Search

Strecksehnenverletzungen des Daumens betreffen die Sehnen der Mm. extensor pollicis brevis, extensor pollicis longus und abductor pollicis longus. Letztere ist praktisch nur bei offenen Verletzungen betroffen. Therapie der offenen Verletzungen ist die Sehnenrekonstruktion durch Naht, gefolgt von einer Ruhigstellung in den distalen Zonen oder einer dynamischen Nachbehandlung in den proximalen Zonen ab T4. Distal des Grundgelenks sind unterschiedliche Varianten des M.-extensor-pollicis-brevis-Verlaufs zu beachten. Bei den seltenen Rupturen der Streckerhaube kommt es zur ulnaren Luxation der langen oder beider Strecksehnen mit Streckinsuffizienz in Grund- und Endgelenk. Diese Verletzung wird haufig als ulnare Seitenbandruptur des Grundgelenks fehlgedeutet und sollte durch Refixation der gerissenen Strukturen therapiert werden. Die geschlossene chronische Ruptur der langen Daumenstrecksehne ist uberwiegend eine Defektverletzung, die eine motorische Ersatzplastik oder ein Sehneninterponat erfordert.

This paper provides a description of recent transformative learning applications in four broad areas – health care study abroad, community, and the workplace. The applications were selected from a ...

Background: Large cystic osteochondral lesions of the talus (OLT) are challenging pathological conditions to treat, but particulated juvenile cartilage allografts (PJCAs) supplemented with bone grafts are a promising therapeutic option. The purpose of this project was to further elucidate the role of PJCA with concomitant bone autografts for treating large cystic OLTs with extensive subchondral bone involvement (greater than 150 mm2 in area and/or deeper than 5 mm). Methods: We identified 6 patients with a mean OLT area of 307.2 ± 252.4 mm2 and a mean lesion depth of 10.85 ± 6.10 mm who underwent DeNovo PJCA with bone autografting between 2013 and 2017. Postoperative outcomes were assessed with radiographs, Foot and Ankle Outcome Scores (FAOS), and visual pain scale scores. Results: At final follow-up (27.0 ± 12.59 weeks), all patients had symptomatic improvement and incorporation of the graft on radiographs. At an average of 62 ± 20.88 months postoperatively, no patients required a revision surgery. All patients contacted by phone in 2018 and 2020 reported they would do the procedure again in retrospect and reported an improvement in their symptoms relative to their preoperative state, especially with pain and in the FAOS activities of daily living subsection (91.93 ± 9.04 in 2018, 74.63 ± 26.86 in 2020). Conclusion: PJCA with concomitant bone autograft is a viable treatment option for patients with large cystic OLTs. Levels of Evidence: Level IV

The detection of robust image features of high distinctiveness forms a ubiquitous problem in digital image processing. Robust image features are the first step and the key to reliably detect patterns or objects in images, which subsequently leads to object classification and semantic interpretation of the objects in a given image. The ideal situation for object recognition and classification is to find unambiguous traits of patterns or objects that are to be processed. For anyone delving into this matter, the subject presents itself as a challenging task. Besides the often not obvious object traits, there are a lot of other issues that have to be taken into account. For instance, lighting conditions can vary as well as the objects’ scales and rotations; image noise or partial occlusion also is likely to occur. Unless one conducts experiments under laboratory conditions, where some of these problems might be ruled out, all these issues have to be addressed properly. So the challenging task is to find image features that are distinct and robust under the varying conditions just stated before. An obvious method for detecting objects is to examine their shape and, as an abstraction of it, their contours. Contour matching usually works well, if the distinct object classes have strong variations in their shape (like the shape of any automobile is quite different compared to the shape of a human). The contour can be represented by a classic chain-code (or its many derivates). For the matching process both contour representations undergo a transformation to achieve scale and rotation invariance and are then compared to each other. The comparison can either be done directly on the transformed image coordinates or on measures deduced from the earlier representation (i.e. the moments, distances, polygonal, or Fourier descriptors yielded from the contour points). Besides those methods, one popular approach is to detect certain local interest points at distinctive locations in the image, such as corners, blobs, or T-junctions. The interest point detector is supposed to be repeatable under varying viewing conditions (e.g. different lighting or different viewing angles). Having found distinctive interest points in an image, the interest points are examined more closely regarding their neighbourhood. Taking the neighboring pixels into account forms an image feature or image descriptor, which has to fulfill certain criteria regarding distinctiveness, robustness against noise, detection errors, and image deformations. These image features can then be matched to features computed from other images. Matching features indicate a high likeliness of correspondence between the two images. Hence patterns or objects in one image can be detected in other images O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m

Introduction: Our statewide surgical quality improvement (QI) collaborative began collecting opioid data to better understand our patients’ pain management and discharge opioid prescriptions. During our pilot there was invalid data requiring variable revision. Collection resumed in 1/2020 and was encouraged during COVID-19, acknowledging that we faced reduced and highly selective operative case volumes with reduced resources. Methods: Institutions from a statewide surgical QI collaborative participated in the revised custom variable opioid data collection. Utilizing the National Surgical Quality Improvement Program (NSQIP) platform, seven custom variable data were collected for 13 general surgery procedures. Variables were abstracted by Surgical Clinical Reviewers from 1/2020-12/2020. Results: 722 cases were performed. 460 (64%) cases had all variable data submitted, 102 (14%) had at least one and 160 (22%) cases had no variables submitted. Postoperative/in-patient opioids and non-opioids administered were the most likely to be submitted (73% and 73%). 489 cases (68%) had submitted data on use of an opioid sparing strategy. 483 (67%) cases had some discharge opioid prescription data, but only 357 cases (49%) had adequate data to standardize for comparison. Conclusion: A significant decrease in collection of the three minimally revised variables was observed. However, from revising the discharge opioid prescription variable from free text to a pre-populated selection, the quality of data improved significantly. This will allow the collaborative to standardize discharge opioid prescribing. Custom variable opioid data collection is feasible and can be utilized to inform collaborative opioid prescribing practices.

Key points Chronic hypercapnia per se has distinct effects on the mechanisms regulating steady-state ventilation and the CO2 /H+ chemoreflex. Chronic hypercapnia leads to sustained hyperpnoea that exceeds predicted ventilation based upon the CO2 /H+ chemoreflex. There is an integrative ventilatory, cardiovascular and metabolic physiological response to chronic hypercapnia. Chronic hypercapnia leads to deterioration of cognitive function. Abstract Respiratory diseases such as chronic obstructive pulmonary disease (COPD) often lead to chronic hypercapnia which may exacerbate progression of the disease, increase risk of mortality and contribute to comorbidities such as cognitive dysfunction. Determining the contribution of hypercapnia per se to adaptations in ventilation and cognitive dysfunction within this patient population is complicated by the presence of multiple comorbidities. Herein, we sought to determine the role of chronic hypercapnia per se on the temporal pattern of ventilation and the ventilatory CO2 /H+ chemoreflex by exposing healthy goats to either room air or an elevated inspired CO2 (InCO2 ) of 6% for 30 days. A second objective was to determine whether chronic hypercapnia per se contributes to cognitive dysfunction. During 30 days of exposure to 6% InCO2 , steady-state (SS) ventilation ( V I ) initially increased to 335% of control, and then within 1-5 days decreased and stabilized at ∼230% of control. There was an initial respiratory acidosis that was partially mitigated over time due to increased arterial [HCO3 - ]. There was a transient decrease in the ventilatory CO2 /H+ chemoreflex, followed by return to pre-exposure levels. The SS V I during chronic hypercapnia was greater than predicted from the acute CO2 /H+ chemoreflex, suggesting separate mechanisms regulating SS V I and the chemoreflex. Finally, as assessed by a shape discrimination test, we found a sustained decrease in cognitive function during chronic hypercapnia. We conclude that chronic hypercapnia per se results in: (1) a disconnect between SS V I and the CO2 /H+ chemoreflex, and (2) deterioration of cognitive function.

Abstract: The author concludes lessons learned from Hungary joining Eurotransplant five years ago through the more than half a century history of the Hungarian organ transplantation. The result of the stepwise evolution is that today’s transplantation activity can be measured by a European benchmark. In comparison to the era before the membership, there are 40% more transplantations in the country. First the numbers of the living donor kidney transplantations significantly raised, followed by the organs transplanted from brain-dead donors: kidney, heart, pancreas, then liver and finally also lung. The ratio of the multiorgan donors changed from about 40% to more than 70%. A reassuring solution was found for the high urgent cases, for the paediatric transplants and for the highly immunized patients, who would have been in a desperate situation without Eurotransplant, but now every Hungarian end-stage organ failure patient has similar chances for getting a potential life-saving organ as their former luckier West-European counterparts. Orv Hetil. 2018; 159(42): 1695–1699.

A nanofabrication method for the production of ultra-dense planar metallic nanowire arrays scalable to wafer-size is presented. The method is based on an efficient template deposition process to grow diverse metallic nanowire arrays with extreme regularity in only two steps. First, III–V semiconductor substrates are irradiated by a low-energy ion beam at an elevated temperature, forming a highly ordered nanogroove pattern by a “reverse epitaxy” process due to self-assembly of surface vacancies. Second, diverse metallic nanowire arrays (Au, Fe, Ni, Co, FeAl alloy) are fabricated on these III–V templates by deposition at a glancing incidence angle. This method allows for the fabrication of metallic nanowire arrays with periodicities down to 45 nm scaled up to wafer-size fabrication. As typical noble and magnetic metals, the Au and Fe nanowire arrays produced here exhibited large anisotropic optical and magnetic properties, respectively. The excitation of localized surface plasmon resonances (LSPRs) of the Au nanowire arrays resulted in a high electric field enhancement, which was used to detect phthalocyanine (CoPc) in surface-enhanced Raman scattering (SERS). Furthermore, the Fe nanowire arrays showed a very high in-plane magnetic anisotropy of approximately 412 mT, which may be the largest in-plane magnetic anisotropy field yet reported that is solely induced via shape anisotropy within the plane of a thin film.

β-cell replacement therapy, available currently as pancreas or islet transplantation, has developed without a clear definition of graft functional and clinical outcomes. The International Pancreas and Islet Transplant Association and European Pancreas and Islet Transplantation Association held a workshop to develop consensus for an International Pancreas and Islet Transplant Association and European Pancreas and Islet Transplant Association Statement on the definition of function and failure of current and future forms of β-cell replacement therapy. There was consensus that β-cell replacement therapy could be considered as a treatment for β-cell failure, regardless of etiology and without requiring undetectable C-peptide, accompanied by glycemic instability with either problematic hypoglycemia or hyperglycemia. Glycemic control should be assessed at a minimum by glycated hemoglobin (HbA(1c)) and the occurrence of severe hypoglycemia. Optimal β-cell graft function is defined by near-normal glycemic control (HbA(1c) ≤6.5% [48 mmol/mol]) without severe hypoglycemia or requirement for insulin or other antihyperglycemic therapy, and with an increase over pretransplant measurement of C-peptide. Good β-cell graft function requires HbA(1c) less than 7.0% (53 mmol/mol) without severe hypoglycemia and with a significant (>50%) reduction in insulin requirements and restoration of clinically significant C-peptide production. Marginal β-cell graft function is defined by failure to achieve HbA(1c) less than 7.0% (53 mmol/mol), the occur-rence of any severe hypoglycemia, or less than 50% reduction in insulin requirements when there is restoration of clinically significant C-peptide production documented by improvement in hypoglycemia awareness/severity, or glycemic variability/lability. A failed β-cell graft is defined by the absence of any evidence for clinically significant C-peptide production. Optimal and good function are considered successful clinical outcomes.

Treatment with a variable angle locking plate can, in theory, maintain near anatomic reduction of intra-articular distal radius fractures, but it is unknown to what extent reduction is maintained as measured by computed tomography. We assessed changes in radiographic fracture position 1 year post-operatively. We included 73 patients of whom 66 patients (90%) had radiographs available for review at 1 year post-operatively. We found a small (less than 2 mm or 2°) but statistically significant change in several measures. Accounting for inter-observer variability, this is probably within measurement error. We found no difference in change in fracture position or range of motion, grip strength or patient-reported outcome between the use of one or two distal rows of screws. Our results show that minimal changes in reduction can be expected after volar plate fixation in most patients. We recommend using only one screw row routinely, limiting costs, surgical time and the risk of misplacement of screws. Level of evidence: IV

As discussed in Chap. 1, quantum computing while not yet scalable has the potential to change the processing capabilities of computing especially for ML and AI processing.

It is important to understand how 5G wireless affects application analysis and design. In order to assess this impact, it is necessary to review 5G’s technical impact on performance. In Chap. 1, I laid the foundation of how the market will likely react to increased wireless performance.

Client/Server provides another level of sophistication in the implementation of systems. The concept of Client/Server is based on distributed processing, where programs and data are placed in the most efficient places.

Blockchain technology represents an interesting architectural invention that will primarily addresses the challenges of cyber security in the internet. As I previous discussed, the existing central database architectures cannot provide the security necessary to launch IoT systems. Blockchain is defined as a “ledger-based” system, in that it is designed to track all transactions and update all members of the chain. In actuality, the block chain design evolved from what started as a linked list data structure. Essentially, a linked-list originally was designed as a data structure that linked to another data element by storing information about where a value was stored was stored in memory.

This chapter will provide the historical structured analysis and design methodology that led to the object paradigm. At the core of an evolutionary approach are a set of traditional tools that need to be extended to meet the needs of an agile architecture in a mobile IoT market.

While 5G is the initiator of possibilities to bring forth the next generation of computing, the Internet of Things (IoT) represents the actual devices that will be the vehicle for its success. For it is IoT that represents the physical components that will make a technology feasible by placing intermediate smart hardware in every place imaginable around the globe.

This chapter provides guidance on system development life cycle methodologies and best practices for project management of in the next generation of systems.

This chapter outlines the process of interfacing new mobile-based system with preexisting applications called legacies. Issues of product fulfillment, connectivity of legacy databases and processes, and integration of multiple systems architecture are covered. This chapter combines many of the suggested approaches to user interface and application specifications development that are covered in previous chapters. The objective of the chapter is to also provide a detailed pathway to ultimately converting legacy systems.

ObjectiveTo evaluate risks of disease reactivity during pregnancy and postpartum following rituximab (RTX) and natalizumab (NTZ) suspension in women with MS.MethodsAn observational cohort study of all women with MS disease onset before childbirth between 2006 and 2017. Women were identified through the Swedish MS Registry, a nationwide clinical register, with substratification into 3 groups: women who suspended RTX and NTZ within 6 months before conception and women who were not treated with any disease-modifying treatment (DMT) within 1 year of conception. The primary outcome was the annualized relapse rate (ARR) during pregnancy and 1 year postpartum.ResultsWe identified 2,386 women with MS onset before a live birth; of these, 76 women suspended RTX and 53 suspended NTZ, and 457 were untreated within 1 year before conception. In all women, regardless of the treatment type, the ARR declined from 0.05–0.04 prepregnancy to 0.03–0.02 during pregnancy, returning to prepregnancy rates at 3–6 months (0.05) postpartum. In the suspended cohort, 76% (98/129) of women resumed a DMT after delivery. The relapse rate 1 year postpartum was significantly higher in the suspended NTZ women compared with the suspended RTX women (adjusted rate ratio [aRR] 7.65, 95% CI 2.47–23.6) and was lower in the suspended RTX women compared with the untreated women (aRR 0.21, 95% CI 0.08–0.61).ConclusionDisease reactivity during the postpartum period was lower among women with MS who suspended RTX before pregnancy, relative to those who suspended NTZ and untreated women. These findings suggest that RTX may exert long-acting effects on MS disease activity that encompass pregnancy and postpartum periods.Classification of evidenceThis study provides Class IV evidence that in patients with MS who were on treatment before pregnancy, RTX reduces clinical disease activity compared with NTZ in the postpartum period.

[This corrects the article DOI: 10.1371/journal.pcbi.1006840.].

This article provides practical guidance on successful management of women with multiple sclerosis (MS) through pregnancy and the postpartum period.Recent studies indicate that most women diagnosed with MS today can have children, breast-feed, and resume beta interferons or glatiramer acetate per their preferences without incurring an increased risk of relapses during the postpartum period. More than 40% of women with mild MS do not require any treatment before conception or in the postpartum period. Women with highly active MS can now become well-controlled before, throughout, and after pregnancy via highly effective treatments. Unfortunately, pregnancy does not protect against relapses following the cessation of fingolimod or natalizumab, and some women experience severe rebound relapses during pregnancy. Accidental first-trimester exposure to teriflunomide or fingolimod increases the risk of fetal harm.Most women with MS can have normal pregnancies and breast-feed without incurring harm. Clinicians should avoid prescribing medications with known teratogenic potential (teriflunomide, fingolimod), known risk of severe rebound relapses (fingolimod, natalizumab), or unclear but plausible risks (dimethyl fumarate, alemtuzumab) to women of childbearing age who desire pregnancy or are not on reliable birth control. If a treatment needs to be resumed during breast-feeding, clinicians should opt for glatiramer acetate, interferon beta, natalizumab, or rituximab/ocrelizumab, as biologically plausible risks to the infant are exceedingly low.

Objectives The Mental Health Index (MHI) is widely used as a measure of mental health status, but has not been evaluated in the geriatric oncology population. This study evaluated the MHI-17 in a geriatric oncology population, to establish validity and scoring rules. Materials and Methods The Carolina Senior Registry ( NCT01137825 ) was used to obtain data for 686 patients with cancer 65 and older who completed the MHI-17. The 17-item patient-reported measure produces one total score summing across four domains: anxiety, depression, positive affect, and sense of belonging. Cronbach's alpha (α), confirmatory factor analyses (CFA), item-response theory (IRT) analyses, and differential item functioning (DIF) analyses were used to evaluate internal consistency and validity. Results and Discussion The revised MHI retained the 13 best-fitting items from the MHI-17 and resulted in a final model that included two subscales: anxiety (four items, RMSEA 0.11; CFI 0.99; TLI 0.98) and depression (9 items, RMSEA 0.10; CFI 0.96; TL 0.95). IRT analyses of the four anxiety items indicated good fit (RMSEA 0.08) and precise measurement of adults with poor mental health, and the nine depression items also fit well (RMSEA 0.05). No meaningful differences were found by sex, education, or treatment stage. Scores were developed to provide meaningful norms. The new MHI-13 is a shorter, more accurate way to assess mental health in older adults with cancer and most importantly allows clinicians to separately identify anxiety and/or depression - a clinically important distinction as treatment differs among these two types of mental health impairment.

Despite considerable efforts there is no consensus regarding the ideal reconstruction method for the pancreatic remnant after pancreaticoduodenectomy (PD). Overall, 86 patients who underwent PD for ductal adenocarcinoma were selected for analysis. One surgeon (RF) took responsibility of all pancreatic resections, either by operating personally or proctoring the procedure. The database was prospectively maintained. End-to-side pancreaticojejunostomy (PJ; Group A) was performed from 01/01 to 10/07 and duct-to-mucosa PJ (Group B) from 10/07 to 12/12. Primary endpoints were 30-day mortality, incidence of pancreatic fistulas, and severe complications. Secondary endpoints were severity of pancreatic fistulas, incidence of unplanned reoperation and reintervention and length of stay (LOS). 30-day mortality, pancreatic fistula, complication, unplanned reoperation and reintervention rates showed no significant differences (2.2 vs. 2.4 %; 6.7 vs. 0 %; 22.2 vs. 29.3 %; 6.7 vs. 0 %; 11.1 vs. 2.2 %). Summarizing unplanned reoperations and reinterventions, the necessity of any unplanned procedure revealed, a significant reduction from 8 (17.8 %) in Group A to 1 (2.2 %) in Group B (p = 0.02). Major complications (Dindo–Clavien Grades III–V) were decreased significantly in Group B (Group A: 9/45 (20 %) vs. Group A: 2/41 (4.9 %); p = 0.05). LOS was significantly shorter in Group B (15 days, +/− 6.01) as compared with Group A (18 days, +/− 8.87; p

Iodinated and gadolinium-based contrast media are used on a daily basis in most radiology practices. These agents often are essential to providing accurate diagnoses, and are nearly always safe and effective when administered correctly. However, reactions to contrast media do occur and can be life threatening. Therefore, it is critical for faculty and staff to know how reactions to contrast agents manifest and how to treat them promptly. The decline in renal function seen occasionally after intravenous administration of iodinated contrast agents is poorly understood and likely multifactorial, and its association with the contrast medium may be overemphasized. However, it is important that radiologists be aware of current understanding and strategies to decrease the incidence of renal dysfunction. Nephrogenic systemic fibrosis, a skin disease, is an adverse reaction related to use of some gadolinium-based contrast agents in patients with chronic renal failure. The types of gadolinium most often associated with this condition and the indications for withholding gadolinium are important and are discussed in this article. The use of enteric contrast agents and contrast agents during pregnancy and nursing are reviewed briefly. Current knowledge for safe use of contrast media and key concepts that all radiologists should know are summarized in this review.

Quality improvement is increasingly important in the changing health care climate. We aim to establish a methodology and identify critical factors leading to successful implementation of a resident-led radiology quality improvement intervention at the institutional level. Under guidance of faculty mentors, the first-year radiology residents developed a quality improvement initiative to decrease unnecessary STAT pelvic radiographs (PXRs) in hemodynamically stable trauma patients who would additionally receive STAT pelvic CT scans. Development and implementation of this initiative required multiple steps, including: establishing resident and faculty leadership, gathering evidence from published literature, cultivating multidisciplinary support, and developing and implementing an institution-wide ordering algorithm. A visual aid and brief questionnaire were distributed to clinicians for use during treatment of trauma cases to ensure sustainability of the initiative. At multiple time points, pre- and post-intervention, residents performed a retrospective chart review to evaluate changes in imaging-ordering trends for trauma patients. Chart review showed a decline in the number of PXRs for hemodynamically stable trauma patients, as recommended in the ordering algorithm: 78% of trauma patients received both a PXR and a pelvic CT scan in the first 24 hours of the initiative, compared with 26% at 1 month; 24% at 6 months; and 18% at 10 to 12 months postintervention. The resident-led radiology quality improvement initiative created a shift in ordering culture at an institutional level. Development and implementation of this algorithm exemplified the impact of a multidisciplinary collaborative effort involving multiple departments and multiple levels of the medical hierarchy.

In the spring of 2017, a full-term infant with microcephaly was delivered in South Florida. During first trimester, the mother presented with fever, nausea, and vomiting. She reported no foreign travel for herself or her partner. The infant's neurologic, ophthalmologic, neuroradiologic, and audiologic findings were highly suggestive of congenital Zika syndrome (CZS), confirmed by IgM antibodies and plaque reduction neutralization test. New observations, including peripheral temporal retinal avascularity and peripapillary retinal nerve fiber layer thinning, are presented from this first known case of non-travel-associated CZS in the United States. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:e93–e98.]

Winner of a Shingo Research and Professional Publication AwardThe new edition of this Shingo Prize-winning bestseller provides critical insights and approaches to make any Lean transformation an ongoing success. It shows you how to implement a sustainable, successful transformation by developing a culture that has your stakeholders throughout the o

Genaue anatomische und biomechanische Untersuchungen sowie klinische Erfahrungen haben in den letzten Jahren unsere Kenntnisse uber die Funktion und Pathologie des distalen Radioulnargelenkes (DRUG) erweitert, sodass eine differenzierte Behandlung moglich ist. Bei Verletzungen reist haufig der ulnare Teil des triangularen Faserkomplexes (TFCC). Die Entwicklung der verschiedenen arthroskopischen Techniken zur Rekonstruktion und der aktuelle Kenntnisstand werden im Folgenden dargestellt. Der ulnare Teil des TFCC ist in einen oberflachlichen, fur die Stabilitat weniger bedeutenden und einen wichtigeren, tiefen in der Fovea ansetzenden Teil zu unterscheiden. Beide Teile konnen zusammen oder jeweils einzeln abreisen. Schlussel zur Diag­nose sind die klinische Untersuchung und die Arthroskopie. Bei der klinischen Untersuchung ist eine Instabilitat im Seitenvergleich und soweit moglich das Ausmas der Instabilitat festzustellen und auf extraartikulare Begleitverletzungen zu achten. Arthroskopisch wird der TFCC von radiokarpal und mehr und mehr auch vom DRUG her dargestellt und palpatorisch beurteilt. Im Falle einer Avulsion in der Tiefe ist eine anatomisch korrekte Refixation an den Knochen angezeigt und nach den vorliegenden Studien und eigenen Erfahrungen erfolgreich. Im Falle einer sehr ausgepragten Instabilitat ist anzunehmen, dass das Ausmas der Verletzung uber den isolierten Abriss in der Fovea hinausgeht und eine alleinige Reinsertion nicht in allen Fallen ausreichend ist.

Die Eizellspende („egg donation“, ED) stellt eine neue, hinsichtlich der Schwangerschaftsraten sehr erfolgreiche Technik der Reproduktionsmedizin dar. Die daraus hervorgegangenen Schwangerschaften sind jedoch komplikationsbehaftet; vor allem Praeklampsien, schwangerschaftsinduzierte Hypertonien und Gestationsdiabetes (GDM) sind hier zu nennen. Risikogruppen dafur stellen Patientinnen mit einem Alter > 50 Jahre und/oder relevanten Vorerkrankungen sowie Mehrlingsschwangerschaften dar. Besonders hoch sind die Risken bei Patientinnen mit bis dahin unbekannten kardialen Erkrankungen und bei Frauen mit 45X0-Turner-Syndrom, bei denen auch ein Mortalitatsrisiko besteht. Bezuglich der perinatalen Ergebnisse wurden erhohte Raten von Fruhgeburtlichkeit und „intrauterine growth restriction“ (IUGR) beobachtet. Aus diesen Ergebnissen ergeben sich die Konsequenzen, das Alter der Empfangerinnen mit 50 Jahren zu begrenzen, den „single embryo transfer“ zu forcieren und bei Frauen mit Monosomie X extrem zuruckhaltend vorzugehen.

Living related kidney donations (LRD) have had a significant impact on therapy of kidney diseases. Due to their ease of scheduling in the general surgery program and better half-life of about 21.6 versus 13.8 years for deceased donor kidneys, this approach has revolutionized nephrology and transplantation medicine. Since the first Hungarian LRD which was performed in 1974 in Budapest, Hungary, donations have expanded especially in the last 3 years. This has been followed in 2000 by living unrelated kidney donations (LURD). Since 2000 LURD can be also performed in Hungary. From the 251 LRD in our country in the last 3 years, 79 living donations have accounted for nearly one-third of the cases. In comparison of 2008, and 2011 the absolute numbers of LRD as well as LURD have more than doubled from 9 to 20 and 6 to 14 respectively. Based on international ranking data from the global observatory on donation and transplantation Budapest has improved from 1.20 in 2000 to 6.20 LRD per million persons (p.m.p.) in 2010. The increase in LURD has also led to some side effects: an increase in recipient age from 26 years in 2000 to 46 in 2011 and greater HLA mismatches. In 2010, Budapest ranked higher than Croatia or Portugal but still behind Germany (8.13 LRD p.m.p.) and the leading countries: the Netherlands (28.49 LRD p.m.p.) and Norway (16.94 LRD p.m.p.). Because of the tremendous progress in LRD, the gap between today's leading countries and Budapest is closing.

End-stage renal failure, a frequent complication of type 1 diabetes mellitus, requires renal replacement therapy. Our team examined the laboratory parameters of carbohydrate metabolism in 18 patients with type 1 diabetes at 10 to 89 months after simultaneous pancreas-kidney transplantation. We compared these results with those of 17 patients with type 1 diabetes who had formerly received kidney-alone transplantations, and were undergoing insulin treatment, as well as with those of 16 metabolically healthy controls. The hemoglobin A1c (HbA1c) and blood glucose levels of the pancreas-kidney transplant recipients were within the normal ranges, not differing significantly from those of the healthy controls. In contrast, the HbA1c and glucose levels were significantly elevated among kidney transplanted diabetic subjects. However, fasting and 2-hour insulin levels of pancreas-kidney transplant patients were significantly higher than those of the controls, indicating insulin resistance. According to these results, the insulin secretion by the pancreas graft sufficiently compensated for insulin resistance. Thus 10 to 89 months after successful pancreas-kidney transplantation, carbohydrate metabolism by type 1 diabetic patients was well controlled without antidiabetic therapy.

Objective To evaluate whether the maximum degree of placental invasion (placenta accreta, increta or percreta) can be predicted with ultrasound imaging, using criteria developed in our department. Methods This was a retrospective study of all 232 patients at risk for placental invasion who were part of a routine screening program for placental invasion from January 2001 to January 2011. The whole placenta was scanned in a systematic manner using both gray-scale ultrasound and color-flow mapping. Sonographic findings were compared with the clinical outcome during and after delivery and the histomorphological examination of the placenta. Results Placental invasion was suspected by ultrasound in 40 (17.2%) patients and was clinically/histopathologically confirmed in a total of 35 (15.1%) patients. The sensitivity, specificity and positive and negative predictive values of ultrasound for placental invasion were 91.4% (95% CI, 77.6–97.0%), 95.9% (95% CI, 92.2–97.9%), 80.0% (95% CI, 65.2–89.5%) and 98.4% (95% CI, 95.5–99.5%), respectively. No case of placenta increta (n = 7) or percreta (n = 17) was diagnosed as showing normal placentation or placenta accreta on ultrasound, giving an overall accuracy for the differentiation between normal placentation/placenta accreta and placenta increta/percreta of 100%. Conclusion Our data suggest that prediction of the degree of placental invasion is possible using prenatal ultrasound, with high overall accuracy. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

Zum globalen Anstieg der Sectiorate tragen Faktoren aus mehreren Bereichen bei: Medizin, Demographie und Veranderungen der Arzt-Patientinnen-Beziehung. Der im Wesentlichen kulturelle, nichtbiologische Charakter dieser Faktoren erklart, warum die Kampagnen zur Senkung der Sectiorate erfolglos bleiben mussten. Zur Nomenklatur wird vorgeschlagen, einen Kaiserschnitt dann als Sectio auf Wunsch der Schwangeren zu bezeichnen, wenn er nach unauffalliger Schwangerschaft mit eutrophem Kind in Schadellage nach der 38. Schwangerschaftswoche stattfindet. Zustand nach Sectio oder nach traumatisierender Geburt sollten als Indikationen anerkannt, der Begriff „tocophobia“ wegen seiner abwertenden, pathologisierenden Konnotationen nicht verwendet werden. Die Sectiofrequenz sollte keinen Qualitatsindikator fur eine Abteilung oder ein nationales Gesundheitssystem darstellen. Nachdem die Spontangeburt zwar ein naturlicher, aber kein ungefahrlicher Vorgang ist, sollte uber die typischen Risken einer Spontangeburt vergleichend zur Sectio aufgeklart werden. Die Sectio kann dann als Geburtsmodus des 21. Jahrhunderts bezeichnet werden, wenn der Patientenaufklarung grose Bedeutung zugestanden wird. Die Gruppe von jungen Schwangeren mit Wunsch nach mehreren Kindern, bei denen vor allem Informationsmangel und Angste vor Schmerzen zum Sectiowunsch fuhrten, stellt eine Zielgruppe fur eine intensive Aufklarung vor. Ferner ist auf eine Verringerung der Mehrlingsrate nach IvF hinzuarbeiten.

The process whereby existing rituals are taken up and re-envisaged is a well known phenomenon in ritual studies. The offering of a piece of white of cloth to the officiating monks during the Theravāda Buddhist funeral ceremony provides a particularly good example. This custom originates in pre-Buddhist funerary rituals, which included the symbolic covering of the dead body with a new, uncut piece of white cloth intended as a new garment for the deceased, but which was afterwards donated to the officiating priests. The present article examines how in the Buddhist funeral the donation of the cloth came to be associated with the monks’ ascetic practice of making their robes from discarded rags (paṃsukūla). A comparison of the lists of “rags” in the Theravāda and Mūlasarvāstivāda Vinayas and in the Visuddhimagga and Vimuttimagga, alongside a historical exploration of the attitude of the Buddhist laity towards monks who adopted ascetic practices, sheds new light on the significance of the paṃsukūla offering. Further, the manner in which an old pre-existing ritual is accommodated within a different conceptual framework provides a clear instance of the primacy of ritual continuity over ritual meaning.