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Background We present a case of a facial palsy as the initial symptom of a bronchogenic carcinoma. Methods Case-report. A 56-year-old patient presented with a peripheral facial palsy. The clinical picture as well as the temporal bone CT were without pathological findings. A 10-day rheologic therapy as well as anti-viral medication were not successful. Five days after rheological therapy had been completed, the patient presented a swelling of the neck. In the computer tomography we found a bilateral thrombosis of the internal jugular vein. In addition, the clinical picture of a left-sided glossopharyngeal palsy appeared. The following thorax CT as well as the diagnostic extirpation of an enlarged cervical lymph node lead to the diagnosis of a metastasized smallcell neuro-endocrine bronchogenic carcinoma with a compression of the right primary bronchus and the vena cava superior as well as an upper inflow congestion. In the cMRT we furthermore found a metastasis in the area of the foramen stylomastoideum. The patient underwent emergency radiation and chemotherapy. Results According to the present findings, this metastasis lead to the facial palsy as the initial symptom of the bronchogenic carcinoma. Conclusion Therefore, therapy resistant facial palsy should be further diagnosed in detail, especially examined by imaging procedures.

A 37-year-old female presented for surgery with central perforation of the eardrum with granulation. Mastoidectomy had been performed 18 years ago following chronic mastoiditis. As the clinical picture now suggested a suspected cholesteatoma, radiological imaging was performed. The CT scan revealed specification of the mastoid and the tympanic cavity. In addition, MRI scan showed signal enhancement in the same areas. However, the suspected cholesteatoma could not be confirmed intraoperatively. Pathohistology revealed a ceruminal gland adenoma. They are a rare phenomenon and should be distinguished from middle ear adenomas, pleomorph ceruminal gland adenomas, ceruminal gland adenocarcinomas and cylindromas of the ceruminal glands. Owing to a high recurrence rate, complete surgical removal is necessary. Despite its rare occurrence, a ceruminal gland adenoma must be taken into consideration in the differential diagnosis of individual cholesteatoma cases.

Lung volume reduction (LVRO) combined with simultaneous resection of bronchial carcinoma ignores the well known principles of functional operability. In case of 6 patients with LVRO and resection of the lung because of a non-small-cell lung cancer (NSCLC) stage 1 (4 ×), stage II (1 ×) and stage IIIa (1 ×) located in the emphysematous lung parenchyma lobectomy was done four times and extraanatomical resection twice. Because of a gangrene the resection of middle lobe was necessary in case of one patient. There were no other perioperative complications. 6 months after the operation 5 patients noticed decreased dyspnea. The survival rate after 2 years was 66%, after 3 years 34%. 1 patient is still alive after 56 months. Cause of death was in every case progress of tumour. Due to the principles of oncologic surgery lung resection will be functional tolerated if the cancer is located in the area of bullous lung destruction; in singular cases lung resection will improve the cardiorespiratory status at least temporary. In case of extraanatomic or segmental resections there is a low rate of morbidity and lethality but a high incidence of recurrence of carcinoma. The short- and medium- term functional results seem to be encouraging. Limitative factor for carrying out extensive resections is the tumour infiltration of non emphysematous lung parenchyma. There is no doubt that simultaneous resection will be reserved for a group of highly selected patients.

BACKGROUND AND OBJECTIVE: In end-stage renal failure the incidence of cancer is increased. With regard to frequency and pattern of distribution of the tumors, there are substantial regional differences. Since this topic has to date received only minimal attention in Germany, we undertook a multi-centric analysis (8 dialysis centres) in North Bavaria in order to address the occurrence of malignant diseases in end-stage renal failure. PATIENTS AND METHODS: Of a total of 2228 patients, who underwent hemodialysis in the period from 1990 - 99 as a consequence of end-stage renal failure, the medical records of 1727 persons were analysed. Only those patients were considered, whose malignancy was diagnosed in the course of the dialysis. The Saarland cancer register served as a comparative age- and sex-matched population, with which we calculated the expected frequency of the various cancers as well as the standard incidence ratio (SIR) for the dialysis patients. RESULTS: In total 125 malignant diseases were documented. The cancer incidence was highest in the first year of treatment and was clearly lower in the subsequent periods. Of great importance was the age of the patients. The highest SIR scores were found for patients of middle age (35 - 50 years). An enhanced risk for cancer of the kidney, bladder, prostate, liver, oral cavity and the pharynx and larynx, as well as of the lymphatic and hemopoetic systems was found, while there was no or only a slight increase in the frequency of carcinoma of the mammary gland, stomach, colon-sigma-rectum and bronchial systems. CONCLUSION: The high incidence of cancer in end-stage renal failure should be given greater attention. Particularly in the high-risk group of younger dialysis patients, a regular screening - especially for tumors of the kidney, bladder and liver - appears justified.

Group phenomena concern the behaviour of particular groups which differs from that of individuals. One relevant phenomenon is the 'risky shift', which describes the observation of groups making riskier decisions than individuals. These phenomena have not been investigated for German physicians as yet.In a prospective study, participating ENT residents received a questionnaire with a description of 12 clinical borderline cases. The participants were asked to answer these individually using a 10-point analogous scale from 1 (no indication for surgery/treatment) to 10 (indication for surgery/treatment). In the afternoon, the questions were again -provided and discussed within the group.For the morning round, the median of the answers had values between 3 and 9 (average: 6.25). After group discussion in the afternoon, the medians averaged 4 with values between the minimum '1' and the maximum '10'. Regarding statistics, these changes in response behaviour were partially significant (p0.05). Furthermore, a trend towards more extreme -decisions was observed.This study shows, that group discussions influence the outcome of the decision-making process in medical residents. Therefore, one should always be aware of this kind of phenomenon when making medical decisions within a group. However, group discussions must still be encouraged and remain fundamental for clinical routine.Gruppenphänomene sind gekennzeichnet durch Verhaltensweisen, die von den Handlungen als Einzelperson differieren. Ein solches ist bspw. das Risikoschubphänomen. ­Diese Beobachtung beschreibt, dass Gruppen fast immer risikoreichere Entscheidungen treffen als die Einzelpersonen. Für Ärzte deutscher Kliniken sind Gruppenphänomene bisher nicht untersucht.Im Rahmen einer prospektiven Studie erhielten die Studienteilnehmer einen Fragebogen mit einer Beschreibung von 12 klinischen Grenzfällen. Die Teilnehmer wurden gebeten, diesen selbstständig mit einer vorgegebenen numerischen Analogskala von 1 (keine OP- oder Therapieindikation) bis 10 (OP- oder Therapieindikation) zu beantworten. Am Nachmittag wurden die Fragen gemeinsam diskutiert und erneut beantwortet.Vor der Diskussion lagen die Antwortmediane der einzelnen Fragen zwischen 3 und 9 (Mittelwert: 6,25), während nach der Diskussion die Mediane Werte zwischen 1 und 10 annahmen (Mittelwert: 4). Diese Änderungen des Antwortverhaltens waren z. T. statistisch signifikant (p0,05). Weiterhin war eine Tendenz in Richtung extremerer Antworten zu verzeichnen.Die Untersuchung zeigt, dass in einer Gruppe von Assistenzärzten gemeinsame Diskussionen von klinischen Fällen die individuellen Entscheidungen der einzelnen Teilnehmer zum Teil signifikant beeinflussen. Somit muss im klinischen Alltag das ‚Phänomen der Gruppe‘ immer reflektiert werden, um sich bei der Entscheidungsfindung nicht durch (unbewusste) Einflüsse anderer Gruppenmitglieder leiten zu lassen. Der hohe Wert der gemeinsamen Diskussion und der Reflexion von Fällen bleibt unbestritten.

Die Prazision osteodensitometrischer Messungen mit der dual energy X-ray absorptiometry (DEXA) hangt von verschiedenen bekannten Faktoren, wie Lagerung, Aortenverkalkung oder Wirbelkorperfrakturen ab. Ziel der Untersuchung war, den Einflus verschiedener Erkrankungen bzw. der Knochendichte auf die Reproduzierbarkeit der Messungen an der Lendenwirbelsaule und am Femur zu uberprufen. Insgesamt wurden 100 Patienten an der LWS p.a., LWS lat. und am Ward‘schen Dreieck doppelt gemessen, wobei zwischen den Messungen neu positioniert wurde. Um den Einflus unterschiedlicher Erkrankungen festzustellen zu konnen, wurden zusatzlich 4 Gruppen a 25 Patienten mit den Diagnosen: Arthrose, Osteoporose und chronische Polyarthritis im Vergleich zur Kontrollgruppe gebildet. Als Mas fur die Reproduzierbarkeit wurde jeweils die mittlere prozentuale Differenz und der Variationskoeffizient der beiden Messungen berechnet. In den vier Gruppen ergaben sich an den drei Mesorten mittlere prozentuale Differenzen von 0,18 bis 2,6%. Nach Berechnung der Variationskoeffizienten fand sich fur die LWS p.a. ein Wert zwischen 1,2 und 2,7% fur die LWS lat. zwischen 7,1 und 15,7% und am Ward‘schen Dreieck zwischen 4,1 und 9,9%. Auffallig war zudem ein nahezu doppelt so hoher Variationskoeffizient der Patienten mit Osteoporose im Vergleich zur Kontrollgruppe an allen gemessenen Regionen. Ergebnis: Die laterale LWS-Messung beim DEXA-Verfahren ist derzeit nicht zu empfehlen. Die LWS p.a.-Messung und mit Einschrankung auch die Messung am Ward‘schen Dreieck konnen bei guter Prazision zur Verlaufsdokumentation der Knochendichte herangezogen werden.

Vier Jahre nach Pneumonektomie links mit Aortenwandresektion und Patchrekonstruktion aufgrund eines T4-Karzinoms, 2 Jahre nach adjuvanter Radiatio und 10 Monate nach Drainagetherapie eines Spatempyemes kam es zu einer Ruptur der Aorta descendens durch Ausris des Dacronpatches. Ursachlich wurde eine Patchinfektion nachgewiesen. Nach primarer notfallmasiger Aortenrekonstruktion wurde sukzessiv zweizeitig eine transdiaphragmale Omentumtransposition sowie eine Heller-Jalousieplastik zur plastischen Deckung der Aortenwand und Sanierung der infizierten Pneumonektomiehohle vorgenommen. Da bei 0,3–2,5% aller Gefasrekonstruktionen mit einem Protheseninfekt zu rechnen ist, ist diese Komplikation auch bei der intrathorakalen Implantation von alloplastischen Gefasprothesen zu berucksichtigen. Nach Lungenresektionen mus die Prothese durch autogenes Material plastisch gedeckt werden, um die Einheilung in einen protektiven Gewebeverband zu ermoglichen. Im Falle septischer intrathorakaler Komplikationen ist ein extraanatomischer Bypass oder ein autogener Gefasersatz zu diskutieren. Sind beide Varianten nicht moglich, mus nach individuellen Losungen gesucht werden. Kommt ein autogener Ersatz nicht in Betracht, ist nach aggressivem lokalen Debridement der infizierten Gefaswand die Deckung der alloplastischen Prothese durch Omentumtransposition und thorakoplastische Verfahren erforderlich, um der erhohten prothetischen Infektresistenz begegnen zu konnen, um eine Verankerung der Prothese im umgebenden Gewebe zu ermoglichen und um eine zusatzliche mechanische Stabilitat der Gefaswand zu erreichen.

The chorda tympani nerve (CTN) is at risk of damage during cochlear implantation, especially during posterior tympanotomy. The aim of this study was, therefore, to elicit the risk of taste disorders following cochlear implantation surgery involving a mastoidectomy and a posterior tympanotomy approach.Twenty-six patients underwent a taste test before, 3 days after, and 6 weeks after cochlear implantation surgery. The taste sensations - sweet, sour, salt and bitter - were determined. Patients' self-ratings of taste function were also obtained. In addition, the surgeons provided information concerning the intraoperative status of the CTN.In total, 19.2% (5 of 26) of the patients had postoperative taste dysfunction, as measured either subjectively or objectively or both. One of these five individuals had taste disturbance as assessed by both subjective and objective measures; in another, it was merely reported subjectively. Three patients were subjectively asymptomatic but the postoperative taste test revealed a dysfunction. Sixteen percent of the patients in whom the CTN was reported to be preserved intraoperatively had a postoperative taste dysfunction. Although the CTN was rerouted in five patients, only two of them (40%) had transient gustatory dysfunction. In two of those patients with postoperative taste dysfunction, the CTN was not intraoperatively exposed (being protected by bone) despite these individuals' experiencing postoperative taste problems. The recovery rate was 100% at 6 weeks after surgery.Our study indicates that cochlear implantation entails only a minimal risk of taste dysfunction and that this is chiefly a transient problem.

A 58-year-old patient presented after having undergone radiation therapy, afterloading therapy and chemotherapy of a T4 nasopharynx carcinoma. On the basis of the MRI findings, local tumour recurrence was suspected. The samples taken from the nasopharynx and the left maxillary sinus confirmed this diagnosis. Neuroradiological imaging showed that the tumour extended into the area around the left skull base and also revealed an irregular formation located in the left temporal flap. Therefore not only tumour resection (Fisch approach type C) but also a temporal craniotomy was indicated in order to determine the degree of intracerebral tumour extension. The dura mater, which had been intact, was intraoperatively opened and revealed vital brain tissue, i. e. tumour infiltration had not reached the brain. It was concluded that the radiological findings probably indicated a postradiogenic necrosis of the temporal flap. The presented case illustrates the rare differential diagnostic procedure carried out in a patient with radiogenic necrosis while taking into account the possibility of local tumour infiltration into the brain parenchyma.

Peritonsillar abscesses are considered to be complications of a peritonsillar inflammation and are a frequently occurring condition. Often, to confirm the presence of an abscess and to locate it following a dry-tap aspirate, computed tomography (CT) is performed. No validated data has been published to date concerning the role of CT in the diagnosis of peritonsillar abscesses.In a retrospective analysis, the records of patients presenting at a German university hospital with a suspected peritonsillar abscess between 2006 and 2011 were evaluated. A particular focus was placed on the diagnostic procedure for patients with dry tap. The CT images were evaluated by 2 neuroradiologists.310 patients with a suspected peritonsillar abscess from the period 2006–2011 were evaluated. In 51 cases (31 male and 20 female patients; 16.5 %), a dry tap was found to have occurred. Of these, in 42 patients (82.3 %) a CT scan was performed to rule out or locate an abscess. In 36 patients (85.7 %), an abscess was verified by CT imaging.Where there are clinical grounds for suspecting a peritonsillar abscess, and where a dry tap occurs, our data indicate that performing a CT scan to verify and locate an abscess is an effective diagnostic procedure. However, greater attention should be paid to additional diagnostic methods.

German ENT clinics currently do not attach great importance to outpatient surgical procedures. However, up-to-date data on the proportion of outpatient surgeries are not yet available.In a retrospective study, outpatient surgical procedures using anesthesia or sedation at a German ENT clinic were analyzed as an illustrative case study.In 2010, the proportion of outpatient surgeries performed under anesthesia or sedation in relation to the total number of surgeries performed under anesthesia or sedation was no more than 3.1%. Although a broad range of surgeries was offered, mainly adenoidectomies were carried out.In view of the increasingly limited financial resources in the German health care system and considering the situation in international health care systems, the significance of outpatient surgical procedures in ENT clinics is expected to increase in the future. Future-oriented clinic organization should therefore include sufficient capacity for outpatient surgeries. The basic requirement is realistic cost reimbursement by the insurers.

In addition to trauma, risk factors for the formation of auricular hematomas include the influence of tangential shearing forces upon the auricle. Thus far, no data are available concerning the impact of these forces as caused by the putting on and removal of motorcycle helmets.In a retrospective observational study, all patients presenting with auricular hematoma and auricular seroma at a German Department of Otolaryngology between January 2005 and March 2011 were analyzed as to a possible connection with the wearing of motorcycle helmets.The proportion of auricular hematoma and seroma patients who were helmet-wearing users of motorcycles, motor scooters or mopeds was 41%. However, none of these patients indicated having put on a protective helmet prior to the occurrence of the hematoma.According to our findings, the wearing of motorcycle helmets, with the possible associated influence of tangential shearing forces when putting on or removing the helmet is - despite isolated cases having been described - not a cause of the acute formation of auricular hematomas or seromas. However, the proportion of motorcycle/motor scooter/moped users among patients with these conditions appears to be higher than that for the population as a whole. It may be, therefore, that this does have chronic effects on the auricle.

Anhand eines Fallbeispieles eines 60jahrigen Patienten mit phlegmonoser Entzundung der Fingerendglieder II und III rechts und fibrosierender Osteomyelitis im Rahmen einer Endangiitis obliterans wird die lokale Anwendung von Taurolin®-2%-Losung adjuvant der chirurgischen Herdsanierung gezeigt. Aufgrund des schweren destruierenden Weichteilinfektes wurde anfanglich eine Grenzzonenamputation diskutiert, die jedoch nach taglicher Spulung und Instillation von Taurolidin vermieden werden konnte. Die Lokaltherapie einer feuchten Gangran des 2.-4. Fingers links mittels isotoner Kochsalzlosung und enzymatischer Wundreinigung blieb bei ahnlicher Durchblutungs-situation uber 15 Wochen erfolglos. Progredienter nekrotischer Zerfall und Handphlegmone erforderten mehrfache Nachresektionen und zwangen letztendlich zu einer Amputation des Mittelfingers. Taurolidin stellt im vorliegenden Fall eine wirkungsvolle adjuvante Therapie alternativ zu einer Vielzahl lokaler Antiseptika dar.

The Permo-Carboniferous Schmidgaden, Weiden, Erbendorf and Stockheim basins from southern Germany host discontinuous seams of high ash coal and carbargillites which were mined for hard coal, explored for uranium and only recently have proved their source rock potential for gaseous and fluid hydrocarbons. Alteration and facies of these carbonaceous beds were geologically and chemically investigated. During silicification which is exclusively confined to the carbonaceous interbeds of pyroclastic depositions, element depletion prograded except for Zn, Pb, U. The anoxic environments under consideration may be subdivided into fluvial/swamp (Upper Westphalian beds from Schmidgaden, Weiden, Erbendorf and Stockheim) and lacustrine depositions (Upper Stephanian and Upper Autunian carbargillites from Erbendorf, Weiden-Bechtsrieth). SiO 2 , MgO, CaO, Mo and Zr have proved to be most suitable for recognition of these environments, whereas, U, K 2 O and notably Cu/Zn are less appropriate. In the ternary plots displaying the organic chemistry of extracts of these carbonaceous beds fluvial swamps have low and lacustrine beds high contents of saturated hydrocarbons. All samples show a pronounced OEP (=odd even predominance) of n -alkanes which partly are environment-controlled (terrestrial origin), partly maturity-controlled. The high iso- and cyclo-alkanes of Schmidgaden and bimodal n -alkyl distribution point to a contribution of algal material. Finally four basin types bearing carbonaceous rocks are discussed with respect to their economic potential and compared with basins elsewhere (Cerilly, Lodeve, St. Hippolyte, Uinta): type I: intramontane fault-bounded basin (swamp), type II: volcanic-depression with steep relief (swamps), type III: halfgraben (lake), type IV: volcanic-depression with smooth relief (lake). Types I and II are of interest for hard coal, organic-hosted U-deposits and mainly gasprone; types III and IV, however, show good source-rock potential for crude oil.

A 28-year-old female patient with a migrant background presented for surgery with a suspected cholesteatoma in the left ear. The patient reported having had an aural discharge for several months; otoscopic examination revealed a runny ear, and discrete granulation tissue was seen. Pure-tone audiometry showed conduction hearing loss of 30-40 dB across all frequencies in the left ear; high-resolution computed tomography of the temporal bone revealed that the mastoid and tympanic cavity were completely obscured. The intraoperative finding showed a caseous space-occupying mass that completely filled the tympanic cavity. The suspected diagnosis of tuberculosis was corroborated by pathohistological, microbiological and molecular biological tests. Tuberculostatic therapy was initiated at a different location. Although tuberculosis of the middle ear is a rare condition in Germany, it should nevertheless be considered when making a differential diagnosis, especially in high-risk patients where cholesteatoma is suspected on clinical and radiological evidence or in patients with a chronic middle ear process.

Objective: The diagnosis of a cholesteatoma can be difficult in cases with an intact tympanic membrane. The aim of our study was to examine whether diffusion-weighted MRI can confirm the diagnosis of a cholesteatoma. Study Design: A preoperative diffusion-weighted MRI (echo-planar imaging) scan of the temporal bone was performed in 31 patients with clinically suspected cholesteatoma. The diagnosis was confirmed by pathohistological examination in 18 cases, while the majority of the remaining patients showed chronic otitis media without cholesteatoma. Results: In 3 out of 18 patients with histologically confirmed cholesteatoma, diffusion-weighted imaging produced a hyperintense signal. Another 4 of the 18 cases had a questionable positive result. No increased signal was observed in 11 of these 18 patients. Of 12 patients without a cholesteatoma, 2 showed a positive signal while a questionable hyperintense signal was observed in 5 patients. Conclusions: According to our present findings, diffusion-weighted MRI (echo-planar imaging) can – with a low sensitivity and specificity – be helpful in individual cases in provisionally diagnosing a cholesteatoma in association with standard MRI and high-resolution CT, even though the lack of a hyperintense signal in diffusion-weighted MRI does not exclude a cholesteatoma.

Recent results show that caloric restriction (CR) improves existing disturbances in cardiac function independent from anti-arteriosclerotic effects. Signalling from adipose tissue to other organs via adipokine-mediated activation of AMP-activated protein kinase (AMPK) contributes to the protection by CR. Therefore, we investigated whether age and nutritional status influence the expressional pattern in cardiac and adipose tissue. Methods: We obtained samples from the right atrium (RA), epicardial and subcutaneous adipose tissue together with a blood sample from male young/old (54,5±4,1 years/77,1±2,9 years) and normosome/obese (BMI 24,0±1,1/BMI 33,8±4,3) patients undergoing cardiac surgery. Mitochondrial respiratory function, the expression of apoptotic and load-associated markers were measured by Real-time PCR together with the expression and plasma release of selected adipokines. Results: Mitochondrial function is depressed in older patients with a further deterioration with advanced obesity. Furthermore, the expression of proapoptotic proteins (Bcl-xS, Bax) or load-induced markers (BNP, beta MHC) are enhanced in old and in young obese patients. Protective adipokines such as adiponectin are reduced in both adipose tissues and in plasma samples in old and in young obese patients and this results in reduced AMPK. Conclusion: These changes in myocardial and adipose tissue gene expression support the occurrence of early alteration associated with obesity even in younger patients. Cardiometabolic pathways activated during CR may yield targets for pharmacological mimetics of selected components within the spectrum of CR actions and may thus yield a promising strategy to improve cardiac function in obese patients.

We present a case of a facial palsy as the initial symptom of a bronchogenic carcinoma.Case-report. A 56-year-old patient presented with a peripheral facial palsy. The clinical picture as well as the temporal bone CT were without pathological findings. A 10-day rheologic therapy as well as anti-viral medication were not successful. Five days after rheological therapy had been completed, the patient presented a swelling of the neck. In the computer tomography we found a bilateral thrombosis of the internal jugular vein. In addition, the clinical picture of a left-sided glossopharyngeal palsy appeared. The following thorax CT as well as the diagnostic extirpation of an enlarged cervical lymph node lead to the diagnosis of a metastasized smallcell neuro-endocrine bronchogenic carcinoma with a compression of the right primary bronchus and the vena cava superior as well as an upper inflow congestion. In the cMRT we furthermore found a metastasis in the area of the foramen stylomastoideum. The patient underwent emergency radiation and chemotherapy.According to the present findings, this metastasis lead to the facial palsy as the initial symptom of the bronchogenic carcinoma.Therefore, therapy resistant facial palsy should be further diagnosed in detail, especially examined by imaging procedures.

A 37-year-old female presented for surgery with central perforation of the eardrum with granulation. Mastoidectomy had been performed 18 years ago following chronic mastoiditis. As the clinical picture now suggested a suspected cholesteatoma, radiological imaging was performed. The CT scan revealed specification of the mastoid and the tympanic cavity. In addition, MRI scan showed signal enhancement in the same areas. However, the suspected cholesteatoma could not be confirmed intraoperatively. Pathohistology revealed a ceruminal gland adenoma. They are a rare phenomenon and should be distinguished from middle ear adenomas, pleomorph ceruminal gland adenomas, ceruminal gland adenocarcinomas and cylindromas of the ceruminal glands. Owing to a high recurrence rate, complete surgical removal is necessary. Despite its rare occurrence, a ceruminal gland adenoma must be taken into consideration in the differential diagnosis of individual cholesteatoma cases.

A 58-year-old patient presented after having undergone radiation therapy, afterloading therapy and chemotherapy of a T4 nasopharynx carcinoma. On the basis of the MRI findings, local tumour recurrence was suspected. The samples taken from the nasopharynx and the left maxillary sinus confirmed this diagnosis. Neuroradiological imaging showed that the tumour extended into the area around the left skull base and also revealed an irregular formation located in the left temporal flap. Therefore not only tumour resection (Fisch approach type C) but also a temporal craniotomy was indicated in order to determine the degree of intracerebral tumour extension. The dura mater, which had been intact, was intraoperatively opened and revealed vital brain tissue, i. e. tumour infiltration had not reached the brain. It was concluded that the radiological findings probably indicated a postradiogenic necrosis of the temporal flap. The presented case illustrates the rare differential diagnostic procedure carried out in a patient with radiogenic necrosis while taking into account the possibility of local tumour infiltration into the brain parenchyma.

Objectives: Adjuvant immunotherapy is an innovative therapeutic option that might potentially improve outcome of early-stage non-small cell lung cancer. Melanoma associated antigen (MAGE)-A3 is a promising target for immunotherapy because it is exclusively presented on the cell surface of cancer cells and might be associated with an aggressive cancer phenotype. The present study was performed to determine the rate of MAGE-A3 expression in early-stage non-small cell lung cancer (NSCLC). Patients and methods: Primary tumor samples from 204 patients with operable clinical Stages I or II NSCLC were collected between March and November 2001. Pathological Stage was determined by the local pathologist in each of the 16 participating institutions. Tissue samples were stored immediately after surgery in a RNA-stabilizing solution and were frozen at -20°C. MAGE-A3 expression was analyzed by detection of MAGE-A3 transcripts using reverse-transcriptase polymerase chain reaction. Results: MAGE-A3 expression was observed in 80 out of the 204 (39.2%) examined Stages I-II primary tumors. Stratification into UICC-Stages showed that 31 out of 105 (29.5%) Stage I non-small cell lung cancers and 49 out of 99 (49.5%) Stage II non-small cell lung cancers expressed MAGE-A3. In comparison to Stage I, the rate of MAGE-A3 positive tumors was significantly increased in Stage II (P = 0.004; Chi-square test). Conclusion: The MAGE-A3 expression rate showed that a promising proportion of operable patients with early-stage non-small cell lung cancers are possible candidates for trials investigating adjuvant therapy with MAGE-A3 immunization. Currently, a phase two trial of adjuvant MAGE-A3 vaccination is in progress.

The treatment of patients with complex facial deformities is one of the most challenging multidisciplinary tasks in plastic surgery. Due to advancements in medical technology and surgical techniques in the last 20 years correction of severe malformations has become possible and is performed by highly specialized teams frequently in a single operation. Recent developments in three-dimensional (3-D) imaging techniques have already greatly facilitated diagnosis of complex craniofacial deformities. Computer-based simulation methods for surgical procedures that are based on imaging data have the potential to improve surgical treatment by providing the ability to perform 'virtual surgery' preoperatively and thus reduce patient risk and morbidity intraoperatively. A method is presented for interactive computer-assisted craniofacial plastic surgery planning and visualization, especially simulation of soft tissue changes using an experimental Craniofacial Surgery Planner. The system computes non-linear soft-tissue deformation because of bone realignment. It is capable of simulating bone cutting and bone realignment with integrated interactive collision detection. Furthermore, soft-tissue deformation and cutting due to surgical instruments can be visualized. Simulation processes are based on an individual patient's preoperative 3-D computed tomography and on a 3-D, photo-realistic model of the patient's preoperative appearance obtained by a laser range scanner. Very fast and robust prediction of non-linear soft-tissue deformation is computed by optimizing a non-linear cost function.

Lung volume reduction (LVRO) combined with simultaneous resection of bronchial carcinoma ignores the well known principles of functional operability. In case of 6 patients with LVRO and resection of the lung because of a non-small-cell lung cancer (NSCLC) stage I (4 x), stage II (1 x) and stage IIIa (1 x) located in the emphysematous lung parenchyma lobectomy was done four times and extraanatomical resection twice. Because of a gangrene the resection of middle lobe was necessary in case of one patient. There were no other perioperative complications. 6 months after the operation 5 patients noticed decreased dyspnea. The survival rate after 2 years was 66 %, after 3 years 34 %. 1 patient is still alive after 56 months. Cause of death was in every case progress of tumour. Due to the principles of oncologic surgery lung resection will be functional tolerated if the cancer is located in the area of bullous lung destruction; in singular cases lung resection will improve the cardiorespiratory status at least temporary. In case of extraanatomic or segmental resections there is a low rate of morbidity and lethality but a high incidence of recurrence of carcinoma. The short- and medium- term functional results seem to be encouraging. Limiting factor for carrying out extensive resections is the tumour infiltration of non emphysematous lung parenchyma. There is no doubt that simultaneous resection will be reserved for a group of highly selected patients.

Mediastinal liposarcoma are of rare entity; there are less than one hundred cases published worldwide. Because of the equivocal and inapparent symptomatology clinical signs often are falsely estimated, and in time of surgery there is generally seen a wide spread tumor growth, so that a radical resection often is impossible. Radiotherapy and chemotherapy are of limited value and mean no chance for curative therapy. The case of a 46 years old patient with an extensive primary liposarcoma of the mediastinum and the results of the review of the literature will be discussed.

The major reason for late graft losses is chronic rejection. Recently, a large number of studies have indicated that proteolytic enzymes play an important role as mediators of glomerular injury. The cysteine proteinases cathepsins B and L degrade structural matrix proteins such as type I collagen and laminin. We investigated intraglomerular protease activities in 12 patients after kidney graftectomy because of end-stage renal disease following chronic rejection. A group of 12 patients undergoing nephrectomy because of cancer served as controls using only non-involved parts of the kidney. The activities of cathepsins B and L in homogenates of isolated glomeruli were measured fluorometrically methylcoumarylamide substrates and related to DNA content. In rejected kidney allografts we observed significantly enhanced intraglomerular cathepsin B activity and cathepsin B + L activity.

In end-stage renal failure the incidence of cancer is increased. With regard to frequency and pattern of distribution of the tumors, there are substantial regional differences. Since this topic has to date received only minimal attention in Germany, we undertook a multi-centric analysis (8 dialysis centres) in North Bavaria in order to address the occurrence of malignant diseases in end-stage renal failure.Of a total of 2228 patients, who underwent hemodialysis in the period from 1990 - 99 as a consequence of end-stage renal failure, the medical records of 1727 persons were analysed. Only those patients were considered, whose malignancy was diagnosed in the course of the dialysis. The Saarland cancer register served as a comparative age- and sex-matched population, with which we calculated the expected frequency of the various cancers as well as the standard incidence ratio (SIR) for the dialysis patients.In total 125 malignant diseases were documented. The cancer incidence was highest in the first year of treatment and was clearly lower in the subsequent periods. Of great importance was the age of the patients. The highest SIR scores were found for patients of middle age (35 - 50 years). An enhanced risk for cancer of the kidney, bladder, prostate, liver, oral cavity and the pharynx and larynx, as well as of the lymphatic and hemopoetic systems was found, while there was no or only a slight increase in the frequency of carcinoma of the mammary gland, stomach, colon-sigma-rectum and bronchial systems.The high incidence of cancer in end-stage renal failure should be given greater attention. Particularly in the high-risk group of younger dialysis patients, a regular screening - especially for tumors of the kidney, bladder and liver - appears justified.

A method for the fast generation of solid molecular surfaces is described. Based on a three dimensional grid, a template driven procedure generates the so called "contact surface", also known as Connolly surface. The main advantages of this method are its good performance and that it directly generates continuously tessellated geometry. Texture mapping is a powerful computer graphics procedure, which can be used to visualize molecular properties on top of solid molecular surfaces. By using texture mapping, traditional color coding can be extended to multidimensional color coding, information filtering and property clipping. Three dimensional textures can be used for interactive color updates on a moving surface, representing the property of a surrounding static scalar field. >

An integrated system for simulating craniofacial surgical procedures is presented. The system computes nonlinear soft-tissue deformation due to bone realignment. It is capable of simulating bone cutting and bone realignment with integrated interactive collision detection. Furthermore, soft-tissue deformation and cutting due to surgical instruments can be visualized. The system has been tested with several individual patient data sets. Simulation processes are based on a 3-D model of a patient's preoperative bone structure of the skull derived from a computer tomography scan and on a 3-D, photorealistic model of the patient's preoperative appearance obtained by a laser range scanner. The multi-layer soft-tissue model is represented by nonlinear springs. Very fast and robust prediction of nonlinear soft-tissue deformation is computed by optimizing a nonlinear cost function.

In addition to standard X-rays, photographic documentation, cephalometric and model analysis, a computer-aided, three-dimensional (3D) simulation system has been developed in close cooperation with the Institute of Communications of the Friedrich-Alexander-Universität Erlangen-Nürnberg. With this simulation system a photorealistic prediction of the expected soft tissue changes can be made. Prerequisites are a 3D reconstruction of the facial skeleton and a 3D laser scan of the face. After data reduction, the two data sets can be matched. Cutting planes enable the transposition of bony segments. The laser scan of the facial surface is combined with the underlying bone via a five-layered soft tissue model to convert bone movements on the soft tissue cover realistically.Further research is necessary to replace the virtual subcutaneous soft tissue model by correct, topographic tissue anatomy.

Slipped capital femoral epiphysis (SCFE) leads to an unphysiologic function in adolescent hips. Evaluation of the slippage as well planning of corrective osteotomies is a major three-dimensional (3D) problem. Therefore, the current clinical evaluation, which is based on biplanar plain radiographs, cannot be satisfying. More is needed than simply measuring the femoral geometry to evaluate the impact of a slippage onto the physiologic hip function. We have developed a computer-based system for planning and evaluation of reorienting osteotomies in severe cases of SCFE. In our system, CT-based 3D computer models of the hip are used to simulate the range of motion within physiologic cartilage-to-cartilage contact. This helps to visualize and quantify the early impingement due to the slippage. In addition, 3D techniques allow to simulate and plan the corrective osteotomy in an intuitive way on the computer screen. Using the same range of motion system mentioned above, the projected result can be evaluated quantitatively and compared to other approaches. The motion simulation is based on the surface geometry of the joint partners rather than on a predefined, fixed rotation center. The presented system allows a much more intuitive and appropriate system for indicating and planning corrective osteotomies than conventional methods.

Chronic renal failure is the consequence of progressive glomerulosclerosis and tubulo-interstitial fibrosis. The initiating hallmark of nephrosclerosis represents nephronal hypertrophy, due to an accumulation of proteins in the glomeruli and tubulointerstitium. From experimental and clinical investigations the conclusion can be drawn that the disturbed intrarenal protein balance with the consequent nephronal hypertrophy is at least partly the result of reduced protein degradation. Potential factors involved in impaired renal proteinase activities are cytokines like transforming growth factor beta 1 (TGF-beta 1), angiotensin II and advanced glycation endproducts (AGEs).Nephrosclerosis as the common histological endpoint of chronic renal insufficiency is the result of an interaction between many pathogenetic factors. Its growing understanding implies the possibility of new therapeutic options to retard the progressive course of chronic renal failure.

The most serious forms of acute renal failure (ARF) are nowadays encountered in the intensive care unit (ICU), where up to 25% of new patients are reported to develop ARF. Lethality rates may reach 50 to 90% when the ARF is part of a multiple organ dysfunction syndrome. A multitude of extracorporeal procedures have been introduced into intensive care medicine. Applied with adequate skills and experience, most of these techniques will suffice to replace excretory renal function. However, because of low efficacy arterio-venous procedures (CAVH and CAVHD) have been abandoned for the veno-venous, pump-driven techniques (CVVH and CVVHD). Up to now, there is no consensus whether continuous or intermittent renal replacement therapy is more advantageous. In many cases, oliguric patients with circulatory instability will be treated by CVVH, even though there is no prospective study to show that in terms of outcome continuous treatment is superior to intermittent hemodialysis. It is equally conceivable to treat such patients with daily, prolonged (intermittent) hemodialysis. Apparently, the dose of replacement therapy, be it continuous filtration (36 to 48 l/24 h) or intermittent hemodialysis (daily 3 to 4 h) with a target BUN of less than 50 mg/dl, is more important than the modality of treatment. Moreover, there is good evidence that the use of biocompatible membranes (no complement- or leukocyte activation) is preferable and that with high-volume hemofiltration bicarbonate-containing replacement fluids should be used. However, despite all the technical advances, we firmly believe that the skills and the experience of those physicians and nurses who actually perform renal replacement therapy in the ICU are more important than the modality of treatment applied.