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Background and importance Allergies should be visible on all patient specific pages or screens of the electronic medical record in the hospital information system. The computerised physician order entry system must have a tiered severity rating for allergies based on the patient’s reaction to the drug. Limiting alert fatigue from drug intolerances that are not true allergies and providing clear warnings to staff during medication order entry is crucial for a clinical decision support system (CDSS). Aim and objectives This study analysed the current practice of documentation of information associated with allergic or idiosyncratic adverse drug reactions (ADRs) in patients admitted to the department of dermatology in order to improve documentation of allergy information and establish a CDSS. The secondary objective was to examine the adherence of follow-up appointments for verification of potential ADRs to improve organisational procedures. Material and methods Medical reports and entries from patients admitted to the department of dermatology over 4 years due to an ADR were retrospectively reviewed. 611 were considered eligible. A subpopulation of 190 ADR related cases was reviewed to examine adherence to follow-up appointments. Results In 23.2% (n=142) of patients, the documentation was incomplete: in 1.6% (n=10) the tested alternative drug was not entered, in 5.6% (n=34) the verified allergy/intolerance was not documented and in 16% (n=98) both were missing. In 28.8% (n=90), when patients got a permanent allergy pass a corresponding entry was made with the brand name and not with the international non-proprietary name. In 53 (27.9%) of 190 cases, patients with follow-up appointment recommendations did not keep their appointment at the department of dermatology’s outpatient clinic to verify the concern. If patients had to arrange the appointment on their own (n=51), 49.0% (n=25) did not keep their appointment. Only patients with follow-up in the allergy unit of the department were documented completely in the drug allergy/intolerance field. Conclusion and relevance Any patient’s allergy information entered into the information technology system must be accurate to allow for clinical decision support screening. Both potential and verified ADRs should be documented, but they must be clearly distinguishable. Fixed appointments improve adherence of follow-up appointments for verification of potential ADRs. References and/or acknowledgements Conflict of interest No conflict of interest

Background and importance We present the case of a young patient with T lymphoblastic lymphoma (T-LBL) who developed severe toxicity after receiving an anthracycline based protocol that is generally well tolerated by healthy patients. We assume that the substitution of daunorubicin by doxorubicin due to a nationwide shortage of daunorubicin played a crucial role in developing severe toxicity. Aim and objectives The 19-year-old man with no previous illnesses was diagnosed in December 2019 with T-LBL, a rare, aggressive neoplasm of precursor T cells that progresses rapidly and requires prompt diagnosis and medical intervention. T-LBL shows morphological and immunophenotypical similarities to acute lymphoblastic leukaemia (ALL). T-LBL treatment is the same as for ALL. Material and methods The induction protocol consisted of dexamethasone, vincristine, daunorubicin and pegasparaginase. Due to a nationwide shortage, daunorubicin (30 mg/m²) was substituted by doxorubicin (25 mg/m²). Results Chemotherapy was initially well tolerated, but beginning on day 15, the patient developed pronounced mucositis and increased skin toxicity (hand–foot syndrome, grade IV). Moreover, coagulation parameters deteriorated, and repeated transfusions with erythrocytes and platelet concentrates were needed. After administration of pegasparaginase on day 31, liver values increased, and finally, the patient had to be transferred to the intensive care unit due to fulminant pancreatitis. After 3 days, the patient could be transferred back to our ward. However, within 2 weeks, the patient developed sensory disturbances in all extremities, which was classified as chemotherapy associated polyneuropathy. In the further clinical course, the patient‘s general condition improved, and PET-CT showed complete metabolic remission. Due to the severe chemotherapy associated side effects, intensive consolidation treatment, according to the protocol, was cancelled. Instead, a consolidating therapy with nelarabine was carried out without complications. To date (October 2020), the patient is in a good clinical condition and has not developed disease recurrence. Probability assessment using the Naranjo algorithm resulted in ‘probable adverse drug reaction’ (score=6). Conclusion and relevance Our case report underlines the fact that shortages of essential anticancer drugs can have a particular impact on the efficacy and safety of established chemotherapy regimens, as these medicines often have few or no proven effective alternatives. References and/or acknowledgements Patel S, et al. A single-centre experience of the nationwide daunorubicin shortage: substitution with doxorubicin in adult acute lymphoblastic leukaemia. Leuk Lymphoma 2013;54:2231–5. Conflict of interest No conflict of interest

Kurzfassung Mithilfe des Umformverfahrens Gleitziehbiegen lässt sich eine sehr große Bandbreite von Profilbauteilen mit variablen Querschnitten unter Nutzung einer Umformanlage und eines Werkzeugsatzes herstellen. Eine lokale Wärmebehandlung kann bei gleichbleibendem Bauteilgewicht zu einer partiellen Erhöhung der Festigkeit in den entsprechenden Bauteilbereichen genutzt werden. Im Rahmen dieser Untersuchungen wird die prinzipielle Machbarkeit der Festigkeitssteigerung von Profilen experimentell und numerisch aufgezeigt. Nach der simulationsgestützten Auslegung des Gleitziehbiegeprozesses mit einer integrierten Wärmebehandlung wird die Versuchseinrichtung vorgestellt. Mithilfe der Finite-Element (FE)-Berechnungen des gesamten Verfahrensablaufs konnten Informationen bezüglich der Prozessparameter und geeigneter Erwärm- und Abkühlstrategien geliefert werden. Diese wurden in der Auslegungs- und Konstruktionsphase des Versuchsaufbaus genutzt. Abschließend wurde der numerisch ausgelegte Prozess umgesetzt und so die Ergebnisse der Simulation validiert.

Pathogen infection can induce plant volatile organic compounds (VOCs). We infected ‘McNeal’ wheat and ‘Harrington’ barley with a Fusarium spp. blend (F. graminearum, F. avenaceum and F. culmorum). Both cereals had the greatest VOC induction 14 days after pathogen innoculation, only slightly lower induction occurred at 7 days, but displayed no induction at 1 days. The induced VOC bouquet for both cereals included six green leaf volatiles (GLVs; e.g. (Z)-3-hexenol and (Z)-3-hexenyl acetate), four terpenes (linalool, linalool oxide, (Z)-b-ocimene and (E)-b-caryophyllene) and benzyl acetate. Neighbouring, uninfected individuals of both cereals had significant VOC induction when exposed to an infected, conspecific plant. The temporal pattern and VOC blend were qualitatively similar to infected plants but with quantitative reductions for all induced VOCs. The degree of neighbouring, uninfected plant induction was negatively related to distance from an infected plant. Plant VOC induction in response to pathogen infection potentially influences herbivore attraction or repellency. Y-tube tests showed that herbivorous female and male Oulema cyanella Voet. (Chrysomelidae: Coleoptera) were significantly attracted to (Z)-3-hexenal and (Z)-3-hexenyl acetate at 300 and 1500 ng/h but were repelled by both GLVs as well as (Z)-b-ocimene and linalool at 7500 ng/h. These O. cyanella behavioural responses were significantly at higher concentrations than those emitted by single plants with pathogen-induced VOCs, so adults might only be able to respond to a dense group of infected plants. Also, O. cyanella dose responses differ from the previously tested congeneric O. melanopus (cereal leaf beetle), which was attracted to three VOCs induced by Fusarium infection of maize, barley and wheat. Future behavioural tests may indicate whether different herbivore dose responses measured with each VOC singly can help to predict attraction or repellency to injured and uninjured VOC bouquets from different host plant species.

A new approach to the interconnect-driven floorplanning problem integrates bus planning and is intended for bus-based designs where each bus consists of a large number of wires. The floorplanner optimizes the timing and ensures routability by generating the exact location and shape of interconnects above and between the circuit blocks. Experiments with Microelectronics Center of North Carolina benchmarks clearly show the advantage of integrated floorplanning over the classical floorplan-analysis-and-then-refloorplan approach. Our floorplans are routable, meet all timing constraints, and are on average 12%-13% smaller in area as compared to traditional floorplanning algorithms.

Familial Mediterranean fever (FMF) is one of the most common autoinflammatory diseases (AID). A variety of relevant mutations in the MEFV gene have been demonstrated. Pro-inflammatory S100 proteins correlate with disease activity in autoinflammatory disorders, and have been previously correlated with clinically active FMF. Here, we describe the association between these biomarkers and stable FMF including different mutations, as recorded in the German AID-Net-registry.

Familial Mediterranean fever (FMF) is one the most common autoinflammatory disease (AID). Pathogenomic relevant mutations in the MEFV gene show autosomal recessive inheritance, but co-dominant mutations have been described.

A novel scintillating fiber hodoscope in helically cylindric geometry has been developed for detection of low multiplicity events of fast protons and other light charged particles in the internal target experiment EDDA at the Cooler Synchrotron COSY. The hodoscope consists of 640 scintillating fibers (2.5 mm diameter), arranged in four layers surrounding the COSY beam pipe. The fibers are helically wound in opposing directions and read out individually using 16-channel photomultipliers connected to a modified commercial encoding system. The detector covers an angular range of 9°⩽ Θ ⩽72° and 0°⩽ ϕ ⩽360° in the lab frame. The detector length is 590 mm, the inner diameter 161 mm. Geometry and granularity of the hodoscope afford a position resolution of about 1.3 mm. The detector design took into consideration a maximum of reliability and a minimum of maintenance. An LED array may be used for monitoring purposes.

Excitation functions of proton-proton elastic scattering cross sections have been measured in narrow steps for projectile momenta p{sub p} (energies T{sub p}) from 1100 to 3300MeV/c (500 to 2500MeV) in the angular range 35{degree}{le}{Theta}{sub c.m.}{le}90{degree} with a detector providing {Delta}{Theta}{sub c.m.}{approx}1.4{degree} resolution. Measurements have been performed continuously during projectile acceleration in the cooler synchrotron COSY with an internal CH{sub 2} fiber target, taking particular care to monitor luminosity as a function of T{sub p}. The advantages of this experimental technique are demonstrated, and the excitation functions obtained are compared to existing cross section data. No evidence for narrow structures was found. {copyright} {ital 1997} {ital The American Physical Society}

Familial Mediterranean fever (FMF) is the most inherited common autoinflammatory disease (AID) with mutations in the MEFV (MEditerraneanFeVer) gene. The Mor- and Pras-Score modified for children and C-reactive protein (CRP) were used to assess FMF disease severity in Germany. We evaluate the applicability of the 2 severity scores and the correlations between ethnic origin, phenotype, and genotype. Among 242 children (median 5 age at diagnosis), we detected 431 pyrin mutations and 22 different sequence variants, including one new mutation (p.Gly488Asp). The 5 most ­frequent alterations were p.Met694Val (55.2%), p.Met680lle (11.8%), p.Val726Ala (10%), p.Glu148Gln (7.9%) and p.Met694IIe (2.3%). The prevailing ancestries of 223 cases were Turkish (82.5%) and Lebanese (8.1%). Homozygous p.Met694Val substitution (30.2%) was associated with a more severe disease activity by Mor-Score, as well as with a higher mean CRP (74 mg/l) compared to patients with other mutations. Indeed, Mor- and Pras-Score were inconsistent with each other. A typical distribution of mutations in different ethnic populations was obvious, but not statistically verifiable due to the low number of cases. The homozygous p.Met694Val substitution was associated with a more severe disease activity in our German cohort. The common severity scores were inconsistent in ­children.

Identifying the presence of axillary node and internal mammary node metastases in patients with invasive breast cancer is critical for determining prognosis and for deciding on appropriate treatment. Sentinel lymph node biopsy (SLNB) is the definitive method to exclude axillary metastases. Patients with positive SLNB results generally undergo axillary lymph node dissection (ALND). The benefit of preoperative identification of axillary metastases is that it allows the surgeon to proceed directly to ALND and to avoid an unnecessary SLNB and the need for a second surgical procedure involving the axillary nodes. Knowledge of the important anatomic landmarks of the axilla is important in finding and accurately reporting suspicious lymph nodes. The pathologic features of nodal metastases illuminate the imaging appearances of these nodes, as depicted with all modalities. Ultrasonography (US) is the primary imaging modality for evaluating axillary nodes. Morphologic criteria, such as cortical thickening, hilar effacement, and nonhilar cortical blood flow, are more important than size criteria in the identification of metastases. US-guided lymph node sampling, especially with core biopsy, is invaluable in confirming the presence of a metastasis in a suspicious node. Core biopsy has been shown to be equal in safety to fine needle aspiration and has a significantly lower false-negative rate. Magnetic resonance imaging is also useful, with the added benefit of providing a global view of both axillae. Computed tomography and radionuclide imaging play a lesser role in imaging the axilla. Preoperative image-based identification and sampling of abnormal lymph nodes that have a high positive predictive value for metastases is an extremely important component in the management of patients with invasive breast cancer.

Modern resilient security systems require a hard to clone physical module integrated in core system units as basic security anchors. Physical Unclonable Functions (PUFs) were introduced in the last decade as possible physical unclonable security anchors. So far, PUFs as analog units exhibited relative inconsistency due to variations in the operating conditions such as temperature, supply voltage, aging and other possible environmental effects. This lead to relatively high unit's implementation complexity. This work introduces a consistent pure-digital PUF concept. The proposed digital PUF is a combined Hardware-Software (HW-SW) module, embedded in a System-on-Chip (SoC) device. The key idea is based on triggering an internal true random process, which creates a hard to predict combined digital HW-SW module. Modern Field Programmable Gate Array (FPGA) SoC-devices often incorporate embedded processors in addition to self-reconfiguring hardware cell-arrays. Such combined self-reconfiguring HW-SW architectures allow practical self-creation of clone-resistant digital PUF modules. As pure-digital units, they exhibit negligible sensitivity to both operation conditions and aging factors. We postulate that self-creation of pure-hardware architectures is highly complex in self-reconfiguring FPGA environment. Therefore a combination of both hardware and software is expected to allow more sophisticated and secure functions with higher robustness against Side Channel Attacks (SCAs). It is assumed that any system is basically clonable, if sufficient financial and technical investments are offered. In the proposed concept, each created digital PUF results with its own unknown and hard to predict individual structure. Therefore, to clone any single digital PUF, an individual attack procedure is needed. In that case, mass-cloning tends to become impractical. As a result, cloning attacks on the proposed system are not economic and hence practically useless. The resulting proposed system, when adequately implemented, offers a practical low-cost security anchor for a large class of modern applications.

Scintillating fibers of type Bicron BCF-12 with 2 × 2 mm2 cross section, up to 600 mm length, and PMMA cladding have been tested, in conjunction with the multi-channel photomultiplier Hamamatsu R 4760, with minimum ionizing electrons. The impact of cladding, extramural absorbers and/or wrapping on the light attenuation and photoelectron yield is studied in detail. Fibers have been circularly bent with radii of 171 mm and arranged in two layers to bundles forming granulated scintillator rings. Their performance in the EDDA experiment at COSY for detection of high energy protons revealed typically more than 9 (6) photoelectrons per fiber from bundles with (without) mirror on the rear side, guaranteeing detection efficiencies >99% and full compatibility with corresponding solid scintillator rings. The time resolution of 3.4 ns FWHM per fiber read out is essentially due to the R 4760.

Objective—To estimate likelihood ratios (LRs) of correctly identifying internal Corynebacterium pseudotuberculosis infection in horses by measurement of antibody titers via serum synergistic hemolysis inhibition (SHI) testing. Design—Retrospective case-control study. Animals—170 horses (171 records; 92 cases of C pseudotuberculosis infection and 79 controls). Procedures—Medical records were reviewed, and horses were grouped on the basis of evidence of internal or external C pseudotuberculosis infection. The LRs and 95% confidence intervals for identification of internal C pseudotuberculosis infection by use of SHI test results were estimated. Results—LRs for C pseudotuberculosis infection increased as antibody titers increased when all horses were included in analyses; LRs for detecting internal infection were significantly > 1 (null value) for reciprocal antibody titers ≥ 1,280 overall and > 160 when horses with external abscesses were excluded. Likelihood ratios for detecting internal infection did not differ from 1 (indicating no change in pretest-to-posttest odds of internal infection) when only horses with external C pseudotuberculosis infection (horses with external and internal abscesses vs those with external abscesses only) were included. The LR for detecting internal infection was 2.98 (95% confidence interval, 2.19 to 4.05) for horses with titers ≥ 512. Conclusions and Clinical Relevance—In the study population, higher titers were typically more indicative of active external or internal C pseudotuberculosis infection than of internal disease specifically. The SHI test was not a useful predictor of internal C pseudotuberculosis infection in horses with external abscesses but was useful in the absence of external disease.

Porous Silicon as regular nanostructured material is used for an electrochemical preparation of different binary and ternary nanostructured compound systems. The nanostructured films are analysed by means of XPS and sputter depth profiling.

The electroless and cathodic electrodeposition of metals (Au, Cu, Ni) into porous silicon (PS) is studied. The electrochemically modified PS layers are analysed by X-ray photoelectron spectroscopy and sputter depth profiling. The electroless deposition oxidizes PS simultaneously. For this reaction a new concept of injection current multiplication is proposed. After cathodic metal deposition the pores are filled with metal quantitatively without oxidation of PS.

Osteoporosis is very common in elderly patients. Despite the severe health-related consequences for individual patients and the socioeconomic costs caused by osteoporotic fractures, treatment rates are still low. Due to drug interactions and patient compliance, polypharmacy is often mentioned as a reason for undertreatment. Several drugs have a direct or indirect effect on bone metabolism. The present paper discusses the risk of interactions of anti-osteoporotic drugs (oral and parenteral bisphosphonates, raloxifene, strontium ranelate, teriparatide, and denosumab) with other common medications in elderly patients and their impact on bone metabolism and fracture risk. In summary, the number and risk of drug interactions of all common anti-osteoporotic drugs are small and clinically rather irrelevant. However, patients with a polypharmacy are at a higher risk of fractures and should receive osteoporosis treatment, if indicated.

The anodic oxidation of silicon in a 0.04 N solution of potassium nitrate in ethylene glycol with small amounts of water is a hole consuming process. Therefore, n-type silicon, anodically biased, behaves in the dark in many respects as a reverse biased diode. Under steady-state conditions a certain, in general a very low electrochemical reaction rate is established. If the sample is locally implanted with ions or locally illuminated the ion implanted or illuminated regions can serve as an additional source of minority carriers and show a faster oxidation rate than the nonimplanted or nonilluminated areas. The influence of radiation damage as well as of a focused laser beam (radius 4 μm) on the local oxidation of anodically biased n-type silicon is discussed. The electrophysical properties of the silicon/anodic oxide interface are investigated by forming Metal/Oxide/Semiconductor (MOS) structures.

The oxidation behaviour of porous Si films formed on p-type doped substrates has been investigated. On freshly prepared porous Si no oxygen is found. During the native oxidation suboxides are formed. For low p-doped samples SiO 2 is formed after 1000 h, whereas on highly doped samples only Si 2 O is found. Part of the difference between low and high doped substrates is probably due to different orientations of the inner surfaces. It seems that the orientation of the inner surfaces of porous Si films formed on p + -doped substrates is more preferentially (111) than it is the case for the lower doped samples. For the anodic oxidation process also suboxide formation is found which results in the formation of SiO 2 .

with care needs Martina Jeskea, Michael Joannidisb, Rafaella Matteucci Gothea, Oliver Galvanc, Hans-Christian Jesked and Johann Michael Hackla a Unit for Medical Basics and Nutritional Sciences, University for Health Sciences, Medical Informatics and Technology UMIT, Hall, Austria b Department of General Internal Medicine, ICU, Innsbruck Medical University, Innsbruck, Austria c Department of Otorhinolaryngology, Innsbruck University Hospital, Innsbruck, Austria d Department of Traumatology and Sports Medicine, Innsbruck Medical University, Innsbruck, Austria

Background Familial Mediterranean Fever (FMF) is an autoinflammatory disorder associated with MEFV pyrin-encoding gene mutations. S100A12 is a pro-inflammatory “damage associated molecular pattern” molecule and is strongly elevated in active FMF Objectives To investigate the association between genotype and S100A12 secretion in clinically active, inactive and subclinical disease in vitro and ex vivo . Methods Serum S100A12 concentration was retrospectively analysed for 125 patients in the German Auto-Inflammatory Diseases Network (AID-Net) Registry according to disease activity and genotype. In vitro , secretion of S100A12, IL-18, IL-1beta and caspase-1 was measured after stimulation of neutrophils from six M694V -positive patients and four healthy controls (HC). Results S100A12 hypersecretion correlated significantly with clinical disease activity and also with genotype in a “gene-dosing” way, being highest in homozygotes > compound heterozygotes > heterozygotes. M694V -positive heterozygous, compound heterozygous or homozygous patients h had higher S100A12 concentration during inactive and subclinical disease than M694V- negative heterozygous, compound heterozygous or homozygous patients respectively. In vitro , unstimulated neutrophils from M694V -positive patient spontaneously secreted higher S100A12, IL-8 and caspase-1 compared to healthy controls. Colchicine significantly inhibited secretion of S100A12 from stimulated and unstimulated patient neutrophils. Conclusions FMF phenotype is known to be more severe in patients with M694V mutations. We describe for the first time a biomarker that correlates with clinical disease activity and FMF genotype both ex vivo and in vitro , which has implications for clinical management. References Wittkowski H. et al. Pediatr Rheumatol 2008. Kallinich T. et al. ARD 2010. Jeske M et al. Klin Padiatrie 2013. Disclosure of Interest None declared

We propose a frequency-dependent sensitivity model for analog blocks and a noise injection model for digital blocks in application to early design planning of mixed-signal system-on-chips (MS-SOCs). We assume no precise layout information about IP cores is available. We also propose an empirical formula for separation-dependent coupling between large-area noisy ports and small-area sensitive ports for lightly-doped substrates that are preferred for mixed-signal circuits. The interaction between digital and analog blocks is incorporated into our floorplanner, which reduces the overall noise and the number of analog blocks with noise limit violations. Experimental results on examples created from MCNC floorplanning benchmarks are very encouraging.

We propose a new approach to substrate noise reduction in early design planning of mixed-signal system-on-chip (MS-SOC). As typical in floorplanning, we assume that no detailed layout information is known for analog and digital blocks. Based on the physics of substrate noise phenomena and extensive noise simulations we propose to represent noise coupling as coupling between large-area (digital) and small-area (analog) substrate noise ports. A separation-dependent noise model for a lightly-doped substrate (preferable for mixed-signal designs) is derived. Our floorplanner reduces the overall noise and the number of analog blocks exceeding their noise limit. Experimental results on examples created from MCNC floorplanning benchmarks are very encouraging.

To reduce substrate-coupling noise in mixed-signal SOCs, we propose a new floorplanning method that considers substrate-coupling noise and adjusts placement of digital and analog blocks to reduce the influence of digital switching on the performance of sensitive analog circuits. A simple model of the influence of distance between blocks on distortion is used to compute a distortion number for a layout. As a result of noise optimization during floorplanning, the distortion numbers for MCNC benchmark-based circuits are significantly reduced compared to floorplans generated without optimizing for noise. Experimental results are very encouraging.

In this paper, we present new methods to improve the performance of sequence-pair-based floorplanning algorithms for SOCs (system-on-chip) and microprocessors. Edge pruning and more accurate initial value settings significantly reduce CPU time for soft-module floorplanning of large numbers of modules using Lagrangian relaxation (LR). A floor planner, ELF-SP, which implements these methods, runs faster than published approaches, and produces better or comparable floorplans.

Approaches to computer-controlled experimentation environments used in engineering education are discussed and analyzed. Problems with developing fully integrated user friendly systems are presented and future directions are proposed.

The widespread utilization of screening mammography has produced a shift in the stage of breast cancer at diagnosis in the US: Currently, 12% to 15% of newly diagnosed breast cancer cases annually are ductal carcinoma in-situ (DCIS). The diagnosis is made, in at least 90% of patients, with mammography. Only about 10% of patients will have a palpable mass. The accurate characterization and visualization of calcifications typically requires magnification of mammographic imaging. The morphology of the calcifications is generally considered to be the most important factor in differentiating benign from malignant formations. Round and uniform shapes are more likely to be benign, while linear and heterogeneous morphologies are associated with DCIS. Following a complete mammographic work-up, most suspicious lesions are potential candidates for a stereotactic core needle biopsy. Ten percent to 50% of patients initially diagnosed with atypical ductal hyperplasia by needle biopsy have subsequently been surgically diagnosed with cancer near the biopsy site. Due to this relatively high incidence of co-existent carcinoma, a needle biopsy diagnosis of atypical ductal hyperplasia necessitates subsequent surgical excision. The most important change in our thinking about DCIS was from a monolithic view, conceiving of DCIS as a single disease highly likely to invade if left untreated, to the realization that DCIS represents a non-obligate precursor with a variable risk of progression, depending on a combination of factors, such as histology, lesion, size, and margin status. In discussing treatment options, patients should understand that local recurrence following total mastectomy is rare and that this is the procedure of choice for disease that cannot be adequately encompassed with a breast-conserving approach. If the patient and her surgeon are in agreement about proceeding with a breast-conserving approach, there needs to be a clear understanding of the incidence and implications of local recurrence. In all such discussions with newly diagnosed patients, however, it is essential to emphasize the excellent prognosis with this disease, irrespective of the surgical approach.

Fatigue-type stress fractures occur following repetitive loading of normal bone. These occur frequently in the tibia, although vertical orientation to the fracture is much less common than transverse orientation. Without a convincing history of new or accelerated muscular activity, imaging can be difficult to interpret and evaluation may require more than one imaging modality to exclude other diagnostic considerations, including neoplasm and osteomyelitis.

Background Nonpalpable mammographic abnormalities are frequently evaluated by means of a stereotactic core needle biopsy. This technique is a very sensitive indicator of invasive cancer, but is less reliable to discriminate between ductal carcinoma in situ and atypical ductal hyperplasia (ADH). The objective of this study was to determine the correlation of the 11-gauge vacuum-assisted core needle biopsy to open biopsy when a diagnosis of ADH is obtained. Hypothesis The use of 11-gauge vacuum-assisted stereotactic core needle biopsy does not conclusively diagnose ADH. Design Retrospective analysis. Setting University-affiliated teaching hospital. Patients Mammographic findings were evaluated with an 11-gauge vacuum-assisted stereotactic core biopsy in 1750 patients. Seventy-seven patients were diagnosed as having ADH; of these, 65 underwent excisional biopsy. Main Outcome Measures Pathological upstaging rate. Results Of the 65 patients who underwent excisional breast biopsy, 11 (17%) had their condition upstaged to a breast cancer diagnosis. These patients had presented at a later age than those who retained a benign diagnosis after excisional biopsy. The number of cores taken did not correlate with diagnostic accuracy. Conclusions Of the 65 patients who underwent open biopsy for ADH in this series, only 83% had an accurate diagnosis. A diagnosis of ADH by stereotactic core needle biopsy should be followed by an open excisional biopsy.

Die Fertigungsgenauigkeit einer Werkzeugmaschine hangt weitgehend von der Gestaltung der Lagerung der Arbeitsspindel ab. Schnelllaufende Spindellager werden heute in zunehmendem Mase im Bereich der Schmierstoff-Unterversorgung betrieben, um das Reibmoment und damit die Lagertemperatur moglichst niedrig zu halten.