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Background: Animal experiments have convincingly demonstrated that prenatal maternal stress affects pregnancy outcome and results in early programming of brain functions with permanent changes in neuroendocrine regulation and behaviour in offspring., Aim: To evaluate the existing evidence of comparable effects of prenatal stress on human pregnancy and child development., Study Design: Data sources used included a computerized literature search of PUBMED (1966-2001); Psychlit (1987-2001); and manual search of bibliographies of pertinent articles., Results: Recent well-controlled human studies indicate that pregnant women with high stress and anxiety levels are at increased risk for spontaneous abortion and preterm labour and for having a malformed or growth-retarded baby (reduced head circumference in particular). Evidence of long-term functional disorders after prenatal exposure to stress is limited, but retrospective studies and two prospective studies support the possibility of such effects. A comprehensive model of putative interrelationships between maternal, placental, and fetal factors is presented., Conclusions: Apart from the well-known negative effects of biomedical risks, maternal psychological factors may significantly contribute to pregnancy complications and unfavourable development of the (unborn) child. These problems might be reduced by specific stress reduction in high anxious pregnant women, although much more research is needed.

Nowadays many types of medical documentation are based on computer facilities. Unfortunately, this involves the considerable disadvantage that almost every single department and specialty has its own software programs, with the physician having to learn a whole range of different programs. In addition, data sometimes have to be entered twice - since although open interfaces are often available, the elaborate programming required to transfer data from outside programs makes the financial costs too high. Since 1995 the University's of Frankfurt am Main Department of Gynecology and Obstetrics has therefore developed a consistent program of its own under Windows NT for in-patient facilities, as well as for some outpatient services. The program does not aim to achieve everything that is technically possible, but focuses primarily on user requirements. In addition to the general requirements for medical documentation in gynecology and obstetrics, the program can also handle perinatal inquiries and gynecological quality control (QSmed [Qualitätssicherung in der Medizin] of the BQS [Bundesgeschäftsstelle Qualitätssicherung]).

Purpose: To evaluate the effectiveness of diagnostic and interventional radiological techniques for neoplastic lesions of the temporomandibular joint (TMJ)., Material and Methods: Modern diagnosis of the TMJ is based on the clinical use of conventional X-ray techniques, computed tomography (CT), magnetic resonance imaging (MRI) and interventional techniques like biopsies, vascular occlusion and ablation., Results: Conventional X-ray still forms the basic diagnostic procedure applied in open and closed mouth position. CT improves the diagnostic information and serves as the standard diagnostical instrument for cartaliganeous or osseous neoplastic lesions. MRI evaluates soft tissue infiltration in multiplanar techniques and high spatial resolution. Interventional vascular and ablative techniques improve the treatment of neoplastic disorders., Conclusion: Radiological diagnostic procedures are essentials for the diagnosis and intervention of neoplastic lesions of the temporomandibular joint.

The composition of vesicles determines the physical state and elasticity of their bilayers. Fatty acid spin labels were incorporated into vesicles, composed of the single chain non-ionic surfactant octaoxyethylenelaurate-ester (PEG-8-L), the sucrose laurate-ester L-595 and cholesterol sulfate (CS) to monitor local dynamic properties of lipid molecules in vesicle bilayers and to study the elasticity of vesicle bilayers. Studies with the spin label probes 5-, 12- and 16-doxyl stearic acid (DSA) indicated that both the order parameter and the rotational correlation times increased when the doxyl group was positioned closer to the headgroup region. These findings indicate that the fluidity of membranes decreased near the headgroup region. Comparing 16-DSA incorporated in vesicle formulations with either 30 or 70 mol% showed no difference in alkyl chain mobility as was reflected by the order parameter. The rotational correlation times, however, showed a slowdown from 0.38 to 0.71 and 1.13 ns when the PEG-8-L molar content was decreased from 100 to 70 and 30 mol% for PEG-8-L:L-595:CS vesicles, respectively. Extrusion measurements indicated an increase in elasticity of vesicle bilayers as the molar content of PEG-8-L was increased from 10 to 90 mol%. Incorporation of cholesterol sulfate stabilizes vesicles and thereby, decreases the elasticity. The increased elasticity correlated excellent with a reduction in the rotational correlation times observed. In conclusion, these results demonstrate that when the molar content of the single chain non-ionic surfactant PEG-8-L in vesicles is increased the elasticity is enhanced and the rotational correlation time is reduced. The enhanced elasticity might contribute to an optimal design of vesicles as drug carriers for transdermal application.

Problem: To provide an overview and to assess the clinical feasibility of Internet technology-based systems for hospital-wide image and report distribution as well as for video conferencing., Methods: The paper describes the theoretical concept behind, the various technical approaches and the experience gained from different systems., Results: Image and report distribution: Advantages include the universal availability of images and reports inside and outside hospitals; ease of use; security features; image and report integration; cost savings by reducing support and training efforts and by optimising available hardware. The main critical issues are performance and workflow integration with RIS and PACS. Video conferencing: main advantages are the standardised, software-based approach and the low investments for hard- and software. Depending on the desired usage the communication performance can be seen as inappropriate., Conclusion: Today, Internet technology-based systems appear to satisfy the main clinical needs in radiology. The mentioned drawbacks could be eliminated by means of modified software implementation and focused standardisation efforts. Considering the numerous advantages of these systems a further distribution can be expected for the future.

One of the possibilities for increasing the penetration rate of drugs through the skin is the use of vesicular systems. Currently, special attention is paid to the elastic properties of liquid-state vesicles, which are supposed to have superior properties compared to gel-state vesicles with respect to skin interactions. In this study, the effects of vesicles on hairless mouse skin, both in vivo and in vitro, were studied in relation to the composition of vesicles. The interactions of elastic vesicles containing the single chain surfactant octaoxyethylene laurate-ester (PEG-8-L) and sucrose laurate-ester (L-595) with hairless mouse skin were studied, in vivo, after non-occlusive application for 1, 3 and 6 h. The skin ultrastructure was examined by ruthenium tetroxide electron microscopy (TEM) and histology. The extent, to which vesicle constituents penetrated into the stratum corneum, was quantified by thin layer chromatography (TLC). The interactions of the elastic vesicles containing PEG-8-L and L-595 surfactants were compared with those observed after treatment with rigid vesicles containing the surfactant sucrose stearate-ester (Wasag-7). Furthermore, skin permeability experiments were carried out to investigate the effect of treatment with PEG-8-L micelles, elastic vesicles (containing PEG-8-L and L-595 surfactants) or rigid Wasag-7 vesicles on the 3H(2)O transport through hairless mouse skin, in vitro, after non-occlusive application. Treatment of hairless mouse skin with the elastic vesicles affected the ultrastructure of the stratum corneum: distinct regions with lamellar stacks derived from the vesicles were observed in intercellular spaces of the stratum corneum. These stacks disrupted the organization of skin bilayers leading to an increased skin permeability, whereas no changes in the ultrastructure of the underlying viable epidermis were observed. Treatment with rigid Wasag-7 vesicles did not affect the skin ultrastructure or skin permeability. TLC measurements showed that after 1 h of non-occlusive application of elastic or rigid vesicles, a six-fold increased amount of elastic vesicle material was present within the stratum corneum compared to rigid vesicle material. After 3 and 6 h of application the amount of PEG-8-L vesicle material in SC decreased to approximately three- and two-fold, respectively, compared to Wasag-7 vesicle material. Pretreatment of the hairless mouse skin with the elastic vesicles containing 70 mol% PEG-8-L increased the diffusion of 3H(2)O with an optimum application dose of 2.5 mg lipids/cm(2) compared to PBS pretreatment. No significant difference in the enhancement of the 3H(2)O-diffusion was observed between PEG-8-L micelles or elastic vesicles containing 30 or 70 mol% PEG-8-L. Pretreatment with the rigid Wasag-7 vesicles decreased the diffusion rate of 3H(2)O, most probably by the formation of a lipid layer on the skin surface. The effect of the elastic vesicles on the skin permeability is supported by the ultrastructural changes observed by TEM in the intercellular lipid domains. The elastic vesicles containing 70 mol% PEG-8-L disorganize the lipid bilayers thereby creating or modifying pathways for possible drug penetration.

Interactions between vesicle formulations and human skin were studied, in vitro, in relation to their composition and elasticity. The skin ultrastructure was investigated using transmission electron microscopy (TEM), freeze-fracture electron microscopy (FFEM) and two-photon fluorescence microscopy (TPE). The main difference between the vesicle formulations was their elasticity. Elastic vesicle formulations contained bilayer forming surfactants/lipids and single-chain surfactant octaoxyethylenelaurate-ester (PEG-8-L), whereas rigid vesicles contained bilayer surfactants in combination with cholesterol. TEM results showed three types of interactions after non-occlusive application of elastic PEG-8-L containing vesicle formulations on human skin: (1) the presence of spherical lipid structures containing or surrounded by electron dense spots; (2) oligolamellar vesicles were observed between the corneocytes in the upper part of the stratum corneum; and (3) large areas containing lipids, surfactants and electron dense spots were observed deeper down into the stratum corneum. Furthermore, after treatment with vesicles containing PEG-8-L and a saturated C12-chain surfactant, small stacks of bilayers were found in intercellular spaces of the stratum corneum. Rigid vesicles affected only the most apical corneocytes to some extent. FFEM observations supported the TEM findings. Major morphological changes in the intercellular lipid bilayer structure were only observed after treatment with PEG-8-L containing elastic vesicles. TPE showed a distinct difference in penetration pathways after non-occlusive application of elastic or rigid vesicles. After treatment with elastic vesicles, thread-like channels were formed within the entire stratum corneum and the polygonal cell shape of corneocytes could not be distinguished. Fluorescent label incorporated in rigid vesicles was confined to the intercellular spaces of the upper 2-5 micrometer of the stratum corneum and the cell contours could still be distinguished.

Novel multicomponent organogels containing an aqueous phase are described, and some properties which influence their potential as delivery devices for hydrophilic drugs and vaccines are discussed. The gel is produced by preparing a hot water-in-oil (w/o) emulsion using sorbitan monostearate, a nonionic surfactant which is also the organogelator, as the principal emulsifying agent. On cooling at room temperature, the w/o emulsion sets to an opaque, semisolid, thermoreversible organic gel. Cooling the emulsion results in a reduced solubility of the sorbitan monostearate in the oil, with a corresponding decrease in solvent-surfactant affinities, causing surfactant self-assembly into aggregates. The microstructure of the w/o gel is seen by light microscopy to consist of a network of tubules and fibrils (containing the aqueous phase) dispersed in the organic medium. X-ray diffraction and freeze-fracture studies suggest that the tubular aggregates in the w/o gel are made up of surfactant molecules arranged in inverted bilayers and that the aqueous phase is accommodated within these inverted bilayers, bound by the polar headgroups of the surfactant molecules. The presence of water in the tubular skeleton of the organic gels results in the establishment of percolating electroconductive aqueous channels in the organogel. Increasing the water content of a w/o gel causes the surfactant tubules to swell with a corresponding increase in conductivity until the tubules are saturated. Further increase in the water content results in the excess water accumulating in droplets within the organic medium and a decrease in conductivity as the gel integrity is compromised. The w/o gels (containing a model antigen, radiolabeled bovine serum albumin, in the aqueous phase) have demonstrated depot properties after intramuscular administration to mice, entrapped antigen being released over a period of days.

Unlabelled: This paper describes the theoretical concept behind, the technical implementation of, and the experiences created with a self-developed system to access radiological patient data by WWW-technology., Materials and Methods: The WWW-system interfaces the RIS via HL7 and the PACS via DICOM. Core components are a secure Web-Server and an underlying database system (DB). The DB contains all relevant information from the RIS and thumbnails of corresponding images archived in the PACS. After authorization, the user receives this information in the form of dynamically generated Web pages. By mouse-clicking a thumbnail, the original DICOM-image is sent. It is displayed with a helper application (DICOM-Viewer), allowing all kinds of image manipulation and post-processing., Results: Determined advantages of the system were: platform independence, security features, a fixed link of image and report, universal availability, and simple usage. The only critical issue was performance. Cost savings could be seen in: a reduction of DICOM workstations, employment of all available hardware, and reduced training and teaching efforts., Conclusions: The author believes that a WWW-based concept is the only feasible approach which is in the same way technically possible, clinically acceptable, and financially affordable in order to grant a variety of users access to radiological data--although improvements in performance have to made by, e.g., closer implementation of those systems to the RIS and PACS architecture, and by employing high-grade image compression.

In this study, we tested a Dutch version of Harter's (1985) Self-Perception Profile for Children for equivalence of measurement and structure across gender and age (grade), using the LISREL confirmatory factor analytic model. The sample consisted of 758 Flemish 4th, 5th, and 6th graders (8-13 years old, M = 10.5 years old). Support was found for equivalence of structure for boys and girls, for 4th and 5th graders, and for 5th and 6th graders. Equivalence of measurement was only partially found. The relation between items and factors was invariant across gender and grade. The error of measurement however was not equivalent, indicating that the items had not the same reliability for boys and girls and across all grade groups.

Introduction: An ROC analysis was carried out in order to determine the reliability of digital luminescence radiography review at a PC and this was compared with a radiological work station and with X-ray film on a viewing box., Material and Method: 54 chest images obtained by digital luminescence radiography were selected, 31 of these contained small pulmonary nodules. In order to evaluate critical detail, five images of a phantom showing round foci were used. Five radiologists examined these, using a Siemens Magic View work station, a PC with proprietary software (ViewMed) and X-ray films on a viewing box. Image processing of the work station used the standard clinical application. ViewMed performs linear scaling of grey levels to 8 Bit. The results were examined statistically by means of a t-test., Results: As far as the chest images were concerned there was no significant difference in the diagnostic value of these methods. There was, however, a highly significant loss of diagnostic information with respect to the round focus phantom when using the PC compared with the other methods., Conclusion: In the configuration in which it was used, the PC should not be relied on as a primary means of examination since critical details cannot always be seen. In routine use these play a subordinate role and there was no significant diagnostic loss where the chest images were concerned. We expect that by improvements in the frequency and contrast processing the PC accuracy will be considerably increased.

The authors believe that the WWW-based access to clinical and radiological data is the only suitable approach that is in the same way technically possible, clinically acceptable and financially affordable with the today existing restrictions in the healthcare sector.

The intercellular lipid bilayers of the stratum corneum provide the permeability barrier of the skin. To perform an electron microscopical examination of the ultrastructure of these bilayers, ruthenium tetroxide fixation is required. In this study an optimal fixation protocol was developed and selected upon comparing seven different fixation procedures, using glutaraldehyde (GA) and the postfixatives ruthenium red, osmium tetroxide (OsO4) and ruthenium tetroxide (RuO4) in combination with potassium ferrocyanide (K4Fe(CN)6) and potassium ferricyanide (K3Fe(CN)6). Instead of fixing skin with either OsO4 or RuO4, these two fixatives were combined in one protocol. In addition, the use of RuRed was introduced and the influence of both K4Fe(CN)6 and K3Fe(CN)6 in combination with RuO4 were examined. Furthermore, we compared two dehydration solvents, methanol and acetone. The most satisfying results were obtained when the skin was prefixed in GA and postfixed in OsO4 and RuO4 with K3Fe(CN)6, i.e. with Fe in its highest oxidation state (Fe3+). No differences were observed between dehydration in methanol and acetone.

In this paper we describe a preparative procedure which allows maximal visualization of all lipid bilayers in the human stratum corneum (SC). We used 50-microns-thick vibratome sections of paraformaldehyde/glutaraldehyde-fixed human skin. The sections were post-fixed in 1% osmium tetroxide and 0.5% ruthenium tetroxide. The vibratome sections were dehydrated only in 70% ethanol in order to prevent dissolution of the lipids. Lipid bilayers, including the alternating electron-dense and electron-lucent lamellae, were visible between all cell layers of the SC. In addition, this preparative procedure also appeared to be excellent for the ultrastructural preservation of lamellar bodies.

A PC-platform is presented using internet technology on Ethernet (local) or ISDN (external) for access to digital hospital infrastructures comprising electronic multimedia patient records integrating information systems of all clinical departments. In addition, a videoconferencing system is implemented for teleconsulting, and a document camera allows transmission of analogue data. In combination with the multimedia-PC. Ethernet as well as ISDN offer satisfying performance for transmission of medical data including images. In 20 cases, visualisation of the electronic patient record, an average CT with report and 58 GIFF Images', or transfer of an ACR-NEMA file from CT, took seconds (Ethernet) or up to 3.5 minutes (ISDN - 58 CT images and report).

Incorrect exposure of conventional radiographs frequently leads to repetition of the examination and thereby to increased radiation exposure for the patient. Underexposed films of an Alderson-Rando phantom, an ankle joint and a patella were digitised by means of an inexpensive fluorescent light scanner, and subsequent image manipulation improved quality so as to make the image diagnostically adequate. For the demonstration of markedly underexposed structures digitalisation with subsequent contrast enhancement was used. Well exposed structures are best evaluated in contrast enhanced transmitted light. Our results suggest it should be possible to reduce the number of repeat exposures and thereby to limit radiation exposure.

One hundred and thirty-two patients with suspected lesions of the femoral arteries following diagnostic and/or therapeutic cardiac catheterisation were studied by colour Doppler sonography (CDS) and digital subtraction angiography (DSA) and the results were compared. CDS was unable to demonstrate 5 out of 23 av fistulae. Intra-arterial DSA showed all av fistulae found at operation. CDS showed lower reliability (95%) than DSA (100%) for the demonstration of pseudoaneurysms. CDS can indicate hematoma and thrombi in pseudo-aneurysms and their exact extent is better shown by sonography. Arterial dissections (2 cases) and intra-luminal thromboses or occlusions of the femoral artery (4 cases) are shown equally well by the two procedures.

The effects of various placement techniques on the formation of microgaps were compared at the gingival margins of class II composite resin restorations. Three incremental techniques (occlusogingival layering, oblique layering, and faciolingual layering) and two one-bulk techniques of placing composite resin were studied. In the first one-bulk placement technique the composite resin was photocured occlusally; in the second one-bulk technique the composite resin was irradiated from three directions; facial, lingual, and occlusal. None of the incremental placement techniques improved the adaptation at the gingival margin compared with a one-bulk technique irradiated occlusally. However, the one-bulk placement technique that was irradiated from three directions created a substantial marginal discrepancy.