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T cells recognize pathogenic antigens via the T-cell antigen receptor (TCR). This protein complex binds to antigen fragments on the surface of antigen-presenting cells. To understand how cellular activation can ensue rapidly from molecular recognition, the localization and distribution of the TCR on the surface of the resting T cell are of particular importance. Conflicting results regarding TCR distribution have emerged from recent studies using a range of imaging techniques, including total internal reflection and single-molecule localization microscopy modalities. Here, we review the differing results and the potential biases inherent in differing imaging approaches. In addition, we review studies showing the impact of differing imaging surfaces on T-cell activation.

Hydrofluoric acid burns are uncommon but unique among chemical burns in that they can cause visually mild burns with significant deep tissue injury and systemic toxicity through multiple mechanisms. We present the case of a patient who presented with bilateral hydrofluoric acid burns to his hands from aluminum brightener. The patient had been using an aluminum brightener with a hydrofluoric acid concentration of 10% for several months at work. On emergency department presentation, the patient endured significant tenderness to his hands and fingers. The patient suffered no serious complications, had no concerning lab or electrocardiographic findings, and was treated symptomatically with calcium gluconate gel. He was discharged home after successful symptom resolution with proper return precautions and instructions on how to safely use hydrofluoric acid containing products. Although not a very common cause of burns, acute care of these burns requires specific knowledge which is imperative for emergency personnel.

Background Surgical approaches to autoimmune thyroid disease are currently hampered by concerns over postoperative complications. Risk profiles and incidences of postoperative complications have not been investigated systematically, and studies with sufficient power to show valid data have not been performed. Methods A prospective multicentre European study was conducted between July 2010 and December 2012. Questionnaires were used to collect data prospectively on patients who had surgery for autoimmune thyroid disease and the findings were compared with those of patients undergoing surgery for multinodular goitre. Logistic regression analysis was used to evaluate risk factors for thyroid surgery-specific complications, transient and permanent recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism. Results Data were available for 22 011 patients, of whom 18 955 were eligible for analysis (2488 who had surgery for autoimmune thyroid disease and 16 467 for multinodular goitre). Surgery for multinodular goitre and that for autoimmune thyroid disease did not differ significantly with regard to general complications. With regard to thyroid surgery-specific complications, the rate of temporary and permanent vocal cord palsy ranged from 2·7 to 6·7 per cent (P = 0·623) and from 0·0 to 1·4 per cent (P = 0·600) respectively, whereas the range for temporary and permanent hypoparathyroidism was 12·9 to 20·0 per cent (P < 0·001) and 0·0 to 7·0 per cent (P < 0·001) respectively. In logistic regression analysis of transient and permanent vocal cord palsy, autoimmune thyroid disease was not an independent risk factor. Autoimmune thyroid disease, extent of thyroid resection, number of identified parathyroid glands and no autotransplantation were identified as independent risk factors for both transient and permanent hypoparathyroidism. Conclusion Surgery for autoimmune thyroid disease is safe in comparison with surgery for multinodular goitre in terms of general complications and RLN palsy. To avoid the increased risk of postoperative hypoparathyroidism, special attention needs to be paid to the parathyroid glands.

Luxatio erecta is a highly uncommon type of shoulder dislocation, representing approximately 0.5% of all shoulder dislocations fitting into this category. In this paper, we present the case of a patient who presented post trauma with bilateral inferior glenohumeral joint dislocations (also called Luxatio Erecta). Considering that Luxatio Erecta only has a 0.5% chance of being present with a unilateral dislocation, the probability of a patient presenting 2 of these dislocations at the same time is approximately 0.25% (0.5% × 0.5% = 0.25%). In addition to this, Luxatio Erecta frequently presents with injuries to the brachial plexus and/or a humeral fracture. Despite this, neither of our patient’s dislocations were associated with any fractures or neurovascular injury and both were successfully reduced the Emergency Department. Both the patient’s presentation and outcome are quite uncommon, which makes this case an invaluable opportunity to go over the unique characteristics to Luxatio Erecta.

We present the case of a patient who presented to the Emergency Department with Posner-Schlossman syndrome, also known as glaucomatocyclitic crisis. While this condition is uncommon, it is essential that physicians be aware of its characteristics and how to treat it, otherwise affected patients are at risk of developing permanent complications such as optic nerve atrophy and loss of vision.

This chapter discusses why a risk governance approach is appropriate for the problem of climate security risk, bringing together aspects of the preceding two chapters to illustrate how the nature of climate security risk favors the IRGC risk governance framework in particular. The global dimensions and deep uncertainties associated with climate security risk suggest that it provides an opportunity to test the framework against a problem that is worthy of the IRGC’s ambition level.

This chapter first provides an overview of NATO’s current posture toward climate security risk, surveying the history of NATO’s institutional transformation, its current environmental policies, and its previous engagement and activities concerning the Middle East and North Africa (MENA) region and the Arctic. The chapter then discusses two recent foresight efforts conducted by NATO’s Allied Command Transformation (ACT): The Strategic Foresight Analysis (SFA) and the subsequent Framework for Future Alliance Operations (FFAO). I discuss the relationship between these two efforts, as well as their outcomes. In particular, I identify three Instability Situations that will serve as the basis for analysis in subsequent chapters. I conclude the chapter with a critique of the common characteristics among these scenarios, and a discussion of how each one compares to its counterpart in the core conclusions of the IPCC Summary for Policymakers. In so doing, I establish why the NATO ACT Instability Situations serve as a reasonable proxy for the perspective of NATO Headquarters with respect to the security consequences anticipated to result from climate change.

Gender-specific aspects have been increasingly considered in clinical medicine, also in oncological surgery.To analyze gender-specific differences of early postoperative and oncological outcomes after rectal cancer resection based on data obtained in a prospective multicenter observational study.As part of the multicenter prospective observational study "Quality assurance in primary rectal cancer", data on tumor site, exogenic and endogenic risk factors, neoadjuvant treatment, surgical procedures, tumor stage, intraoperative and postoperative complications of patients with the histological diagnosis of rectal cancer were registered. Data from the years 2005-2006 and 2010-2011 were investigated with respect to gender-specific differences of postoperative morbidity, hospital mortality, local recurrency rate, disease-free and overall survival by univariable and multivariable analyses.Overall, data from 10,657 patients were evaluated: 60.9% of the patients were male, who were significantly younger (p 0.001). Men had a significantly higher rate of alcohol (p 0.001) and nicotine abuse (p 0.001) as well as a trend to a higher body mass index (BMI) compared with women. Although, there was no significant difference in the distribution of various tumor stages comparing men and women, neoadjuvant radiochemotherapy was used significantly more often in male patients (p 0.001). In addition, male patients underwent an abdominoperineal rectum exstirpation more often, whereas creation of an enterostoma and Hartmann's procedure were more frequently used in women (p 0.001 each). Multivariate analysis revealed that male patients developed a higher overall morbidity (odds ratio, OR: 1.5; p 0.001) during both study periods and from 2010-2011 a higher hospital mortality (OR: 1.8; p 0.001). After a median follow-up period of 36 months, gender did not have a significant impact on overall survival, disease-free survival or on the local tumor recurrency. The 5‑year overall survival was 60.5%, disease-free survival 63.8% and local recurrency rate was 5%.Independent of other variables, gender differences were found with respect to early postoperative outcome but not to oncological long-term results after surgery of rectal cancer.

Anamnese und klinischer Befund: Bei einer 61-jahrigen Patientin bestand seit 2 Monaten eine erhebliche Leistungsminderung mit zunehmender Belastungsdyspnoe und Schmerzen im rechten Oberbauch (Vorerkrankungen: Asthma bronchiale, arterielle Hypotonie). Bei leicht reduziertem Allgemeinzustand waren Druckschmerz im rechten Oberbauch sowie Aszites nachweisbar. Untersuchungen: Laborchemisch fielen keine Hormonabnormitaten auf. Eine Angio-CT erbrachte eine Raumforderung der rechten Nebenniere und Thrombose der V. cava inferior (Tumorzapfen kranial bis vor den rechten Vorhof reichend) mit ausgepragten Tumorgefasen direkt zur V. cava inferior. Kaudal endete der kaval eingebrochene Tumor etwa in Hohe des Lobus caudatus der Leber mit ausgedehntem randstandigen, umflossenen Cavathrombus nach inferior bis in die Vv. iliacae communes beidseits. Therapie und Verlauf: Es erfolgte eine offene radikale Adrenalektomie rechts mit Resektion des periadrenalen Gewebes und Exstirpation der intrakavalen Tumorthromben (Cavotomie, passager-digitaler Verschluss des praatrialen Blutflusses aus der V. cava inferior durch den Herzchirurgen) mit postoperativ problemarmem stationarem Verlauf. Anschliesend wurde die Patientin adjuvant fur 3 Jahre mit Mitotane therapiert. Uber bislang 7 Jahre kam es nicht zu einem Rezidiv. Folgerung: Tumorbedingte thrombotische Verschlusse der V. cava inferior und anderer venoser Gefase sind bei Nebennierentumoren sehr selten, insbesondere in der hier beschriebenen Auspragung. Die Kombination aus R0-Resektion und adjuvanter Mitotane-Therapie ist das Vorgehen der ersten Wahl mit einzig kurativem Potenzial, auch bei fortgeschrittenem invasivem NNR-Karzinom.

Die differenzierte Diagnostik und Behandlung schlecht heilender und chronischer Wunden wird als Wundmanagement bezeichnet. Die lokale Therapie erfolgt hierbei nach dem TIME-Konzept und beinhaltet die konsequente Umsetzung des Prinzips der idealfeuchten Wundbehandlung. Die enorme Vielfalt der Wundauflagen ermoglicht eine individuelle Versorgung. Die Auswahl der Wundauflage richtet sich nach der Menge des Wundexsudats, dem Wundtyp bzw. der Beschaffenheit des Wundgrunds, der Wundgrose und der Lokalisation. Die Behandlung chronischer Wunden stellt eine besondere Herausforderung dar und sollte in einem multidisziplinaren Ansatz erfolgen. Fur ein optimiertes, fachubergreifendes Wundmanagement ist eine sorgfaltige Wunddokumentation unabdingbar.

Jegliche Zerstorung oder Zusammenhangstrennung von Geweben wird als Wunde bezeichnet. Die Unterscheidung erfolgt hinsichtlich ihrer Genese, des zeitlichen Verlaufs, der Komplexitat oder ihrer Keimbelastung. Die Wundklassifizierung dient der Auswahl der optimalen Wundbehandlung. Die Indikationsstellung und Durchfuhrung des Wundverschlusses stellt eine Kernkompetenz des Chirurgen dar. Die Behandlung akuter Wunden konzentriert sich primar auf das lokale Trauma und erfolgt nach standardisierten chirurgischen Prinzipien. Die Heilung verlauft idealerweise in typischen Wundheilungsphasen. Bei chronischen Wunden liegt der Schwerpunkt auf der Beurteilung und Behandlung der Grunderkrankung.

Hintergrund: In der vorliegenden Arbeit werden die haufigsten Beruhrungspunkte bestimmter Erkrankungen bzw. Verletzungen dargestellt, die in die Zustandigkeit der Fachgebiete Neurochirurgie und Allgemeinchirurgie fallen. Methode: Die Dringlichkeiten und die Prognose bezuglich Diagnostik und Therapie des Schadel-Hirn-Traumas, ggf. mit Mehrfachverletzung, der extra- und intraspinalen Tumoren und der Hirnmetastasen werden analysiert. Ergebnisse: Die Dringlichkeit allgemeinchirurgischer und neurochirurgischer Masnahmen folgt keiner gleichbleibenden allgemeingultigen Schablone, sondern ist den Zufalligkeiten des Einzelfalls unterworfen. Schlussfolgerung: Bei der gemeinsamen chirurgischen und neurochirurgischen Behandlung ist die Unterscheidung der lebensnotwendigen von den aufschiebbaren oder im Hinblick auf die Prognose unangemessenen Eingriffen von grundsatzlicher Bedeutung. Die Reihenfolge der neurochirurgischen und allgemeinchirurgischen Masnahmen muss den Erfordernissen des Einzelfalls angepasst werden.

The impact of hospital and surgeon volume on the treatment outcome based on data obtained from cohort and register studies has been controversially discussed in the international literature. The results of large-scale prospective observational studies within the framework of clinical healthcare research may lead to relevant recommendations in this ongoing discussion.Within the framework of the prospective multicenter German Gastric Cancer Study 2 (QCGC 2), from 1 January 2007 to 31 December 2009 a total of 2897 patients with the histological diagnosis of gastric cancer from 140 surgical departments were registered and analyzed. The departments were subdivided according to the number of cases into 4 volume groups: I)5, II) 5-10, III) 11-20 and IV)20 patients with surgical interventions per year.Overall 1163 patients (65.6 %) underwent surgical interventions in the departments of groups III and IV. Of the patients 521 (18 %) were scheduled for neoadjuvant treatment but with no significant differences among the various volume groups. In the departments of volume groups I and II subtotal gastric resection was performed significantly more often. Transthoracic extended surgical interventions in cases of a proximal tumor site were significantly more frequent in departments from volume group IV (p 0.001). The proportion of intraoperative fresh frozen sections correlated with the case volume: group I 23.2 % vs. group IV 61.2 %. Overall hospital mortality was 6.1 % and slightly higher in volume group I with 7.8 %. The median survival time and the 5‑year survival rate showed no significant differences between the various volume groups independent of tumor stages. There was a tendency towards a longer median survival time in volume group IV only for proximal tumor sites, i.e. adenocarcinoma of the esophagogastric junction (AEG). Using Cox regression analysis hospital volume did not have an independent impact on long-term survival.Hospital volume effects could only be detected for the treatment of AEG. To improve oncological long-term outcome, centralization of treatment of proximal gastric cancer appears to be recommendable.

The benefits of primary tumor resection in metastatic disease remains a matter of debate. Existing data are almost exclusively limited to results from retrospective analyses. Data from prospective, randomized trials are currently not available.The results from two prospective observational studies involving gastric and rectal cancer patients are presented and discussed in the context of the available literature.Based on data collected within the prospective quality assurance studies on gastric and rectal cancer conducted by the Institute for Quality Assurance in Surgery at Otto von Guericke University, Magdeburg, Germany, the long-term outcome after palliative primary tumor resection in patients with International Union Against Cancer (UICC) stage IV rectal cancer (2005-2008, n = 2046) and metastatic gastric cancer (2007-2009, n = 687) was analyzed and compared to published data.The median survival time following palliative primary tumor resection of UICC stage IV rectal cancer in the patients analyzed was 20 months. In patients with hepatic metastases undergoing metastasectomy the median survival was 38 months. This increased to 58 months for patients with lymph node negative primary tumors. In metastatic gastric cancer patients undergoing palliative (R2) gastric resection and also patients not undergoing surgery showed a prognostic benefit from palliative chemotherapy; however, the median survival time was significantly prolonged if palliative chemotherapy was preceded by resection of the primary tumor (11 versus 7 months, p 0.001).Together with previously published data, the results from the two observational studies on rectal and gastric cancer presented here suggest a prognostic benefit from palliative resection of the primary tumor in metastatic disease.

The present review summarizes existing data regarding estrogen metabolism and hormone-responsive cancers. Endogenous estradiol breakdown takes place by oxidation at the A-ring and the D-ring; the resulting metabolites, however, are not inactive substances, as assumed formerly, but elicit different biological effects, with A- and D-ring metabolites to some extent developing opposite actions. Multiple results are available showing stimulating and inhibiting properties of some metabolites on the growth of cancer. Among the D-ring metabolites are substances with proliferation-stimulating properties, e.g. 16 alpha-hydroxyestrone, and among the A-ring metabolites, the catechol estrogens, compounds with inhibiting properties. There are indications that endogenous production of proliferation-stimulating metabolites, especially 16 alpha-hydroxyestrone, which has been shown to be mutagenic, is increased in some cancers. In these cases the ratio of A- to D-ring metabolism is shifted in favour of the D-ring metabolites. This ratio can be influenced by various substances e.g. by indole-3-carbinol, an ingredient of cruciferous vegetables, which can increase the body's own production of catechol estrogens. However, as yet only a few metabolites have been investigated with respect to their influence on cancer development and growth. Presumably other metabolites may also be able to interfere directly or indirectly with cancer progression. Thus a great deficit in research work remains in this field. The existing findings on the pathophysiology of estradiol metabolism on the development and progression of cancer offer promising opportunities for clinical-pharmacological intervention in the treatment of human cancer. 2-Methoxyestradiol, physiologically present at low concentrations, seems to be of special interest. Several investigations were able to demonstrate that 2-methoxyestradiol inhibits proliferating tumoric tissues. Inhibition of neoangiogenesis and inhibition of tubulin polymerization have been revealed as mechanisms. Specific studies on the clinical use of this estradiol metabolite seem to be justified.

Drug resistance is the major reason for failure in cancer chemotherapy. Resistance may be either pre-existent (intrinsic resistance), or induced by drugs (acquired resistance), So far, no strategy has been found to overcome resistance, which is based on highly complex and individually variable biological mechanisms. In present clinical practice, drug resistance can only be recognized during treatment, after long lag times. Thus diagnostic tests are re quired, indicating resistance at an earlier stage, in order to avoid unnecessary medication, frequently associated with toxic side-effects. A number of new anti-cancer drugs are now available. In contrast to the unspecifically acting cytostatic chemotherapy, these compounds have targeted actions. However, as recent studies have shown, resistances and severe side-effects can also be found with targeted drugs. With the increasing number of new treatment regimens, the early diagnosis of resistance will optimize therapy, and indeed will be indispensable for individual cancer therapy. The resistance assays available for use in clinical practice should be integrated into cancer therapy. Research into this neglected area needs to be intensified.

Hintergrund und Methode Im Rahmen der Datenerhebung der prospektiv-multizentrischen Beobachtungsstudie zur operativen Therapie des Magenkarzinoms „Ostdeutsche Magenkarzinomstudie 2002 (EGGCS)“ wurde die Situation der chirurgischen Palliation beim Magenkarzinom im Erfassungszeitraum 01.01. bis 31.12.2002 analysiert.

Drug resistance is the main cause of the failure of chemotherapy of malignant tumors, resistance being either preexisting (intrinsic resistance) or induced by the drugs (acquired resistance). At present, resistance is usually diagnosed during treatment after a long period of drug administration. In the present paper, methods for a rapid assessment of drug resistance are described. Three main classes of test procedures can be found in the literature, i.e. fresh tumor cell culture tests, cancer biomarker tests and positron emission tomography (PET) tests. The methods are based on the evaluation of molecular processes, i.e. metabolic activities of cancer cells. Drug resistance can be diagnosed before treatment in-vitro with fresh tumor cell culture tests, and after a short time of treatment in-vivo with PET tests. Cancer biomarker tests, for which great potential has been predicted, are largely still in the development stage. Individual resistance surveillance with tests delivering rapid results signifies progress in cancer therapy management, by providing the possibility to avoid drug therapies that are ineffective and only harmful.

Postoperative Wundinfektionen sind nach Pneumonien und Harnwegsinfektionen die dritthaufigste nosokomiale Infektionsart in deutschen Akutkrankenhausern. Sie fuhren zu gesteigerter Morbiditat und Letalitat, verlangertem Krankenhausaufenthalt und hoheren Behandlungskosten. Zu den wichtigsten Risikofaktoren zahlen der mikrobiologische Befund im Bereich der Hautinzision, eine nichtfristgerechte Antibiotikaprophylaxe, die Dauer der Operation, der Notfalleingriff, ein schlecht oder nichteingestellter Diabetes mellitus, maligne Grunderkrankung, chronischer Tabakabusus und hohes Lebensalter. Anasthesiologische Masnahmen zur Vermeidung von Wundinfektionen umfassen die Aufrechterhaltung von Normothermie, eine adaquate Infusionstherapie, die strenge Indikationsstellung fur allogene Bluttransfusionen und die rechtzeitige Antibiotikaprophylaxe. Die Blutglucosekonzentration sollte postoperativ im Bereich von 8,3–10 mmol/l (150–180 mg/dl) gehalten werden; niedrigere Werte sind mit einer erhohten Komplikationsrate assoziiert. Die intra- und postoperative Hyperoxie mit 80%igem Sauerstoff hat sich nicht als wirksam zur Verhinderung von Wundinfektionen erwiesen. Eine Infiltration des Wundgebiets mit Lokalanasthetika zur postoperativen Schmerztherapie beeintrachtigt die Wundheilung nicht.

Ein seit Jahren alkoholabhangiger Patient wurde mit den Zeichen einer Sepsis aus einem Krankenhaus der Regelversorgung in das Universitatsklinikum Magdeburg verlegt. Die Ursache war ein zuvor erfolglos konservativ behandelter, akuter Schub einer chronischen Pankreatitis. Die Computertomographie von Hals, Thorax und Abdomen zeigte abszessverdachtige Areale, welche kontinuierlich vom Abdomen bis in den Parapharyngealraum reichten. Bei der interdisziplinaren Notoperation wurden Hals, Mediastinum und Abdomen drainiert. Unter Antibiose und parenteraler Ernahrung kam es zur Genesung.

It is well established that estrogens and progestogens are able to influence the vasotonus in postmenopausal women. The present study was undertaken to find out if the NO/cGMP-system is involved in this hormone action. Urinary cGMP excretion which can reflect intracellular cGMP production elicited by NO (EDRF) was investigated in 20 postmenopausal women. In an open cross-over study design norethisterone acetate was administered orally for 8 days, estradiol valerate orally for 9 days and a combination of both substances for 12 days. After all three treatment phases urinary cGMP expressed as percentage of the pretreatment value was increased at a statistically significant level. Due to high individual variations no significant differences could be found among the values after the three treatment phases. It was concluded that the NO/cGMP-system may play a role in maintaining vasotonus in postmenopausal women under hormone replacement therapy.

History and clinical findings The histological investigation of a surgical specimen (after cholecystectomy) from a 73-year-old woman revealed a poorly differentiated carcinoma with glandular structures and a lymph node metastasis. Investigations Comparative immunochemistry, done to exclude metastatic growth of the previously demonstrated endometrioid ovarian carcinoma, was (1) negative for CK7 and CA125, positive for CK20, chromogranin A and synaptophysin (gall bladder and lymph node metastasis); (2) positive for CK7 and CA125, negative for CK20, chromogranin A and synaptophysin (ovary). Diagnosis The tumor lesion within the gall bladder and lymph node was classified as a neuroendocrine carcinoma, not a metastasis of the ovarian carcinoma. Treatment and clinical course The patient underwent another laparotomy with resection of the stump of the cystic duct and the liver parenchyma surrounding the former gall bladder, including dissection of the lymph nodes within the hepatoduodenal ligament. After 14 months another metastasis of the neuroendocrine carcinoma of the gall bladder was found. But for eight years there has been no recurrence of the endometrioid adenocarcinoma of the left ovary. Conclusion Because of the increasing incidence of malignant diseases and second neoplasms there is a growing need for such diagnostic tests as histological and immunohistochemical analysis. This is the first case, according to the available literature, of an endometrioid adenocarcinoma of the ovary concomitant with a neuroendocrine carcinoma of the gall bladder.

High temperature PEMFCs based on phosphoric acid-doped ABPBI membranes have been prepared and characterised. At 160 °C and ambient pressure fuel cell power densities of 300 mW cm–2 (with hydrogen and air as reactants) and 180 mW cm–2 (with simulated diesel reformate/air) have been achieved. The durability of these membrane electrode assemblies (MEAs) in the hydrogen/air mode of operation at different working conditions has been measured electrochemically and has been correlated to the cell resistivity, the phosphoric acid loss rate and the catalyst particle size. Under stationary conditions, a voltage loss of only –25 μV h–1 at a current density of 200 mA cm–2 has been deduced from a 1,000 h test. Under dynamic load changes or during start–stop cycling the degradation rate was significantly higher. Leaching of phosphoric acid from the cell was found to be very small and is not the main reason for the performance loss. Instead an important increase in the catalyst particle size was observed to occur during two long-term experiments. At high gas flows of hydrogen and air ABPBI-based MEAs can be operated at temperatures below 100 °C for several hours without a significant irreversible loss of cell performance and with only very little acid leaching.

Die sich mit dem wissenschaftlichen Erkenntniszuwachs und den gesellschaftlichen Rahmenbedingungen standig wandelnden Voraussetzungen fur medizinische Behandlungsablaufe haben in den letzen Jahren das Interesse an der Ergebnisqualitat dieser Prozesse unter klinischen Alltagsbedingungen verstarkt. Im Hinblick auf die Entwicklung der chirurgischen Therapie des Magenkarzinoms liegen in Deutschland zwei prospektive multizentrische Beobachtungsstudien vor, die Deutsche Magenkarzinomstudie (GGCS ’92) und die Qualitatssicherungsstudie der Ostdeutschen Arbeitsgruppe fur Qualitatssicherung und regionale Entwicklung in der Chirurgie e.V. (EGGCS ’02). Aufgrund des Studiendesigns sind die beiden Untersuchungen gut vergleichbar. Insgesamt konnte im Vergleich mit der GGCS ‘92 eine Verbesserung der peri- und fruhpostoperativen Behandlungsqualitat des Magenkarzinoms in den zwischen den Studien liegenden 12 Jahren konstatiert werden. Die onkologischen Langzeitergebnisse sind jedoch fur das gesamte Patientenkollektiv mit einer Funfjahresuberlebenswahrscheinlichkeit von ca. 40% nach wie vor unbefriedigend. In den letzten Jahren hat sich zunehmend die Erkenntnis durchgesetzt, dass auch beim Magenkarzinom eine multimodale Therapie ein Weg zur Verbesserung dieser Resultate sein kann. Diese Entwicklungen waren der Anlass, die neue Qualitatssicherungsstudie fur Magenkarzinome zu initiieren. Bei der Uberarbeitung der Erfassungsbogen wurde besonderer Wert auf die gegenuber 2002 detaillierte Erfassung der multimodalen Therapiekonzepte gelegt. Mit Hilfe der im Januar 2007 beschlossenen Unterstutzung der Studie durch den Konvent der leitenden Krankenhauschirurgen sollte ein hoher Erfassungsgrad der bundesweit behandelten Magenkarzinome moglich sein.

500 radius segments of a certain length of the corpses of 6 female and 36 male persons (medium age: 54.4 years) were chosen to determine the fracture load and the ultimate breaking stress by means of a machine testing the pressure power in a compression test. The mean fracture load is 7371 N and the average ultimate breaking stress 38 MPa. Fracture load and ultimate breaking stress of preserved specimens are significant higher than those of non preserved specimens. The bone, therefore, becomes more fragile by the preservation. Fracture load and ultimate breaking stress decrease distinctly with advancing years. The ends of the radii are clearly less capable of being strained than the middle parts of the shafts. The fracture load of the radius increases with the total length. Language: de

64 non preserved and 35 preserved clavicles were fractured in three defined positions in a bending test by a tension testing machine with electronic measurement of force. 30 non preserved bones were fractured in an axial infraction test. Force-deflection-diagrams were registered, and the values of maximum load, breaking load, ultimate deflection and energy were correlated to cross section and thickness of compacta. The significantly greater non preserved male clavicles are loadable at a higher level (medium breaking load about 1200 N) than female bones (medium breaking load abut 800 N). The breaking energy of the more flexible female clavicles is about 30% lower than those of males whereas elastic modulus of female clavicles is significant greater. Preservation has a significant influence on biomechanical properties of bones: ultimate deflection decreases; breaking energy, ultimate stress and elastic modulus increase. Breaking load is greatest in the middle portion of the clavicle, while deflection is greatest in the sternal portion. Removal of periosteum causes lower breaking load, deflection, ultimate stress and elastic modulus as well. With axial load clavicle fractures occur most frequently between middle and sternal third.

In order to investigate whether a relationship exists between in vivo insulin secretion and islet mass, 8 patients suffering from severe chronic relapsing pancreatitis were studied before and after pancreatectomy by glucose-glucagon-test (per os 1.75 g glucose; i.v. glucagon 0.01 mg/kg b.w.) and by intravenous glucose-tolerance-test (iGTT) (i.v. glucose 0.33 g/kg b.w.). Postoperative in vitro assessments of pancreatic insulin and alpha-amylase content were performed, and morphometric studies were carried out. Patients were characterized by reduced c-peptide secretion when compared with healthy subjects. The c-peptide response to the glucose-glucagon-test correlated well with the morphometrically estimated exocrine and islet tissue mass (P less than 0.05) and with the content of insulin and amylase in the tissue. The findings suggest that in subjects suffering from severe chronic relapsing pancreatitis the maximal insulin response might represent a parameter for the patient's islet mass.

The frequent resistance of malignant tumors to chemotherapy documents the fact that numerous patients are uselessly traumatized by highly toxic drugs. Investigations into this resistance have shown that many different mechanisms exist which can abolish the antitumor action of chemotherapeutics. So far, no safe method has been found to counteract this resistance. To date, the only way to avoid harm by an ineffective chemotherapeutic is to refrain from its use when resistance to it is detected. The present survey reports on the available assays that diagnose resistance reliably; sensitivity tests are excluded as being unreliable. Resistance assays are still not fully recognized in hospitals, despite the fact that they are able to optimize chemotherapy by eliminating treatment that is ineffective and merely harmful. Since the number of chemotherapeutics will increase enormously in the future, pharmacological cancer treatment cannot dispense with resistance assays.

INTRODUCTION: Aim of the study was to determine the epidemiology of sepsis in an university surgical intensive care unit. We were mainly interested in getting information about incidence, reason and clinical course of peritonitis. The results should give more information about diagnostic and therapy of sepsis in the surgical intensive care. METHODS: We analyzed our 2 676 ICU-patients from 2000 to 2002 with infection as main diagnosis. By means of medical report we analyzed the kind of infection and the clinical course of 561 (21 %) patients. For 356 (13.3 %) patients with peritonitis we observed the kind, the reason and the severity of infection and further the special events in the clinical course. RESULTS: The incidence of severe sepsis was 14.8 %. With 63 % the peritonitis is the main infectiological diagnosis on admission to ICU. 33.8 % of infections are hospital acquired. 71.3 % of patients with peritonitis developed a severe sepsis or septic shock during the clinical course. On average 4.7 further abdominal surgical interventions and 5.1 new occurring nosocomial infections marked a difficult surgical and infectious treatment course. Hospital acquired infections (70 %), high value of scoring and inadequate surgical treatment (23.7 %) have proved to be a good prognostic instrument for the development of tertiary peritonitis. With a share of 17 % from patients with peritonitis and a mortality of 35 % they have a strong influence on the ICU-mortality. CONCLUSION: Peritonitis is the main reason of severe sepsis on the surgical ICU. Hospital aquired infections especially the tertiary peritonitis have the highest mortality. High mortality is the consequence from the large number of difficult clinical courses and high rates of severe sepsis and septic shock. “Second hits” play a crucial role for the therapy and the prognosis of these patients. To decline the mortality future studies must more consider the problem of hospital acquired and tertiary abdominal infections.

The effect of treating mammary tumor-bearing rats with 2-methoxyestradiol (2-MeE2) on the urinary excretion of 12 phytoestrogens was investigated and compared with the changes in urinary excretion of estradiol metabolites. Alterations of excretion were registered for isoflavonoids, lignans and coumestans. However, due to large variations statistical significant differences were found only for two lignans, i.e. significant increases of enterodiol and matairesinol. Since the single components of phytoestrogens showed diverse alterations, excretions were expressed also by the ratio of total isoflavonoids to total lignans and compared with the estrogen ratios 2-hydroxyestrone to 16α-hydroxyestrone and A-ring to D-ring metabolites. The ratio of isoflavonoids to lignans was consistently decreased, whereas both ratios of estradiol metabolites were highly increased. The latter effect is probably due to demethylation of 2-methoxyestrone resulting in high catechol estrogen levels in urine. These results suggest that the high levels of catechol estrogens, produced by 2-MeE2 treatment, may have influenced the urinary excretion pattern of phytoestrogens.

In Germany, data of cancer patients are recorded not only in epidemiological registers but also in clinical cancer registers. To ensure the networking of all included medical partners, quality control, and clinical research it is necessary that cancer cases are captured more or less completely. The aim of the present study was to compare the data sets of two registers.Data from patients with colorectal cancer from two large surgical clinics in Magdeburg are recorded in two registers - the Clinical Cancer Registry Magdeburg and the Institute of Quality Assurance in Operative Medicine at the Otto-von-Guericke University Magdeburg. Here we compared the data sets in order to check the completeness of data capturing and to determine factors influencing the degree of completeness.From all patients captured in the Institute of Quality Assurance, 78.9% are found also in the clinical cancer registry. The percentage improves over the course of time, but also depends on diagnostic criteria such as the staging. There are some differences between both registries, explainable by their specific objectives. Particularly, it is demonstrated that incomplete follow-up record may bias estimates of survival rates from registries.Ensuring the completeness and correctness of data is a major challenge for cancer registries. It has distinct influence on estimated quality parameters such as survival rates.