenreaktion ist eine vorangegangene Strahlentherapie wegen eines Uterus-Ca. Die chirurgische Behandlung mus sich oft auf die Anlegung einer Colostomie zur Kotableitung beschranken. Darmresektionen durfen nur weit im Gesunden vorgenommen werden. Die Letalitat chirurgischer Eingriffe wegen Strahlenfolgen am Darm betragt 25 %.

From 1957--1977 193 patients were treated at the surgical clinic of the University of Tubingen for carcinoma of the extrahepatic bile ducts. Gall bladder carcinoma made up 139 cases; 54 were of bile duct carcinoma. The tumors were no longer operable in two-thirds of the patients with extrahepatic bile ducts cancer. The life expectancy rate of five years for patients with gall bladder carcinoma held for 7%. Up to now only one patient with a bile duct malignancy has survived longer than five years. In the last decade essentially no improvement of median life expectancy has occurred despite improved operating techniques. Due to uncharacteristic, misleading upper abdominal symptoms, patients who suffer gall bladder or bile duct cancer are unfortunately accurately diagnosed only after the carcinoma has overcome organ borders or is already metastatic. There is reasonable hope for improved early prognosis of extrahepatic bile duct carcinoma with ERCP (Endoscopic Retrograde Cholangio-Pancreaticography) and computer-tomography. Because the possibility of a relationship between gall bladder stones and/or the chronic inflammation of gall bladder and bile ducts and the development of cancer is not out of the question, widespread prophylactic cholecystectomy and gall passage cleansing should be employed.

The Transient Network Analyzer (TNA), an electromagnetic analog of a power system, is used to study the transient voltages due to switching operations. This paper describes how a mini-computer has been used to enhance the operations of the TNA. The interfacing of the mini-computer and the TNA allows digital control of the TNA switching operations and provides a means of making sophisticated measurements and analyses of the results of that switching.

The one layer anastomosis after Gambee is compared with the two layer anastomosis after Dick at the small bowel of 20 minipigs. The end-to-end anastomosis after Gambee consists of an interrupted, inverting suturing of the bowel wall. Dick suggested a closed method, applying bronchial clamps before resecting the bowel. Seromuscular sutures and inner all layer sutures are inserted interrupted. Experimental studies have been done after 4, 7, 14 and 21 days. In Histology two layer anastomoses caused delayed wound healing after 4 days. Twenty-one days after the operation histological findings in both groups were equal. Microangiographic studies showed, that in single layer anastomoses revascularization began 3 days earlier than in two layer anastomoses. Measuring of the bursting strength showed no significant differences. All parameters suggest equal value of both techniques. In our opinion the two layer anastomosis after Dick combines the advantages of a closed method with a simple, easy performable technique. We therfore apply it all over the gastrointestinal tract with exception of esophagel and rectal anastomoses.

This paper outlines the results of a general transient network analyzer study on a 765 kV circuit to determine the phase-to-ground switching surge overvoltages for a variety of circuit breaker and transmission line conditions. The circuit was modelled after the standard transmission line as specified in ANSI standard C37.071a- 1974. An electronic differential analyzer was used to control the transient network analyzer and to rapidly measure switching surge statistical data. The results are given in terms of curves showing the variation in surge magnitudes with network and circuit breaker parameters including closing span, insertion time, insertion resistance and compensation.

Between 1970 and 1980 53 children with epiphyseal injuries were treated. Analysing these 53 cases we found that metaphyseal lesions of the epiphyseal plate (i.e. epiphyseolysis, separation of the epiphysis with triangular metaphyseal fragment) heal completely, even in those cases in whom an open reduction was necessary. Conservatively treated epiphyseal injuries (i.e. fracture of the epiphysis, crushing of the epiphyseal plate) showed bad results. Contrary to these results 80% of open reduced injuries showed good results. We can conclude that epiphyseal injuries do not necessarily end in disturbances of growth or malformation if surgical correction of the injury is done as early as possible and if the injured extremity is immobilised at least 3 to 5 weeks. Destruction of the epiphyseal vascular system can only be avoided by surgical reposition of the epiphyseal injury.

The concept of optimal power flow (OPF) is defined, and security-constrained OPF (SCO) is described. Two examples are presented to show how the SCO program provides enhanced capability for the utility engineer in solving problems. One deals with VAr support for transmission system expansion, and the other concerns substation capacitor bank location. >

Es werden die Ergebnisse der konservativen Behandlung distaler Radiusfrakturen bei 303 Patienten uber einen Entstehungszeitraum von zwei Jahren dargestellt. 226 Patienten konnten im Rahmen einer Nachuntersuchung erfast werden. 78% aller Frakturen heilten zufriedenstellend aus, wahrend die Ergebnisse bezogen auf die verschiedenen Altersgruppen zum Teil erheblich differieren. Neben der Darstellung der funktionellen und anatomischen Resultate in bezug auf Alter, Geschlecht und Lokalisation wird auf die Technik der Frakturenbehandlung sowie die Nachbehandlung eingegangen.

The discrepancies between measured and calculated small-signal space-charge wavelengths are discussed. It is shown that conventional methods of calculation are inadequate, causing errors up to 40 percent in a typical case. It is demonstrated that these errors cannot be explained by beam scalloping action, and that they are most severe when a high-perveance beam is used at low voltages with a high magnetic field under conditions of low interception. Although these effects would not be noticed in klystrons with relatively short drift lengths, they may in many cases explain the critical variation of gain and efficiency with magnetic field. A more accurate method of calculating space-charge wavelengths is developed, and the effectiveness of this method is demonstrated by a comparison with measurements.

A ten-stage electrostatic depressed collector, designed with the aid of an analog computer, was tested on a 1-kW CW 750-MHz klystron. Excellent correlation was achieved between computed and measured performance under varying conditions of RF drive. At full RF power output approximately 60 percent of the spent beam energy was recovered by use of the depressed collector. The net power conversion efficiency of the tube was raised from its undepressed value of 54.3 percent to approximately 70.9 percent. At one-half full power output, a collector efficiency of 70 percent was measured. At zero RF power output collector efficiency was 80 percent. To achieve these results it was necessary to install a small focusing coil between the final drift tube and the collector. No spurious oscillations or instabilities were detected when collector depression was employed, nor was electron backstreaming increased significantly. Intentional short circuiting of adjacent collector electrode pairs was shown to cause only minor degradation in collector performance.

Contrary to the cortical parts of a bone, the spongiose parts of metaphysial sections of the skeleton possess elasticity reserves to a much lesser extent only. Therefore, if pretensioning forces are to be applied to such skeletal zones they can be maintained over no more than a very limited timespan. Various investigations into the compression stress load tolerances of bones (cf. RITTER and GRUNERT, 1973; WALDE et al., 1975) have shown a value range of 1,000 to 2,000 kp/mm2 (1,422,330 to 2,844,660 p.s.i.), whereas the pressure loads which may come to bear on the spongiosa is only one hundreth that magnitude, i.e. approx. 10 to 20 kp/mm2 (14,223.30 to 28,446.60 p.s.i.).

This program has moved from computation to model tests of sub-assemblies. The earlier computer delays were considerably reduced by the use of a new time-sharing computer facility. The bunching and interaction computer study resulted in a design meeting the full requirements for efficiency, gain, flatness and bandwidth. First gun tests showed a substantially longer beam than the calculated size, with severe interception. A second design was close to being acceptable but further work is required. The same computer program was used to solve the converse problem of collector design; a practicable magnetic field shape was found which holds the collector power density at a safe level. A common rectangular cavity design was adapted to serve the three required cases of single tuned unloaded, single tuned loaded, and double tuned loaded cavities. Loading is provided by suitably placed silicon carbide blocks. Since the iterated input and output guides, seen from a plane midway between beams, are already a good match at center frequency to the plain WR 137 guide, two short matching sections at each end are sufficient to reduce the band edge mismatch to an acceptable level. (Author)

A ten-stage electrostatic depressed collector has been designed and tested on a one-kilowatt CW klystron. The collector design is based on an extensive study of electron trajectories, utilizing an alalog computer. The computer program includes both the effect of space charge and the effect of the residual magnetic field in the collector.

Von 1974–84 wurden an der Chirurgischen Universitats-Klinik Tubingen 163 Patienten wegen eines Traumas splenektomiert. Bei der Nachuntersuchung fanden wir keine erhohte Infektanfalligkeit und kein OPSI-Syndrom. Nahezu 40% unserer Patienten hatten noch funktionsfahiges Milzrestgewebe im Szintigram auf Grund spontaner Splenosis peritonei, Autotransplantation oder wegen einer Nebenmilz. Die Bestimmung der Serumimmunglobuline IgM, A, G, des Antikorpertiterverlaufs nach Tetanusimpfung, der Lymphocytenstimulation durch ConA, PHA, PWM und der Granulocytenphagocytose zeigte keinen Unterschied zwischen splenektomierten Patienten mit oder ohne Milzrestgewebe und einer Kontrollgruppe.

Die operative und konservative Behandlung zentraler Talusfrakturen ist langwierig und oft die Spatergebnisse von 67 konservativ behandelten Calcaneusfrakturen berichtet, wobei eine Gruppe uber langere Zeit durch Gipsbehandlung immobilisiert, die andere Gruppe fruhfunktionell behandelt wurde. Die fruhfunktionelle Therapie ergab die besseren Ergebnisse. Diese Patienten hatten eine bessere Beweglichkeit im unteren Sprunggelenk, weniger Schmerzen im Bereich der Fuswurzel, konnten eher voll belasten und waren haufiger im alten Beruf wieder voll arbeitsfahig.

Bei 10 714 Laparotomien traten 84 Wunddehiscenzen auf; das entspricht einer Haufigkeit von 0,8%. Die Letalitat betrug 36,6%. Bei der Pathogenese einer Bauchwandruptur mussen allgemeine Faktoren (Eiweisstoffwechselstorungen, Medikamente, Hormone), mechanische Faktoren (ausgepragte Adipositas, Erbrechen, Meteorismus, Ascites) und lokale Faktoren (fehlerhafte Nahttechnik, Nahtmaterial, Wundinfektion) berucksichtigt werden. 23,2 % der Wunddehiscenzen hatten ihre Ursache in postoperativen Peritonitiden, perforierten Appendicitiden und infizierten Wundhamatomen.

Bei nicht resektablen Carcinomen des proximalen Hepato-Choledochus, geringfugigem intrahepatischem Aufstau und niedrigen Bilirubinwerten bietet die endlose Drainage gegenuber der HepatoEnterostomie mehr Sicherheit. In den letzten 5 Jahren sind 8 Patienten mit einer endlosen Drainage versorgt worden. 2 Patienten sind wahrend des stationaren Aufenthaltes verstorben. 2 Patienten sind nach 81/2 bzw. 91/2 Monaten ihrem Grundleiden erlegen. 4 Patienten sind zwischen 5 und 11 Monaten p. o. noch am Leben. Bei haufigen Spulungen mit steriler NaCI-Losung und Wechsel der Drainage alle 2–3 Monate ist die Funktion stets gut.

Bei 131 Patienten mit Umwandlungsresektion war der ulcusbedingte Ersteingriff bei 75% eine BII-Resektion. Indikation zur Korrekturoperation war beim BI in 90% ein Rezidivulcus, beim BII jedoch in 25% funktionelle Storungen. Beim BII waren die Rezidivulcera haufiger durch Penetration, Perforation und Blutung kompliziert. Schwere Komplikationen waren in 20% und in 10% ein letaler Ausgang die Folge. Bemerkenswert war, das die Letalitat nach BII-BI-Umwandlung deutlich uber der nach BI-Nachresektion oder BI-BII-Umwandlung lag. In Kenntnis des hohen Operationsrisikos sollte als Alternative zur Behandlung des Rezidivulcus an die thorakale trunculare Vagotomie gedacht werden.