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Home-monitoring represents an innovative and growing health service area in which suitable conditions have to be created for the attending doctor and also for the patient. For this it is necessary to offer the technical supply and also to establish simultaneously organisational structures in the cooperation between the doctor and the patient based on prevalent experiences of general ambulant care. The medical care as a whole can be optimised to be more patient-orientated by integrating assistant medical staff and by establishing modern IT communication channels. The evolving home-monitoring in consideration of the doctor-patient experiences can contribute to an improvement in the patient's quality of life.

Background: We have previously reported that irradiation of mice in utero significantly increased the tumor incidence in the offspring of irradiated mothers. The joint effects of irradiation and cigarette smoking (CS) on tumor incidence and on the process of carcinogenesis were investigated., Materials and Methods: Pregnant C57Bl/6J female mice were irradiated with a single dose of gamma-ray (1 Gy or 3 Gy) and/or exposed to CS of IR3 non-filtered cigarettes before or during pregnancy, tumors were investigated both with histological and immunohistochemical methods., Results: Longer exposure (60 days) of the mice to CS before pregnancy and irradiation during pregnancy significantly increased the tumor incidence in the mothers and their offspring. Parallel activation of Caspase-8 and inactivation of Caspase-9 was found., Conclusion: Joint exposure of mice to prolonged CS before pregnancy and irradiation during pregnancy significantly increased the tumor incidence both in the mothers and their offspring.

Background: The aim of this study was to study and analyse distribution, range and intraday variation of ocular perfusion pressure (OPP) in patients with primary open-angle glaucoma (POAG) in the framework of telemedical home-monitoring., Methods: In the project Teletonometry Mecklenburg-Vorpommern (TTMV) patients were equipped with a home-monitoring system for self-measurement of intraocular pressure and blood pressure. All measurements were transmitted via telephone modem to an electronic patient record that automatically calculated OPP. We present the temporal characteristics of OPP in 70 patients with POAG. After the measurement of blood pressure and intraocular pressure was performed, the individual ocular perfusion pressure was calculated by the formula: (OPP=[2/3 x (2/3 x DBP + 1/3 x SBP)]-IOP)., Results: In 3282 OPP measurements the percentage of values less than 50 mmHg was: left eye 2273/69.2%--right eye 2362/71.9 % and less than 40 mmHg: left eye 687/20.9 %--right eye 794/24.2%. 50/51 (left eye/right eye) patients had an individual OPP average of less than 50 mmHg and 10/10 (left eye/right eye) patients less than 40 mmHg. The diurnal OPP trend showed 4 phases (7-12, 12-18, 18-22, 22-7 hour). In the intervals from 22-7 hour and 7-12 hour ocular perfusion pressure values were low. Between 7-12 hour ocular perfusion pressure was significantly depressed as in the other phases (p<0.05)., Conclusions: Ocular perfusion pressure of glaucoma patients calculated using intraocular pressure (self-tonometry) and blood pressure demonstrates a feasible method to evaluate individual diurnal OPP fluctuations. However, this OPP could be described a bit more precisely as the really topical ocular perfusion. Many physiological conditions may not be included, e. g., autonomic circulation. Simultaneous measurement of blood pressure and intraocular pressure enable the detection and analysis of side effects and interactions between glaucoma and hypertension therapy. In clinical practice OPP telemonitoring presents a new way to examine ocular blood circulation in routine glaucoma work-up. The diurnal OPP variations were associated with the fluctuations of systemic blood pressure for the most of part.

Background: Elevated intraocular pressure (IOP) is a clinically relevant factor in glaucoma progression. As a dynamic parameter the IOP depends on various internal and exogenic influencing factors. Therefore, we analysed intraindividual IOD variations between ambulant care and 24-h home-monitoring using self-tonometry., Patients and Methods: This study is based on paper-based glaucoma cards of 25 patients with primary open angle glaucoma. Additionally, all patients participated in a telemedical home-monitoring study with self-measurements of IOP and blood pressure stored in an electronic patient record. The glaucoma cards contained a total number of 409 IOP values with documentation periods from 0.5 to 10 years. In the teletonometry project all 25 patients were observed for 6 months with 1490 recorded IOP values. Statistical analysis was performed with SPSS software., Results: Average IOP values for all 25 glaucoma patients were 16.3 +/- 2.9 mmHg for both eyes in glaucoma card documentation, whereas the electronic patient records showed IOP averages of 18.9 +/- 4.7 mmHg for right eyes and 18.2 +/- 4.4 mmHg for left eyes. Corresponding to the practice opening hours the glaucoma cards contained no IOP records from 12:00 pm to 01:30 pm as well as between 06:00 pm and 07:15 am. In these time periods 17 % of all IOP values recorded in 24-hour teletonometry were higher than 20 mmHg. However, statistical analysis and clinical evaluation of device parameters and measurement characteristics revealed sporadic measuring errors., Conclusions: The additional involvement of self-tonometry in telemedical 24-h home-monitoring is a feasible method to record and detect intraday IOP fluctuations. Compared to single IOP measurements documented in common paper-based glaucoma cards, the 24-h electronic patient record showed more frequent circadian IOP variations. As a result, self-tonometry and home-monitoring can be a useful link to fill the gap between singular ambulant IOP measurement and hospitalisation with 24-hour IOP profiles.

Background: At the University Eye Hospital of Greifswald, we have developed a digital patient record that allows close monitoring of glaucoma, diabetes and hypertension. The record stores contemporary, long-term profiles containing intraday variation and interaction of intraocular pressure, blood pressure and serum glucose levels even at night., Methods: All patients are equipped with a home monitoring system. They subsequently transmit self-measurements via the "telemedical interface" to the server. Physicians use a web front-end to access electronic patient records; this provides a PDF export filter for printing. We intend to include a total number of 120 patients from Mecklenburg-Vorpommern who suffer from glaucoma possibly combined with hypertension/diabetes. This long-term investigation was designed as a randomised cross-over study in two groups., Results: Especially for this project an electronic patient record was developed and implemented. The components of the home monitoring system were modified and connected to a custom-built "telemedical interface". To date the study includes 120 patients, 60 of whom constantly measure and transmit their values to the electronic patient record, while the others are treated without home monitoring. All self-measurements are presented in a tabular form. In addition, dynamically generated graphics provide a diagrammatic view of all values. On demand, a detailed protocol for every single measurement report allows a comprehensive evaluation of the quality of the self-measurements. Ocular perfusion pressure is calculated automatically from intraocular pressure and blood pressure. The presented system documents continuously all information that is relevant for treatment and provides fast access for all attending physicians., Conclusions: Central data collection and unlocalised access improve information exchange between involved physicians. Flexible measurement periods allow the detection of pressure spikes even at night. In addition, this may help to classify glaucoma (normal-pressure glaucoma) and its causal connection to blood pressure. The patients benefit from individualised therapy adaptation and early therapeutic intervention in case of critical parameters.

Ten career conversations between adolescent peers were video-taped to examine the joint actions of adolescents that emerge in actual conversations about career. Based on an action-theoretical approach, joint action refers to the intentional behavior of a group of people attempting to realize a common goal or engage in a common process. The actual conversations and the adolescents' recall of their thoughts and feelings during the conversations were used to identify the joint actions that occurred in the conversations and the meaning that the conversations had for the adolescents. Goals of the actions included educational planning, career selection, and personal future. The functions the adolescents undertook in the conversations to reach these goals were identified as exploring, formulating, validating, and challenging. Based on these results, it was proposed that self-refinement was the project that energized and guided the joint actions and lent meaning to the conversations., (Copyright 1999 The Association for Professionals in Services for Adolescents.)

The atomic bombing of Hiroshima and Nagasaki and the nuclear accident at Chernobyl raised the question of prenatal sensitivity to ionizing radiation-induced cancer. In this study, mice were exposed to single doses of gamma-radiation (0.2-2.0 Gy) at different embryonic stages. The tumor incidence increased with dose from 15% in control mice to 35% in mice irradiated with 2.0 Gy on 18 d of prenatal life. Various oncogenic events were investigated in lymphoid, liver, lung, and uterine tumors. We observed threefold to fivefold increases in myc expression in 25% of the lymphomas, and the expression of Ha-ras and p53 genes decreased in 40% and 60% of the lung tumors by twofold to fivefold. Point mutations were tissue specific: Ha-ras codon 61 mutations were found in about 40% of the liver adenocarcinomas, Ki-ras codon 12 mutations in about 17% of lung tumors, and p53 mutations in about 15% of the lymphomas. Amplification and rearrangement of the p53, myc, and Ha-, Ki- and N-ras genes were not detected. Loss of heterozygosity on chromosome 4 at the multiple tumor suppressor 1 and 2 genes was observed in all types of malignancies. Allelic losses on chromosome 11 at the p53 locus were found in lymphoid, liver, and lung tumors, but they were absent from uterine tumors. Multiple oncogenic changes were often detected. The frequency of carcinogenic alterations was similar in spontaneous and radiation-induced lymphoid, liver, and uterine tumors. In radiation-induced lung adenocarcinomas, however, the incidences of many oncogenic changes were different from those found in their spontaneous counterparts. This suggests that different oncogenic pathways are activated during spontaneous and in utero gamma-radiation-induced murine lung carcinogenesis.

Authors have treated 37 fractures of the scapula during 3 years. The questions of the aetiology, classification, diagnosis and therapy of this injury are reviewed. It is stated that the majority of the scapula fractures heal on conservative therapy; in consequence the functional treatment has a leading role. The fractures of the articular surfaces with step formation, the fractures of the scapular neck process dislocated in a high degree, or unstable fractures of the scapular neck combined with the comminutive fractures of the operative therapy are assessed. Attention is called to the most frequent operative complications and to the possibility of their prevention.

Obstructing carcinoma of the left side of the colon causes proximal distension of the colon with subsequent thinning of the colonic wall and vascular impairment. Conventional surgical treatment is multi-staged. Each stage carries its own morbidity and mortality. An alternate treatment, extended right hemicolectomy, requires a single surgical procedure. Fifty-six cases of acute obstructing carcinoma of the left colon are presented: 16 in Group I were treated conventionally; 40 in Group II were treated by extended right hemicolectomy. In Group I, four died within one week of surgery. Six survived with a colostomy; all suffered from poor quality of life until death. For the six who received complete treatment, average total hospitalization was 54 days. Group II suffered no peri-operative mortality. Patients were discharged without a colostomy after an average hospitalization of 15.7 days. Advantages of and conditions for treatment by extended right hemicolectomy are discussed.

Staging of rectal carcinoma is essential for its management. 23 patients with rectal lesions were examined by endorectal ultrasonography. Of these 19 had rectal carcinoma and in 4 there was an abscess of the rectal wall, previously diagnosed by sigmoidoscopic biopsy. 10 of those with carcinoma were examined by computerized tomography as well, and 10 were operated on. In most cases the staging of rectal carcinoma by endorectal ultrasonography was accurate and compared well with the operative histological results. We conclude that endorectal ultrasonography is the method of choice for staging of rectal carcinoma prior to treatment.

The effects of prenatal exposure on gamma/neutron radiations (0.5 Gy at about the 18th day of fetal life) were studied in a hybrid strain of mice (DBA/Cne males x C57BL/Cne females). During ontogeny, measurements of sensorimotor reflexes revealed in prenatally irradiated mice 1) a delay in sensorial development, 2) deficits in tests involving body motor control, and 3) a reduction of both motility and locomotor activity scores. In adulthood, the behaviour of prenatally irradiated and control mice was examined in the open field test and in reactivity to novelty. Moreover, their learning performance was compared in several situations. The results show that, in the open field test, only rearings were more frequent in irradiated mice. In the presence of a novel object, significant sex x treatment interactions were observed since ambulation and leaning against the novel object increased in irradiated females but decreased in irradiated males. Finally, when submitted to different learning tasks, irradiated mice were impaired in the radial maze, but paradoxically exhibited higher avoidance scores than control mice, possibly because of their low pain thresholds. Taken together, these observations indicate that late prenatal gamma/neutron irradiation induces long lasting alterations at the sensorimotor level which, in turn, can influence learning abilities of adult mice.

Serum concentrations of CA-15.3, tissue polypeptide antigen (TPA) and mucinous-like carcinoma-associated antigen (MCA) were measured in 327 women: 81 controls, 93 patients with benign breast disease, 46 patients recently diagnosed with breast cancer and 107 patients during breast cancer follow-up. CA-15.3 was elevated in 16% of the controls, in 29% of the patients with benign breast disease, in 65% of the breast cancer patients and in 74% of the follow-up patients. TPA was elevated in 4%, 11%, 36% and 75%, respectively. The corresponding figures for MCA were 10%, 8%, 30% and 64%. The highest sensitivity for cancer detection (74%) was obtained with a combination of CA-15.3 and TPA, while the specificity of this panel was 75%. The negative predictive value of these combined tests was 93%. MCA scored lower values, being only 30% sensitive. The CA-15.3/TPA panel may increase sensitivity compared with single marker tests and provide additional information for clinical evaluation.

Primary sclerosing cholangitis is a chronic, fibrosing, inflammatory condition of unknown origin of extra and intrahepatic bile ducts. Recurrent cholangitis and jaundice are the most frequent clinical manifestation in symptomatic patients. We report a patient with primary sclerosing cholangitis presented with recurrent attacks of acute pancreatitis. Such a combination was not reported till now in the literature. The acute pancreatitis was probably due to reflux of bile and sludge into the pancreatic duct due to stricture of the distal part of a common bile and pancreatic ducts. Endoscopic insertion of a biliary stent managed to prevent jaundice and recurrent pancreatitis.

Evaluating the surgical results obtained with 74 cases of acromioclavicular dislocation the authors review the problems of diagnostics and surgical treatment of the injury. It is pointed out that the restoration of the functional anatomical condition--and simultaneously the reduction of the number of posttraumatic complaints--may be ensured only with operation in cases of severity grade II and III. However the results of the operative techniques applied in a rather wide range at present do not come up to expectation. The disturbances of healing are due in the majority of the cases to the use of implants unsuitable from biomechanical point of view. The application of appropriately solid acromioclavicular plates means significant progress in this field. The time and way of restoration of the injured capsule and ligament system influences decisively the results. Sutures of the ligament applied within 24 hours after the injury heal well. If the ligaments show strong splitting up or the operation is performed delayed plastic reinforcement or completion is justified in each case owing to the partial resorption. From the viewpoint of the surgical technique the use of the softpart flaps formed from the environment appear to be the most favourable.

Histological effects of in utero neutron irradiation (0.5 Gy) were investigated in fetal mouse cerebellum. Irradiation was performed on the 18th embryonic day. Histological alterations were examined at 2, 6 and 12 h after irradiation. The effect was most pronounced in the EGL, 6 h after irradiation. In some cells (about 24%) karyopycnosis, destruction of cytoplasmic organelles and shrinkage were observed. Remnants of destroyed cells--the pycnotic nuclei with some cytoplasmic debris around them--were rapidly phagocytized by the surrounding cells. In addition to glial elements, the EGL germinal cells also showed phagocytic activity. Dense particles appearing light-microscopically as pycnotic nuclei, proved to be mostly remnants of destroyed, phagocytized cells under electron microscope.

Pregnant mice were irradiated with 0.5 Gy fission neutrons on the eighteenth day of their gestation. The average litter size at birth was unchanged but mortality increased 5-6 fold in the first 3 days. The irradiated mice were the same weight as control mice at birth but showed a progressively increasing weight deficiency up to at least 36 days as compared to controls. Brain weight was 37, 45 and 25 per cent less in 2-, 3- and 52-week old irradiated animals, respectively, and the ratio of brain weight to body weight was 25, 27 and 13 per cent less. The concentrations of DNA, RNA and protein (mg/g wet tissue) were the same in irradiated and control mice in both brain and liver at all three ages. Total DNA, RNA and protein contents of whole brain after irradiation were 56-75 per cent of the control levels. No definite decrease was observed in liver. Histological study at 6 hours after irradiation showed nuclear pyknosis in the central nervous system from definite to very severe according to the part examined. It is concluded that damage to the central nervous system of the 18-day mouse foetus after neutron irradiation is mainly due to killing and/or inhibition of the differentiation of neuroblasts.

During the period 1979-80, 20 patients with morbid obesity underwent a gastric bypass procedure in our department. The selected patients were under 50 years old and were overweight by 45 kg or more. Previously, all the patients had unsuccessfully followed prolonged dietary regimes, some had tried dental splinting, and one had undergone three unsuccessful jejunoileal bypasses. The surgical technique used in two cases was transection of the stomach and gastrojejunostomy. In 18 cases, a gastric stapling procedure was performed. the upper gastric pouch was restricted to 5% of the entire stomach, and the gastrojejunostomy was limited to a 12-mm diameter. In the case with the failed jejunoileal bypass, dismantling of the intestinal bypass, reanastomosis, and a gastric bypass were performed in one stage. Weight loss averaged 8 kg/month for three months after the intervention, and then decreased to 2 to 4 kg/month. Laboratory studies after 6 and 12 months showed no deviation from normal. The use of the gastric bypass procedure, which does not involve metabolic complications or serious side effects, in refractory obesity results in a satisfactory long-term weight reduction, and an improvement in the quality of life.

Open leg fractures observed in 81 patients are analysed by the authors. In case of conservative treatment alone and in the group, which has been treated with primary osteosynthesis satisfactory results have been observed by the authors. False joint and osteomyelitis happened only in the group, in which the patients obtained firstly conservative treatment and in the case of the failure of this treatment osteosynthesis has been carried out. In the authors' opinion the most frequent complications are due - besides the damage of the soft parts - to the repeated and sometimes erroneous interventions.

The cytomorphology of murine lymphocytes was examined with transmission and scanning electron microscopy after fission neutron irradiation in the dose range of 0.5-4.5 Gy. The micromorphology of the cell surface changed significantly: the villous cell surface characteristic of lymphocytes became smooth. Cytoplasmic protrusions of various sizes and shapes appeared. In addition to the changes on the cell surface, alterations in cytoplasmic organelles and nuclear membranes were also observed. Even the forms of the nuclei had changed, the nucleoli were often segregated and at several sites accumulation of nuclear bodies was evident.

A case of isolated tuberculosis observed in the tensinous part of the quadriceps muscle is reported by the authors. The rarity of the case is pointed out. A few possibilities of the development of this tuberculoma are dealt with. In the authors' case the focus developed probably after haematogenous generalization. One year after the operation the patient is symptomfree and has no complaints.

Pregnant female C57B1/6 mice were irradiated with a single whole-body dose of 0.5 Gy neutrons. The F1 hybrid embryos were exposed to the neutrons in utero on Day 17 +/- 2 of gestation. 178/439 (40.6%) of the irradiated fetuses and 26/217 (12%) of the control mice died within 2 weeks after birth. In both irradiated and control mice, most deaths (95 and 77%, respectively) occurred within 3 days of birth: most animals in both groups died on Day 2. There was no significant difference in the number of living young born per litter (7.2) between the neutron-irradiated mothers and their unirradiated controls. The irradiated mice weighed significantly less than their controls. On the first day after birth, body weights of mice irradiated in utero averaged only 85% of control weights. Body weights did not reach control levels until 6 months after birth. Several organs were weighed at regular intervals in both irradiated and control mice. Spleens and thymus glands showed no significant differences between the two groups. The livers and kidneys of the irradiated mice weighed slightly less than their controls. The brain weight of 21-day-old neutron-irradiated mice was 30-35% less than control brains. The weight loss of the brain was not only a relative loss, but also an absolute one, based on brain weight/body weight ratios. Histological analysis of the central nervous system showed pycnotic nuclei, inhibition of mitosis in neuroblasts, and cell death in the irradiated brains. The weight reduction of the brain was not due to water loss. Our hypothesis is that the early mortality after birth is related to the killing of the radiation-sensitive neuroblasts. When newborn mice (1-7 days old) were irradiated in vivo with the same neutron dose of 0.5 Gy, neither the reduction in brain weight nor the early mortality was observed. The early deaths of the neutron-irradiated mouse embryos does not appear to be caused by either the hematological or the gastrointestinal radiation syndrome.

In dog experiments homologous tendos conserved in beta-propiolacton and by means of gamma-radiation have been transplanted by the authors. After the 1st, 3rd and 8th post-operative week various regions of the graft and the recipient tendon stump have been examined by means of light--, polarisation microscopic and electron microscopic method. The examinations have unanimously shown that the tendon grafts conserved in beta-propiolacton are reorganized quickly, within 8 weeks nearly completely besides hardly visible inflammatory reaction. In the meantime, the originally collagen fibrous framework is decomposed and on it a new collagen fibrous structure develops, and thus a new tendon--capable to function--is formed. On the other hand, the reorganization of the grafts conserved with gamma-radiation is protracted or it fails to occur, and cicatrization is observed. Some problems of the modern tissue preservation, the collagen synthesis occurring in the active fibroblasts, the secretion of the collagen precursory substance into the extracellulary space, as well as the formation, the structure and the constitution of the newly synthesized collagen fibres--forming the transplant--are discussed by the authors. The obtained results are demonstrated in light-, polarization microscopic and electron microscopic pictures.

Splenic abscess is an uncommon disease that has a high mortality rate if not treated surgically. With the aid of new diagnostic tools, such as ultrasonography, scanning and computerized axial tomography, it is possible to diagnose the entity antemortem. Even though it often has a nontypical clinical course, it may overlap other systemic diseases. We describe an unusual case of splenic abscess with rare complications, the operation and the outcome.

Previous investigations showed that when pregnant mice were exposed to a single whole-body dose of 0.5 Gy fission neutrons on Day 17 +/- 2 of gestation [H. H. Vogel, Jr. and S. Antal, Radiat. Res. 98, 52-64 (1984)] about 40% of the newborn mice died and the body and brain weights of surviving animals decreased by 30-35%. Decreases of body and brain weights were most prominent by the third week after birth, but the content of nucleic acids related to wet weight did not change in liver and brain upon irradiation [S. Antal, A. Fónagy, Z. Fülöp, E. J. Hidvégi, and H. H. Vogel, Jr. Int. J. Radiat. Biol. 46, 425-433 (1984)]. Studies presented in this paper show that after a single whole-body dose of 0.5 Gy neutron irradiation on Day 18 of pregnancy protein synthesis decreased in liver and brain of 3-week-old mice irradiated in utero. Incorporation of labeled amino acids in vivo into acid soluble nuclear proteins decreased by 15% in liver and by 40% in brain. It was significantly reduced into brain histones and certain brain nonhistone proteins (separated by two-dimensional electrophoresis). The amount of H1 and H4 brain histones decreased as well. Investigations with isolated protein synthesizing systems proved that the peptide bond formation was not impaired by irradiation. The aminoacylation of transfer-RNA, however, decreased in both liver and brain by 26-34 and 34-41%, respectively. Comparing the aminoacylation capacities in the two unirradiated organs, a much lower (about one-third) capacity was found in brain than in liver. Moreover, this low aminoacylation capacity of brain decreased further by about 40% after neutron irradiation. These results suggest that in the developing irradiated brain the reduced capacity of aminoacylation of transfer-RNA might be rate limiting for the efficiency of protein synthesis.

The post-thrombotic syndrome is a complex disease to whose development at least three factors contribute: (1) incompetence of the venous valvular system; (2) opening of the local arteriovenous shunts; and (3) disturbances in the lymphatic system. Our surgical treatment considers all three factors by providing: (1) stripping of the saphenous veins; (2) wide excision of the ulcerated region with the fascia, followed by immediate skin graft; and (3) large excision of subcutaneous tissue and fascia. Of fifty-one patients with chronic post-thrombic leg ulcers operated on according to these principles, only one had recurrence, a recurrence rate of only 0.5%. This compares favorably with other published results.