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Purpose The superparamagnetic iron oxide (SPIO) Resovist is a contrast media with shortening of both T(1) and T(2) relaxation time. This study evaluates the impact of SPIO-enhanced T(1)- and T(2)-weighted images for the differentiation of liver lesions. Materials and methods SPIO-enhanced MRI examinations (1.5 T, Symphony Quantum) of 61 patients were analyzed. Thirty-seven patients had malignant liver lesions (metastases n = 32, HCC n = 5) proven by biopsy or laparotomy, 11 patients had benign liver lesions (FNH n = 2, hemangiomas n = 4, benign cysts n = 5, normal liver on laparoscopy n = 13). After unenhanced T(1)- and T (2)-weighted imaging, a bolus injection of 1.4 ml SPIO (Resovist) was given, followed by T(1)-weighted imaging at 20 s, 60 s, and 5 min and T(2)-weighted imaging at 10 min post injection. A score from 1 (benign) to 5 (malignant) was used by three blinded radiologist for the ROC analysis of the unenhanced T(1)-/T(2)-weighted images (set 1) and of the combinations of unenhanced T(1)/T(2)-weighted and SPIO T(1)-weighted images (set 2), unenhanced T(1)/T(2) and SPIO T(2)-w images (set 3) and all images (set 4). Results The accuracy of plain MRI (set 1: 56 %) was increased by SPIO-enhanced T(1)-weighted images (set 2: 81 %) and SPIO-enhanced T(2)-weighted images (set 3: 90 %). Best results were obtained using unenhanced T(1)-weighted, unenhanced T(2)-weighted and both SPIO T(1)-weighted and T(2)-weighted images (set 4: 93%). The accuracy of predicting histopathologic diagnosis was 91%. Conclusion For the differentiation of liver lesions, SPIO-enhanced T(2)-weighted images had a greater impact on the accuracy of MRI than T (1)-weighted images, but SPIO-enhanced T(1)-weighted images provided additional information in some patients and should not be deleted.

Purpose Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract with an increasing detection rate due to improved differentiating methods in current diagnostic pathology. This study evaluates the radiologic characteristics of these neoplasms to discover specific signs leading to an earlier diagnosis. Materials and methods As part of a randomized phase III clinical trial of the European Organization for Research and Treatment of Cancer (EORTC), 72 patients with advanced stage GIST were treated with the selective tyrosine-kinase-inhibitor imatinib (Glivec, Novartis, Switzerland). For initial staging, 60 patients underwent MRI and 12 patients underwent CT. Results GISTs are mesenchymal tumors that grow submucosally and exophytically and become multiple, nodular or ovoid in the advanced stage. The predominant findings are peripheral solid structures with strong contrast enhancement and a central necrosis. Metastases are primarily located in the liver, where they appear as oval or round, sharply delineated solitary lesions with central necrosis. CT demonstrates the primary tumors and local recurrences as nearly isodense with the liver. On MRI, the lesions are hypointense on T 1 -weighted sequences and hyperintense on T 2 -weighted sequences, compared to the liver. Conclusion Immunopathology now enables the exact histologic separation of GISTs from other mesenchymal tumors. The radiological morphology is not sufficiently specific to differentiate GISTs from other mesenchymal tumors. In view of new therapeutic options, cognizance of their typical manifestations is of increasing importance for radiologists.

Die aktuelle Musterbauordnung vom Oktober 2002 sieht die Gleichstellung tragender Baukonstruktionen in der neuen Gebaudeklasse 4 vor, d. h. bis zu einer Gebaudehohe von 13 m durfen diese Konstruktionen in Massivbauweise oder Holzbauweise errichtet werden. Aufgrund des damit verbundenen erhohten Brandrisikos im Geschoswohnbau wurde die Erarbeitung einer Muster-Holzbaurichtlinie mit neuen Konstruktionsvorschriften fur den mehrgeschossigen Holzwohnbau notwendig. Damit sollen die bestehenden Schwachstellen im Geschoswohnbau beseitigt werden. Das diese Vorgehensweise dringend erforderlich ist, haben die vorliegenden Untersuchungen an bestehenden Gebauden bestatigt. Die vorgestellten Untersuchungsergebnisse zeigen, das das Risikopotential durch das Ereignis "Brand" im Wohnbau in starker Abhangigkeit von der Art der Bauweise steht. Die Moglichkeit der gestalterischen Freiheit, die Planern und Bauherren mit den neueren Entwicklungen in den Rechtsgrundlagen geboten werden, erfordern verantwortungsbewuste Planung, um nicht ein Absinken des Sicherheitsniveaus zu riskieren. Die Verwendung von brennbaren Stoffen in mehrgeschossigen tragenden Gebaudekonstruktionen erfordert die Betrachtung der Tragfahigkeit des Gesamtsystems und nicht der Brandwiderstandsdauer einzelner Bauteile. Dies betrifft vor allem den Mehrgeschosbau, da das Versagen einzelner Bauelemente und deren Verbindungen katastrophale Folgen fur das gesamte Gebaude haben kann. Die gultigen Normen DIN 4102 und ONORM B 3800 sowie die betreffenden Eurocodes berucksichtigen bereits weitgehend, das Bauteile nicht isoliert betrachtet werden durfen. Dazu sind grundlegende Kenntnisse uber den Brandschutz erforderlich, insbesondere sind die konstruktiven Schwachpunkte wie Anschlusse und Verbindungen zu beachten und zu bewerten.

AIM Osteochondral grafting procedures have developed into one of the preferred methods of treatment for focal osteochondral lesions, although the management of the donor site remains problematic. In this animal study, an attempt at sealing the donor site with a fully-resorbable tricalcium phosphate bone cement was evaluated. METHOD Autologous osteochondral transplantation of the medial and lateral condyle was performed on the ovine knee using a standard operative protocol. The ensuing defect was filled with the original beta-TCP cement laterally, while medially the cement was augmented with 50 micro g BMP-2. Two groups, consisting of 10 sheep each, were evaluated after three and 6 months, respectively. RESULTS The clinical evaluation of the specimens revealed an improved reconstruction of the joint surface following the application of the augmented biomaterial. Macroscopically, the superficial border of the original donor site could easily be outlined at both time periods in both groups. Solid osteointegration of the bone cement could be documented radiographically as early as three months following implantation. CONCLUSION The beta-TCP bone cement represents a promising resorbable filler for osteochondral defects. The augmentation with BMP-2 seems to expedite the remodelling process and improve the surface reconstruction.

Purpose: The weight of the spleen can be easily calculated from sonographic measurements. This study investigates the correlations between the weight of the spleen determined sonographically and the weight measured at autopsy or after splenectomy. Materials and Methods: The splenic weight at autopsy or after splenectomy was correlated with the calculated sonographic splenic weight in 55 patients who had a sonographic examination within the preceding three weeks. Results: A significant correlation (r = 0.978) was found between the sonographically calculated splenic weight (460.82 grams) and the measured weight of the removed spleen (average weight 463.18 grams). Spleens weighing more than 1 kg showed a slightly weaker correlation. Conclusion: This study proves that the simple formula of length x transverse diameter x vertical diameter x 0.6 provides a reliable calculation of the weight of the spleen.

Aim: Retrograde cement application is considered an integral part of the modern femoral cementing technique. Both pressurisation and rapid cement application reduce the risk of interface bleeding and blood laminations. In this context cement gun performance has received little attention. Method: In our study we examined the handling characteristics of four different cement delivery systems (Syringe®, Vaku-Mix®, Optivac® and MixOR®-System). To allow for cement viscosity as another variable, six different bone cements (Palacos® R, Palamed G®, CMW 1 Radiopak®, CMW 2000®, Simplex® P, VersaBond®) were used with each system. We recorded cement gun performance and measured extrusion times and maximum cement delivery speeds of all possible combinations (gun/mixing system plus cement type). Results: The fastest cement application could be achieved with the Vaku-Mix® cement delivery system and the corresponding cement gun (Mark III). With regard to cement type, VersaBond® and prechilled Palacos® yielded significantly shorter extrusion times than most of the other cements due to their lower viscosities. Conclusion: Our results have shown significantly different efficacies of commonly used cement delivery systems/guns in clinical routine. Improved systems should be provided by the suppliers.

Tension-band-wiring is mostly used for fixation of olecranon fractures. It is the standard procedure for more than 30 years and rarely discussed critically. Plate fixation is the standard for multi fragment fractures. Up to now intramedullary procedures like Rush-pin, KUntscher-nail, Smith-Petterson-nail and Maatzscrew were not equivalent to tension-band-wiring and plate osteosynthesis. In the last years interlocking nails have been developed for use in metaphyseal fractures like proximal tibia fracture and proximal humerus fracture. A interlocking nail could combine the advantages of an intramedullary implant with the stability of an extramedullary fixation. Excision of the olecranon fragments should be reserved for those cases when anatomic restoration cannot be achieved with internal fixation. The olecranon osteotomy has in contrast to olecranon fracture a much higher rate of complication despite it is an ideal fracture. The osteotomy site has less influence on stability of the osteosynthesis like primary stability.

Hintergrund. Das “Lymphatic mapping” und das Sentinel-Lymphknotenkonzept sind beim malignen Melanom und beim Mammakarzinom bereits etabliert.Die Anwendung bei anderen soliden Tumoren ist Gegenstand derzeitiger Untersuchungen und wird kontrovers beurteilt. Als Erfolg versprechender Ansatz bietet sich das selektive Lymphknotenstaging bei Patienten mit einem Magenkarzinom an. Die vorliegende Pilotstudie untersucht die Durchfuhrbarkeit mittels Radiokolloidtechnik und die Genauigkeit bei der Bestimmung des Lymphknotenstatus. Patienten und Methode. Bei 15 Patienten mit einem Magenkarzinom (u T1–3) erfolgte 17 (±3) h praoperativ eine submukose endoskopische Umspritzung mit 0,4 ml 60 MBq m99Tc-Nanocis® um den Tumor. Unmittelbar nach der Laparotomie wurde die Aktivitat der 16 Lymphknotenstationen (JGCA) mit einer Hand-γ-Sonde gemessen. Alle Patienten wurden einer Gastrektomie mit D2-Lymphadenektomie unterzogen.Nach der Resektion wurde der Operationssitus nach verbliebener Aktivitat abgescannt. Alle Nuklid speichernden Lymphknoten mit einer 10fachen Aktivitat gegenuber dem Grundrauschen wurden als Sentinel-Lymphknoten (SLN) definiert und am Operationspraparat entfernt. Die SLN's wurden gesondert in Serienschnitten und mittels Immunhistochemie aufgearbeitet. Ergebnisse. Bei 14 von 15 Patienten konnte ein SLN detektiert werden (93%). Die mediane Zahl der SLN's betrug 3 (1–5).Von 14 untersuchten Patienten waren 9 nodal positiv. In 8 von diesen 9 Fallen konnte mit dem SLN der positive Lymphknotenstatus vorausgesagt werden,wobei in 5 Fallen die Lymphknotenstation mit dem befallenen SLN die einzige befallene Station war. Damit lag die Sensitivitat der Methode bei 89%.In einem Fall zeigte die immunhistochemische Untersuchung des SLN bei einem initial nodal negativen Patienten isolierte Tumorzellen im Randsinus (“Upstaging”). Zusammenfassung. Das “Lymphatic mapping” und die Sentinel-Lymphknotendiagnostik sind beim Magenkarzinom durchfuhrbar.Die ersten Ergebnisse deuten auf eine korrekte Bestimmung des Lymphknotenstatus mit dieser Methode hin.Durch die gezielte histologische Aufarbeitung der SLN's ist zusatzlich ein Upstaging moglich.Weitere zahlenmasig grosere Untersuchungen mussen sich anschliesen,um den klinischen Wert der Methode weiter zu klaren.

Biobanks are important resources for biomarker discovery and assay development. Biomarkers for Alzheimer's and Parkinson's disease (BIOMARKAPD) is a European multicenter study, funded by the EU Joint Programme-Neurodegenerative Disease Research, which aims to improve the clinical use of body fluid markers for the diagnosis and prognosis of Alzheimer's disease (AD) and Parkinson's disease (PD). The objective was to standardize the assessment of existing assays and to validate novel fluid biomarkers for AD and PD. To support the validation of novel biomarkers and assays, a central and a virtual biobank for body fluids and associated data from subjects with neurodegenerative diseases have been established. In the central biobank, cerebrospinal fluid (CSF) and blood samples were collected according to the BIOMARKAPD standardized pre-analytical procedures and stored at Integrated BioBank of Luxembourg. The virtual biobank provides an overview of available CSF, plasma, serum, and DNA samples at each site. Currently, at the central biobank of BIOMARKAPD samples are available from over 400 subjects with normal cognition, mild cognitive impairment (MCI), AD, frontotemporal dementia (FTD), vascular dementia, multiple system atrophy, progressive supranuclear palsy, PD, PD with dementia, and dementia with Lewy bodies. The virtual biobank contains information on over 8,600 subjects with varying diagnoses from 21 local biobanks. A website has been launched to enable sample requests from the central biobank and virtual biobank. © 2015 Reijs, Teunissen, Goncharenko, Betsou, Blennow, Baldeiras, Brosseron, Cavedo, Fladby, Froelich, Gabryelewicz, Gurvit, Kapaki, Koson, Kulic, Lehmann, Lewczuk, Lleó, Maetzler, de Mendonça, Miller, Molinuevo, Mollenhauer, Parnetti, Rot, Schneider, Simonsen, Tagliavini, Tsolaki, Verbeek, Verhey, Zboch, Winblad, Scheltens, Zetterberg and Visser.

This chapter outlines important factors for the design process of wearable robots. First, the challenges are discussed and possible user groups are detailed and categories of devices given. Then, major differences of classical design methods from the field of robotics are illustrated. This is due to linking between the machine and the user and challenges of user intention detection. Finally, some design approaches, guidelines and best practices for the development of wearable devices are discussed.

The seeds of the Hawaiian baby woodrose ( Argyreia nervosa) are used by adolescents as a supposed hallucinogenic drug. These seeds are legally available and broadly sold. The active components are alkaloids structurally related to lysergic acid diethylamide (LSD). However, the psychic effects are very different from those of LSD and are dominated by rather sedative, uncomfortable autonomic disturbances similar to the effects of scopolamine. The (psycho)pharmacological profile is described on the basis of the active substances lysergacidamide and lysergacidethylamide (and their isomers). It is shown that neither the substances themselves nor the mixture are able to evoke LSD-like perceptual variances. The exposure of Argyreia nervosa is described focusing on potential fetal distress by contained ergometrine and the case history of an intoxication.

Die Brandereignisse der letzten Zeit in unterirdischen Verkehrsanlagen zeigen, das Vorkehrungen fur den Brandschutz in unterirdischen Verkehrsanlagen nach dem heutigen Stand der Kenntnis neu zu uberdenken und zu definieren sind. Der vorliegende Beitrag stellt einen Auszug aus einem laufenden Forschungsprojekt an der TU Wien dar, das sich mit der Reduktion von gefahrlichen Abplatzungen bei unterschiedlichen Brandbelastungen an Tunnelinnenschalenbeton befast. Dazu werden die derzeitigen Versuchsergebnisse und die daraus gewonnenen Erkenntnisse dokumentiert.

Up to now, no reliable methods for the pre- or intraoperative prediction of the nodal status are available in gastrointestinal cancer patients. Therefore, after the successful application of the sentinel lymph node concept in melanoma and breast cancer, ongoing research on this field is extended to gastrointestinal tumor entities. According to recent experiences, the most promising tumor entities are colon, gastric and anal cancer. First results with these patients indicate that the method could be a reliable predictor of the nodal status and, thus, may have important future implications for adjuvant therapy and the extent of surgery. The dye method for colon cancer and the combined method (dye and radiocolloid) for gastric cancer seem to be appropriate approaches, even when the general experience is still low. In rectal cancer, however, current experience failed yet to yield satisfying results. Up to now, anal cancer has not been a focus of publication, even when the concept seems to be very attractive for the evaluation of the inguinal lymph node status.

Referring to the German PRISCUS list, the paper analyzes differences in the prescription of potentially inadequate medication (PIM) between older and younger patients. We account for changes in the development over time and for the influence of the publication of the PRISCUS list.The retrospective study analyzes pharmaceutical prescriptions based on data from the Techniker Krankenkasse for the years 2008-20012. Age groups are compared regarding PIM prescriptions as share of total prescriptions within therapeutic areas (based on ATC codes). For a comparison of prescribed daily doses between age groups the median of those younger than 65 was indexed to the value 100.The share of older insured with at least one PRISCUS prescription declined from 21,7 % in 2008 to 18,9 % in 2012. Moreover, the total share of PIM prescriptions is steadily higher for elderly persons. Comparing major therapeutic areas shows a heterogeneous picture. An influence of the PRISCUS list on the prescription behavior is not observable.The share of PIM prescriptions in the TK sample is slightly declining over time. Unexpectedly, the total share is higher for the elderly than for those below 65. With regard to different therapeutic areas, results are less clear. For future research, our findings emphasize the need to rely on the applied methods.

The Global Precipitation Climatology Centre Drought Index (GPCC-DI) provides estimations of precipitation anomalies with respect to long term statistics. It is a combination of the Standardized Precipitation Index with adaptations from Deutscher Wetterdienst (SPI-DWD) and the Standardized Precipitation Evapotranspiration Index (SPEI). Precipitation data were taken from the Global Precipitation Climatology Centre (GPCC) and temperature data from NOAA's Climate Prediction Center (CPC). The GPCC-DI is available with several averaging periods of 1, 3, 6, 9, 12, 24 and 48 months for different applications. Since spring 2013, the GPCC-DI is calculated operationally and available back to January 2013. Typically it is released at the 10th day of the following month, depending on the availability of the input data. It is calculated on a~regular grid with 1° spatial resolution. All averaging periods are integrated into one netCDF-file for each month. This dataset can be referenced by the DOI:10.5676/DWD_GPCC/DI_M_100 and is available free of charge from the GPCC website ftp://ftp.dwd.de/pub/data/gpcc/html/gpcc_di_doi_download.html.

Aim: The purpose of this study was to determine the efficacy of pulsatile jet lavage and manual syringe lavage with regard to their cleansing capabilities as measured by cement penetration into cancellous bone both in vivo and in vitro. Methods: Three separate experiments were performed. Study A: In a cadaver study 36 left human cadaver femora were used for implantation of cemented femoral components. Conventional broaches were used for femoral preparation. Bone lavage was carried out either using jet lavage or manual syringe lavage of equal volume. The allocation to two different lavage groups was randomised. In both groups high-pressurising cementing techniques were implemented with the use of a proximal seal and additonal finger packing. Study B: To guarantee standardised cement pressurisation and equal bone quality, the influence of jet lavage (1000 ml) versus syringe lavage (1000 ml) was studied in 11 paired human cadaver femora in an additional study without prosthesis implantation. The specimens were imbedded in specially designed pots. Bone cement was applied in a retrograde manner and subjected to a standard pressure protocol with a constant force of 3000 N. Study C: To directly compare the effectiveness of both pulsatile jet and syringe lavage with regard to cement penetration in vivo, a new sheep model allowing for standardised bilateral, simultaneous cement pressurisation was used. After femoral neck osteotomies both femoral cavities of 10 sheep were prepared for retrograde cement application. After randomisation one side was lavaged with 250 ml irrigation using a bladder syringe, the contralateral femur with the identical volume but using a pulsatile lavage. A specially designed apparatus was used to allow for bilateral simultaneous cement pressurisation. Analysis: In all studies horizontal sections were obtained from the femoral specimens at predefined levels using a diamond saw. Microradiographs were taken and analysed using image analysis to assess cement penetration into cancellous bone. Results: Study A: Compared with syringe lavage the use of jet lavage significantly improved the penetration of cement into cancellous bone (p = 0.027). In the presence of strong, dense cancellous bone the findings were more pronounced. Study B: Our results show that in equal quality bone, the use of jet lavage yields significantly (p < 0.001) improved cement penetration compared to syringe lavage specimens. Study C: The results of the in vivo study confirmed the superiority of jet lavage bone surface preparation (p = 0.002). Conclusions: The use of jet lavage yields significantly improved interdigitation between cancellous bone and cement both in vitro and in vivo and should be regarded as mandatory in cemented total hip arthroplasty. High pressurising techniques are effective means to improve cement penetration, but should only be administered with jet lavage to reduce the risk of fat embolism.

Introduction: Cemented total hip arthroplasty (THA) has to be considered a high-risk procedure with respect to cardiovascular complications. The insertion of cement and prosthesis may lead to intravasation of fat and bone marrow into the circulation. Methods: This article represents a review on the relevant literature about thromboembolic complications associated with the use of bone cement in THA. Results/Discussion: The method of canal preparation and lavage is of paramount importance to reduce the potential embolic load. Additionally, thorough cleaning of the intramedullary cavity (using jet lavage) improves the cement penetration into the bone and increases the shear strength of the bone-cement interface. Modern cementing techniques include the use of high pulsatile lavage, a cement restrictor and cement pressurization. With the application of these techniques a sufficient drainage of the medullary canal should be guaranteed to minimise the risk for thromboembolic complications. During the insertion of cementless implants the intravasation of embolic material seems to be less, but it is likewise possible to have a thromboembolic complication during cementless THA. However, it is not justified as a consequence to use the thromboembolic risk as the main indication for implant choice, in particular as the overall risk of a serious fatal complication is low.

Hintergrund. Die idiopathische polipoide choroidale Vaskulopathie (IPCV) wurde ursprunglich als eine bilaterale Erkrankung mit peripapillar gelegenen polipoiden Lasionen v. a. bei pigmentierten Rassen beobachtet. Bisher wurden nur wenige Patienten in Europa beschrieben. Material und Methode. Eine retrospektive Studie des klinischen Spektrums von 9 Patienten kaukasischer Abstammung und IPCV anhand von Fluoreszein- und Indozyaningrunangiographien (ICGA). Ergebnisse. Die ICGA zeigte bei allen Patienten die typischen hyperfluoreszenten polipoiden Dilatationen im Bereich der inneren Aderhaut. Die IPCV war unilateral bei 6, bilateral bei 3 Patienten, mit makularen Lasionen bei 6 und peripapillaren Lasionen bei 3 Patienten. Wahrend einer mittleren Beobachtungszeit von 29,4 Monaten (6–92 Monate) wurde bei einem Auge eine Glaskorperblutung und bei 3 Augen eine spontane Regression beobachtet, neue Lasionen entstanden bei 2 Augen. Eine fokale Laserkoagulation wurde bei 3 von 5 Patienten erfolgreich durchgefuhrt. Schlussfolgerung. Das klinische Erscheinungsbild der IPCV kann mit dem der exsudativen altersbedingten Makuladegeneration und der Retinopathia centralis serosa uberlappen, jedoch sind der naturliche Verlauf, die Visusprognose und die Reaktion auf eine Laserkoagulation verschieden. Mittels ICGA ist eine Differenzierung moglich.

AIM Autologous grafting has developed into one of the preferred methods of treatment for focal osteochondral lesions, although basic research on this topic remains sparse. In an animal study, questions regarding the healing of such osteochondral transplants are clarified. METHOD An autologous osteochondral transplantation was performed on the ovine knee using the standard operative protocol. Two groups, consisting of 10 sheep each, were evaluated after 3 and 6 months, respectively. RESULTS During the clinical evaluation of the specimens, neither osteophytes nor synovial changes were observed. The consistency of the cartilaginous tissue began to reach a level equivalent to the surrounding tissue only after 6 months. Macroscopically, the superficial border of the transplanted osteochondral plug could easily be outlined at both time points. Radiographically, a solid osteointegration of the graft could already be documented at 3 months. In contrast, integration of the chondral surface of the OAT was not seen macro- or microscopically at any point in time. A firm physical interdigitation of the reconstructed joint surface could not be demonstrated. CONCLUSIONS The lack of integration of the cartilaginous portion of the transplanted plugs into the reconstructed joint surface leads to questions regarding the long-term survival of the joint itself.

before and after Hyaluronic Acid Therapy. Aim: In the study we evaluted the effectiveness of intraarticular injected hyaluronic acid (Hyalart®) with regard to the changes in the parameters maximal isokinetic muscle strength, total work, pain at rest, and pain under toad. Method: We examined 43 patients with osteoarthritis in both knee joints (Kellgren II or II according to X-ray) in right/left comparison. We used the isokinetic system Cybex 600 for measuring the maximal isokinetic muscle strength and the total work. We used the visual analog scale for the pain.The evaluated parameters were measured before and after a 5-week treatment phase with 5 intraarticular injections (one injection per week with 20 mg hyaluronic acid). Results: In knees treated with hyaluronic acid the mean peak torque of the knee extensor was 57 ± 26.15/32 ± 19.63 Nm vs. 77.17 ± 32.54/47.83 ± 21.43 Nm after (p 0.01) between treated and untreated knee were found for total work of the extensor and flexor of the knee. The pain at rest decreased from 3.83 ± 1.72 cm to 1.36 ± 1.42 cm and the pain under load decreased from 7.57 ± 1.34 cm to 3.75 ± 1,32 cm in the treated knee group (p < 0,01). Conclusion: The intraarticular injection of hyaluronic acid is effective and safe in the treatment of patients with gonarthrosis. The treatment resulted in a functional improvement of the knee joint and had a good pain lowering effect in patients suffering from gonarthrosis.

Previous dielectric relaxation measurements of glycerol and propylene carbonate and new results on propylene glycol performed below the conventional glass transition temperatures T_(g) after long periods of aging all show that the excess wing (a second power law at higher frequencies) in the isothermal dielectric loss spectrum, develops into a shoulder. These results suggest that the excess wing, a characteristic feature of a variety of glass-formers, is the high frequency flank of a Johari–Goldstein β-relaxation loss peak submerged under the α-relaxation loss peak. With this interpretation of the excess wing assured, the dielectric spectra of all three glass-formers measured at temperatures above T_(g) are analyzed as a sum of a α-relaxation modeled by the Fourier transform of a Kohlrausch–Williams–Watts function and a β-relaxation modeled by a Cole–Cole function. Good fits to the experimental data have been achieved. In addition to the newly resolved β-relaxation on propylene glycol, the important results of this work are the properties of the β-relaxation in this class of glass-formers in the equilibrium liquid state obtained over broad frequency and temperature ranges.

Bei der Schizophrenia simplex handelt es sich um eine schizophrene Psychose mit niedriger Pravalenz aber schlechter Prognose, bei der Negativsymptome im Vordergrund stehen. Wir berichten uber einen 22-jahrigen Mann, der sich unter einer Therapie mit atypischen Neuroleptika (Clozapin, Risperidon) erfreulich stabilisiert hat.

Caveolae are plasma membrane microdomains that have been implicated in the regulation of several intracellular signaling pathways. Previous studies suggest that caveolin-1, the main structural protein of caveolae, could function as a tumor suppressor. Caveolin-1 is highly expressed in terminally differentiated mesenchymal cells including adipocytes, endothelial cells, and smooth muscle cells. To study whether caveolin-1 is a possible tumor suppressor in human mesenchymal tumors, we have analyzed the expression using immunohistochemistry in normal mesenchymal tissues, 22 benign and 79 malignant mesenchymal tumors. Caveolin-1 was found to be expressed in fibromatoses, leiomyomas, hemangiomas, and lipomas at high levels comparable to normal mesenchymal tissues. The expression of caveolin-1 was slightly reduced in four of six well-differentiated liposarcomas and strongly reduced or lost in three of three fibrosarcomas, 17 of 20 leiomyosarcomas, 16 of 16 myxoid/round cell/pleomorphic liposarcomas, five of eight angiosarcomas, 15 of 18 malignant fibrous histiocytomas, and eight of eight synovial sarcomas. The immunohistochemical findings were confirmed by Western blot analysis in a number of tumors. High levels of both the 24-kd [alpha]- and the 21-kd [beta]-isoform of caveolin-1 were detected in the nontumorigenic human fibroblast cell line IMR-90. In contrast, in HT-1080 human fibrosarcoma cells, caveolin-1 is strongly down-regulated. We show that the [alpha]-isoform of caveolin-1 is potently up-regulated in HT-1080 cells by inhibition of the mitogen-activated protein kinase-signaling pathway with the specific inhibitor PD 98059, whereas the specific inhibitor of DNA methylation 5-aza-2'-deoxycytidine only marginally up-regulates caveolin-1. In addition, re-expression of caveolin-1 in HT-1080 fibrosarcoma cells potently inhibited colony formation. From these we conclude that caveolin-1 is likely to act as a tumor suppressor gene in human sarcomas.

Aim: The purpose of this investigation was to study two different broach surface designs with regard to cement penetration into human cancellous bone. Methods: In a cadaver study 15 paired human cadaver femora were prepared using broaches of identical geometry but different surface characteristics. All left femora were prepared using chipped toothed broaches, all right femora using diamond shaped broaches. Cancellous bone was irrigated with 1 liter pulsed lavage. The specimens were imbedded in specially designed pots. Bone cement was applied in a retrograde manner and subjected to a standard pressure protocol with a constant force of 3000 N. Radiographs were taken and horizontal sections were obtained at predefined levels using a diamond saw. Microradiographs were taken and analyzed using image analysis to assess cement penetration into cancellous bone. Results : Pressure curves recorded during cement pressurisation were comparable. The microradiographic evaluation revealed no significant morphometric differences in the different groups with regard to cement penetration into cancellous bone. These findings were similar in all sections obtained. Conclusions: A standardized model was developed allowing comparison of cement penetration into cancellous bone depending on bone preparation. In the presence of pulsed lavage there is no significant influence of broach surface characteristics on cement penetration into cancellous bone of the upper end of the femur.

Microsurgical epididymal sperm aspiration (MESA) combined with intracytoplasmic sperm injection (ICSI) represents a great advance in the therapy of non-reconstructable obstructive azoospermia. For procedure synchronization, a great number of organizational facilities are needed. Intentional cryopreservation of the aspirate may reduce these problems, therefore the aim of this study was to analyse the amount and quality of aspirate fluid obtained by means of MESA and the quality of the vials after thawing. Furthermore, the available cryopreserved straws were calculated. A total of 93 consecutive MESA procedures were performed and epididymal spermatozoa were obtained in 88 patients. Mean sperm concentration was 40.9 x 10 6 spermatozoa/ml. Global and progressive motility were 24.8 and 7.5% respectively. In one-third of the aspirates, no progressive motile spermatozoa were found. The mean number of straws available was 7.6. In 33 ICSI cycles with frozen-thawed epididymal spermatozoa, a pregnancy rate of 42.4% was achieved. In conclusion, these data show that enough spermatozoa are available for various ICSI cycles following a single MESA procedure in men with non-reconstructable obstructive azoospermia. Furthermore, ICSI with cryopreserved spermatozoa leads to excellent pregnancy rates.

Recent studies show the sentinel lymph node biopsy (SNB) as a reliable method for the determination of the nodal status in patients with breast cancer. We present our experience with this method during 3 years and discuss its potential and limitations. From 11/95 to 3/99 we performed a sentinel node detection in 146 patients with breast cancer stage I to III. We used the raionuclide method including preoperative lymphscintigraphy and intraoperative gamma.probe detection. The detection rate varied with the tumor size between 94% for tumors with a diameter 5 cm). The accuracy of the SNB in the prediction of the nodal status varied also with the tumor diameter between 100% for very small tumors ( 5 cm). In the subgroup of patients restricted to T1-2-tumors (n = 106), 57 patients (53%) showed true negative, 4 (4%) false negative SNB. 38 (36%) revealed tumor cells in the HE-staining and an additional 7 patients (7%) solely in the immunohistochemical staining. The presented results show, that SNB is a reliable method for the evaluation of the nodal status in early breast cancer patients with a tumor size up to ca. 3 cm. While in about 50% of these patients a surgical intervention could be avoided after a negative SNB, an additional 5-10% of conventionally nodal negative patients can be found by the immunohistochemical examination of the sentinel node. The sn-concept can also identify parasternal metastasis and can be applied in patients after neoadjuvant therapy and patients with recurrent tumor. Indications and contraindications of this method, however, still remain to be determined.

A detailed dielectric investigation of liquid, supercooled liquid, and glassy ethanol reveals a third relaxation process, in addition to the two processes already known. The relaxation time of the newly detected process exhibits strong deviations from thermally activated behavior. Most important, this process is the cause of the apparent excess wing, which was claimed to be present in the dielectric loss spectra of glass-forming ethanol. In addition, marked deviations of the spectra of ethanol from the scaling proposed by Dixon and Nagel have been detected., 8 pages including 4 figures submitted to Phys. Rev. B

Die vorliegende prospektive offene kontrollierte Studie vergleicht die Effizienz einer 10-tagigen Buprenorphin-/19-tagigen Carbamazepin-Entgiftungsmedikation (BPN/CBZ) in der Prufgruppe versus einer 14-tagigen Oxazepam-/19-tagigen Carbamazepin-Entgiftungsmedikation (OXA/CBZ) in der Kontrollgruppe bei 27 opioidabhangig-polytoxikomanen Patienten hinsichtlich der Behandlung akuter Entzugssymptome. Prufgrosen waren die somatischen und psychischen Entzugssymptome, die mit den Skalen ASI, HAMD, SCL-90-R und SOWS erfasst wurden, sowie die Abbruchquote. Von den 15 Patienten der BPN/CBZ-Gruppe und 12 Patienten der OXA/CBZ-Gruppe, schlossen 18 (67%) die Studie am 21. Tag ab. Von den 9 Studienabbrechern bekamen 4 (27%) Buprenorphin/Carbamazepin und 5 (42%) Oxazepam/Carbamazepin. Der SOWS-Gesamt-Score zeigte einen signifikanten Gruppenunterschied uber den Testzeitraum zugunsten der BPN/CBZ-Gruppe. Der HAMD-Score unterschied sich am Aufnahmetag nicht (BPN/CBZ 11,6; OXA/CBZ 11,0), am 14. Tag jedoch hochsignifikant (BPN/CBZ 3,0; OXA/CBZ 6,1). Bei 3 von 9 Faktoren des SCL-90-R zeigte sich ein Trend zugunsten des BPN/CBZ. Die ASI-Testung ergab fur BPN/CBZ am 7. und 14. Behandlungstag einen hochsignifikant bzw. signifikant geringeren Score im Vergleich zu OXA/CBZ. In beiden Gruppen traten keine ernsten Nebenwirkungen auf. Das Behandlungsschema mit BPN/CBZ zeigt gegenuber dem Behandlungsschema OXA/CBZ eine signifikant bessere Wirkung auf Angst, Depressivitat und Entzugssymptome wahrend der Opioidentgiftung sowie einen Trend zu einer geringeren Abbruchquote. Die Eignung von Buprenoprphin zur Detoxifikation wird anhand seiner pharmakologischen Eigenschaften (κ-Antagonismus, partieller μ-Agonismus) diskutiert.

Die bisher unheitliche Terminologie des Pseudomyxoma peritonei, das seltene Auftreten und die unterschiedliche Tumorbiologie der Erkrankung machen es schwierig, eine einheitliche Therapiestrategie zu definieren. Prinzipiell sind beim Pseudomyxoma peritonei multimodale Therapiekonzepte zu favorisieren. Eine Kombination von optimaler chirugischer Cytoreduktion und postoperativer intraperitonealer Chemotherapie ist erfolgversprechend. Das chirurgische Vorgehen umfast die Peritonektomie mit dem Ziel makroskopischer Tumorfreiheit. In der fruhen postoperativen Phase, in der eine homogene intra-abdominelle Chemotherapeuticaverteilung bei Fehlen von Adhasionen erreicht werden kann, ist die intraperitoneale Chemotherapie mit 5-FU und Mitomycin C bisher die am weitesten etablierte Methode. Ein Behandlungsversagen ist oft auf eine unzureichende und inkonsequent radikale chirurgische Cytoreduktion sowie eine inhomogene intra-abdominelle Verteilung des Chemotherapeuticums zuruckzufuhren. Zur Sicherstellung einer standardisierten Therapie und zur weiteren Klarung der offenen therapeutischen Fragen ist bei der Seltenheit der Erkrankung eine zentrenorientierte Behandlung zu fordern. Die Entwicklung verbesserter Therapiekonzepte mus auf einer differenzierten histopathologischen Klassifiktion basieren. Dabei sollte zukunftig zwischen der prognostisch gunstigen disseminierten peritonealen Adenomucinosis und der aggressiven peritonealen mucinosen Carcinomatosis unterschieden werden.

Navigation systems using both satellite navigation and inertial navigation are getting more and more important. To reduce the high costs of inertial navigation systems the use of micromechanical acceleration sensors and gyroscopes is becoming essential. In this paper two different one-axis accelerometers, a three-axes accelerometer and a gyroscope for inertial navigation applications are presented.

The physiological and pathophysiological roles of the central nervous endogenous cannabinoid system are not completely understood, but still represent a challenge in basic neurobiological, cognitive, and psychiatric research. The system has been implicated in the pathogenesis of schizophrenia. Binocular depth inversion, an illusion of visual perception, provides a model of impaired perception during psychotic states. Using this model the effects of nabilone, a psychoactive synthetic 9-trans-ketocannabinoid, and of cannabidiol, the main natural component of herbal cannabis, and a combined application of both substances on binocular depth inversion and behavioural states were investigated in nine healthy male volunteers. The time course of the effects of both substances on binocular depth inversion was analysed after oral administration using three different groups of natural stimuli. A significant impairment of binocular depth perception was found when nabilone was administered, but combined application with cannabidiol revealed somewhat reduced effects on binocular depth inversion. The influence of psychoactive cannabinoids on this perceptual model and the role of the endogenous cannabinoid system in visual information processing are discussed.

Fire safety design of nuclear reactor buildings may be based on the results from numerical fire simulations At the time being two main types of fire models are available for this purpose, field and zone models. The limitations of the codes and the applicability of such codes will be discussed.

The spalling of high strength concrete under f i e attack is discussed in this paper. Two series of f i e tests on reinforced concrete elements were carried out in order to investigate the spalling behavior and effect of spalling on the fire endurance of reinforced concrete elements. The results of the f i e tests on 30 specimens can be summarized as follows: a) the spalling is significantly affected by the water-cement ratio of the concrete, the permeability of the concrete, the amount of steel reinforcement, the f i e intensity and the age of the concrete at f i e exposure, b) the addition of polypropylene fiber into concrete is a good measure for the prevention of spalling and can improve the f i e endurance of reinforced concrete elements, c) the addition of polypropylene fiber into concrete at a ratio of Ikg polypropylene fiber per lm3 concrete reduces the depth of spalling by about 18mrn.

SummaryThirty-three inpatients with vitiligo were compared at the Tomesa Klinik (Bad Salzschlirf, Germany) to a healthy control group using the Beck Depression Inventory, Interaction Anxi

Intraluminale Duodenaldivertikel gehoren zu den seltensten angeborenen duodenalen Fehlbildungen. Diese sackformigen Gebilde im mittleren duodenalen Abschnitt konnen Symptome von Oberbauchschmerzen bis zu Hamorrhagien verursachen. Wir berichten von einem 33-jahrigen Patienten, der sich mit dem Bild einer akuten Pankreatitis in unserer Klinik vorstellte. Wegweisend fur die Diagnose sind ERCP und Endosonographie. Wichtige Differenzialdiagnosen sind neben der Choledochozele die duodenalen Duplikaturen. Die interventionelle Endoskopie ist bei weniger schwerwiegenden Verlaufen mittlerweile eine etablierte Therapieoption.