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A comparison between two inter-laminar stator core insulation failure detection techniques for generators based on low flux core excitation is presented in this paper. The two techniques under consideration are: 1) the iron core probe based method developed recently and 2) the existing air core probe based method. A qualitative comparison of the two techniques is presented along with an experimental comparison on a 120-MW generator stator core. The test results are compared in terms of fault detection sensitivity, signal to noise ratio, and ease of interpretation, which are the main requirements for stator core inspection. In addition to the comparison, the performance of the iron core probe technique for machines with short wedge depression depth is presented along with the recent improvements in the algorithm. It is shown that the main requirements for stator core inspection are significantly enhanced with the new iron core probe-based core fault detector. Index Terms--AC machines, inter-laminar insulation failure, regular maintenance, stator core fault, stator core inspection.

An advanced technique for detecting incipient interlaminar insulation failure in stator cores of large electric machines is proposed in this paper. The proposed scheme is an offline method based on low flux stator core excitation that employs a new probe. An iron-core probe is placed in the wedge depression area of the stator and scanned axially to detect the variation in the measured flux due to a fault. Two fault indicators that provide clear indication on fault severity and location are proposed in this paper. A 120-MW ac machine stator was tested under a number of intentionally inserted fault conditions using portable field equipment recently developed. The experimental results show that the fault existence, location, and severity can be determined reliably using the proposed scheme. It is also shown that the fault detection sensitivity and reliability, inspection speed, and user convenience are significantly enhanced. Index Terms--AC machines, fault diagnostics, inter-laminar insulation failure, regular maintenance, stator core fault, stator core inspection.

A comparison between two inter-laminar stator core insulation failure detection techniques for generators based on low flux core excitation is presented in this paper. The two techniques under consideration are: 1) the iron core probe based method developed recently and 2) the existing air core probe based method. A qualitative comparison of the two techniques is presented along with an experimental comparison on a 120-MW generator stator core. The test results are compared in terms of fault detection sensitivity, signal to noise ratio, and ease of interpretation, which are the main requirements for stator core inspection. In addition to the comparison, the performance of the iron core probe technique for machines with short wedge depression depth is presented along with the recent improvements in the algorithm. It is shown that the main requirements for stator core inspection are significantly enhanced with the new iron core probe-based core fault detector. [ABSTRACT FROM AUTHOR]

An advanced technique for detecting incipient interlaminar insulation failure in stator cores of large electric machines is proposed in this paper. The proposed scheme is an offline method based on low flux stator core excitation that employs a new probe. An iron-core probe is placed in the wedge depression area of the stator and scanned axially to detect the variation in the measured flux due to a fault. Two fault indicators that provide clear indication on fault severity and location are proposed in this paper. A 120-MW ac machine stator was tested under a number of intentionally inserted fault conditions using portable field equipment recently developed. The experimental results show that the fault existence, location, and severity can be determined reliably using the proposed scheme. It is also shown that the fault detection sensitivity and reliability, inspection speed, and user convenience are significantly enhanced. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease (COVID-19) vaccine-related side effects have a determinant role in the public decision regarding vaccination. Therefore, this study has been designed to actively monitor the safety and effectiveness of COVID-19 vaccines globally., Methods: A multi-country, three-phase study including a cross-sectional survey to test for the short-term side effects of COVID-19 vaccines among target population groups. In the second phase, we will monitor the booster doses' side effects, while in the third phase, the long-term safety and effectiveness will be investigated. A validated, self-administered questionnaire will be used to collect data from the target population; Results: The study protocol has been registered at ClinicalTrials.gov, with the identifier NCT04834869., Conclusions: CoVaST is the first independent study aiming to monitor the side effects of COVID-19 vaccines following booster doses, and the long-term safety and effectiveness of said vaccines.

Attention-deficit/hyperactivity disorder (ADHD) exerts lifelong impairment, including difficulty sustaining employment, poor credit, and suicide risk. To date, however, studies have assessed selected samples, often via self-report. Using mental health data from the entire Swedish population ( N = 11.55 million) and a random sample of credit data ( N = 189,267), we provide the first study of objective financial outcomes among adults with ADHD, including associations with suicide. Controlling for psychiatric comorbidities, substance use, education, and income, those with ADHD start adulthood with normal credit demand and default rates. However, in middle age, their default rates grow exponentially, yielding poor credit scores and diminished credit access despite high demand. Sympathomimetic prescriptions are unassociated with improved financial behaviors. Last, financial distress is associated with fourfold higher risk of suicide among those with ADHD. For men but not women with ADHD who suicide, outstanding debt increases in the 3 years prior. No such pattern exists for others who suicide., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Aims: The aim of this study is to assess the prevalence of non-opioid drug use among opioid-addicted, buprenorphine injecting individuals in Georgia, during and after a 12-week course of buprenorphine-naloxone (Suboxone®) or methadone., Methods: Randomized controlled trial with daily observed Suboxone® or methadone and weekly counseling, urine tests and timeline followback (TLFB) in weeks 0-12 and 20, and the Addiction Severity Index (ASI) at weeks 0, 4, 8, 12, 20., Results: Of the 80 patients (40/group, 4 women), 68 (85%) completed the 12-weeks of study treatment and 66 (82.5%) completed the 20-week follow-up. At baseline, injecting more than one drug in the last 30 days was reported by 68.4% of patients in the methadone and 72.5% in the Suboxone® groups. Drug use was markedly reduced in both treatment conditions but there were significant differences in the prevalence of specific drugs with more opioid (1.5 vs. 0.2%; p=0.03), less amphetamine (0.2 vs. 2.8%; p<0.001) and less marijuana (1.7 vs. 10.2%; p<0.001) positive urine tests in the methadone vs. Suboxone® groups. At the 20-week follow-up, TLFB results on the 34 that continued methadone or the 3 on Suboxone® showed less opioid (5.6 vs. 27.6%; p<0.001), illicit buprenorphine (2.7 vs. 13.8%; p=0.005), benzodiazepine (13.5 vs. 34.5%; p<0.001), and marijuana (2.8 vs. 20.7%; p<0.001) use than the 29 who did not continue opioid substitution therapy., Conclusions: Despite small but significant differences in opioid and other drug use, both treatments were highly effective in reducing opioid and non-opioid drug use., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This paper provides an overview on the status of antagonist models for treating patients with substance use disorders. It begins with an overview describing the ambivalence about stopping or not stopping substance use and how antagonist approaches, combined with psychosocial treatment, are aimed to address it. It then goes on to review data on disulfiram and acamprosate treatment of alcohol dependence and naltrexone treatment of opioid and alcohol dependence. The superior results achieved by extended release formulations are emphasized. The mixed findings on naltrexone treatment for amphetamine dependence are presented and the chapter ends with a brief review of vaccine development for treatment of substance use disorders. Overall conclusions are that the strongest treatment effects are with extended release naltrexone with opioid dependence. Disulfiram treatment of alcohol dependence also has strong effects but is not widely used due to low levels of patient acceptance and concerns about its potential for serious adverse events. Less robust but clinically meaningful effects are seen with naltrexone or acamprosate treatment of alcohol dependence. Vaccines are a very interesting and promising new development but many challenges and hurdles must be overcome before they are ready for clinical use.

Background: With up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine., Methods: Longitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV- opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks., Results: Fifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<0.0001), other opiates/analgesics (p<0.0001), and HIV risk behaviors (drug, sex, total; all p<0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake., Conclusions: Methadone maintenance was well accepted by HIV+ and HIV- opioid dependent individuals and has the potential for significant public health impact if made more widely available with sustained access and support., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Context: The usual treatment for opioid-addicted youth is detoxification and counseling. Extended medication-assisted therapy may be more helpful., Objective: To evaluate the efficacy of continuing buprenorphine-naloxone for 12 weeks vs detoxification for opioid-addicted youth., Design, Setting, and Patients: Clinical trial at 6 community programs from July 2003 to December 2006 including 152 patients aged 15 to 21 years who were randomized to 12 weeks of buprenorphine-naloxone or a 14-day taper (detox)., Interventions: Patients in the 12-week buprenorphine-naloxone group were prescribed up to 24 mg per day for 9 weeks and then tapered to week 12; patients in the detox group were prescribed up to 14 mg per day and then tapered to day 14. All were offered weekly individual and group counseling., Main Outcome Measure: Opioid-positive urine test result at weeks 4, 8, and 12., Results: The number of patients younger than 18 years was too small to analyze separately, but overall, patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12 (chi(2)(2) = 4.93, P = .09). At week 4, 59 detox patients had positive results (61%; 95% confidence interval [CI] = 47%-75%) vs 58 12-week buprenorphine-naloxone patients (26%; 95% CI = 14%-38%). At week 8, 53 detox patients had positive results (54%; 95% CI = 38%-70%) vs 52 12-week buprenorphine-naloxone patients (23%; 95% CI = 11%-35%). At week 12, 53 detox patients had positive results (51%; 95% CI = 35%-67%) vs 49 12-week buprenorphine-naloxone patients (43%; 95% CI = 29%-57%). By week 12, 16 of 78 detox patients (20.5%) remained in treatment vs 52 of 74 12-week buprenorphine-naloxone patients (70%; chi(2)(1) = 32.90, P < .001). During weeks 1 through 12, patients in the 12-week buprenorphine-naloxone group reported less opioid use (chi(2)(1) = 18.45, P < .001), less injecting (chi(2)(1) = 6.00, P = .01), and less nonstudy addiction treatment (chi(2)(1) = 25.82, P < .001). High levels of opioid use occurred in both groups at follow-up. Four of 83 patients who tested negative for hepatitis C at baseline were positive for hepatitis C at week 12., Conclusions: Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification. Further research is necessary to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence., Trial Registration: clinicaltrials.gov Identifier: NCT00078130.

Background: Tracheobronchial stents are inserted mainly in cases of malignant and benign airway stenosis. Further indications are esophago-tracheal fistulas, mediastinal fistulas and tracheomalacia., Methods: A retrospective analysis was conducted on patients' records, information provided by the general practitioners and relatives of the patients from July 1993 to December 2006 in the Department of Pneumology of the Heidehaus Hospital Hannover (since 6/05 Department of Pneumology and Internal Intensive Care Medicine, Oststadt-Heidehaus Hospital)., Results: During the observation period of 13 years a total of 269 stents (177 permanent, 92 temporary) were implanted in 207 patients (1.3 stents per patient). The vast majority of patients (173/207) suffered from an underlying malignancy. About half of the stents were deployed in the trachea. The median length of placement was 116 days in patients with malignancies and 313 days in patients with benign diseases. In about 40 % of the patients notable complications were observed which were directly or indirectly associated with the stents. These findings show the importance of a critical indication for stent implantation. In benign diseases a stent can remain for years inside the tracheobronchial system, if it is well tolerated in the beginning. In malignant diseases the result depends decisively on the stage of the tumour: has the stent been implanted before any other tumour therapy is started or is it an end-stage tumor with no other therapeutic option? In general, complications of stents occur quite frequently., Conclusions: The analysis of stent data leads to some aspects for the prevention of stent-related complications. There should be a strict indication and appropriate choice of stent material. Nevertheless, there remains an ethical dilemma in patients with end-stage disease as to whether to implant a stent or to do nothing against the tumor, because the benefit immediately after stent insertion vanishes with progression of the tumour, so causing extra complications.

When the sanatorium "Heidehaus" was founded on June 1, 1907 in the northern countryside of Hannover with Dr. Otto Ziegler as head about 120 beds for patients with tuberculosis were available. By 1914 about 200 patients were being treated by 4 physicians and 10 nurses. An operating theatre and a modern radiology unit were added in 1927. Shortly after the 2nd World War 400 patients with tuberculosis were hospitalised simultaneously. With the introduction of antituberculous triple drug treatment the number of patients dropped significantly. During this period many traditional facilities, used to care for patients with tuberculosis lost their financial basis and closed. However in the 1960s Prof. Schindler, the head of Heidehaus, widened the spectrum of the hospital into a modern chest hospital, focused on lung and airway diseases. In particular in the 1980s and 1990s this trend continued and 2 independent departments, i. e., pneumology and thoracic surgery were founded. In 2005 due to restructuring by the community of Hannover the "Heidehaus" moved completely and merged with another traditional hospital to become the new "Oststadt-Heidehaus". In its new surroundings both departments for pulmonary medicine and thoracic surgery offer a broad spectrum of modern thoracic medicine in cooperation with other disciplines.

Objective: Assess the validity of medical products reporting program (MEDWatch) reports of abuse/dependence and withdrawal associated with Ultram (tramadol)., Methods: Reports of possible abuse/dependence or withdrawal associated with Ultram during 13 quarters following launch were spontaneously reported to the manufacturer Ortho-McNeil Pharmaceutical (OMP) and also solicited from 255 NIDA grantees and addiction treatment professionals by an Independent Steering Committee (ISC). Reports were classified by the ISC using DSM-IV criteria, by the Drug Safety and Surveillance (DSS) units of Robert Wood Johnson Pharmaceutical Research Institute (PRI) using World Health Organization Adverse Reaction Terms (WHOART) terms, and reported to the food and drug administration (FDA) via MEDWatch. Rates of abuse/dependence and withdrawal per 100000 persons exposed were calculated separately for classifications made by the PRI and the ISC, and confidence intervals calculated to determine the degree to which they agreed., Results: For 681 reports submitted to PRI, confidence intervals of ISC ratings contained PRI ratings 12 of 13 times for abuse/dependence, and 12 of 13 times for withdrawal. For 242 reports submitted to the ISC, confidence intervals of ISC ratings contained PRI ratings 10 of 13 times for abuse/dependence, and 12 of 13 times for withdrawal. Proactive surveillance increased the total number of cases of abuse/dependence but not withdrawal. Many cases of withdrawal without signs or symptoms of abuse/dependence were identified., Conclusions: There was good/excellent concordance between MEDWatch and ISC classifications. Proactive surveillance increased cases of abuse/dependence but not withdrawal. Withdrawal with no signs or symptoms of dependence was common. More use of proactive surveillance is likely to improve assessments of public health risks associated with adverse events.

Objective: Vascular endothelial growth factor (VEGF) is an important cytokine in the process of angiogenesis. Elevated serum levels of the cytokine may determine cancer patients who will benefit from adjuvant anti-angiogenic therapy in the future. To correlate serum levels of VEGF with tumour stage and established prognostic markers in patients with small cell lung cancer (SCLC), a prospective study was performed on 70 patients., Methodology: From August 1999 to May 2000, 70 consecutive patients (51 male, 19 female) with histologically proven SCLC were enrolled into the study. Staging of the disease included clinical investigation, bronchoscopy, chest X-ray, thoracic computed tomography and ultrasound. The patients were grouped into five stages according to the Marburg classification (very limited disease (VLD), limited disease (LD), extensive disease I (EDI), extensive disease II (EDII) and extensive disease III (EDIII)). Prior to treatment, a 10 mL serum sample from each patient was examined by ELISA to quantify levels of VEGF and neuron-specific enolase (NSE). Lactate dehydrogenase (LDH) and albumin levels were determined by photomorphometric analysis. Statistical analysis was performed using the Waller-Duncan k ratio t-test and Pearson's correlation test., Results: Serum VEGF levels correlated well with tumour stage (P < 0.0001). Albumin levels were not correlated with tumour stage, but levels of NSE and LDH increased with stage progression. When patients were divided into two groups (VLD and LD vs EDI-III), VEGF levels were significantly lower in the initial stages of the disease compared with extensive disease (P < 0.0001). Serum levels of VEGF correlated better with tumour stage than did concentrations of NSE, LDH or albumin., Conclusion: Serum VEGF levels may serve as an additional prognostic marker in the course of patients with SCLC. Further studies are needed to determine whether these patients may benefit from additional anti-angiogenic therapy in the future.

Objective: The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) End-of-Life Care Consensus Panel was convened in 1997 to identify clinical, ethical, and policy problems in end-of-life care, to analyze critically the available evidence and guidelines, and to offer consensus recommendations on how to improve care of the dying. Topic selection and content presentation were carefully debated to maximize the project's focus on providing practical clinical and other guidance to clinicians who are not specialists in palliative care. This statement examines current legal myths, realities, and grains of truth in end-of-life care., Participants: The Consensus Panel comprises 13 medical and bioethics experts, clinicians, and educators in care at the end of life selected by the Ethics and Human Rights Committee, College leadership, and the Center for Ethics and Professionalism at the ACP-ASIM., Evidence: A literature review including a MEDLINE search of articles from 1970-1998 and review of end-of-life care literature and organizational bibliographies was conducted. Unpublished sources were also identified by participants, as was anecdotal clinical experience., Consensus Process: The draft statement was debated by panel members over a series of 3 to 4 meetings. For this statement, the initial draft and subsequent revised drafts were discussed in 1998-1999. The statement then underwent external peer review and revision before panel approval and the journal peer review process., Conclusions: Legal myths about end-of-life care can undermine good care and ethical medical practice. In addition, at times ethics, clinical judgment, and the law conflict. Patients (or families) and physicians can find themselves considering clinical actions that are ethically appropriate, but raise legal concerns. The 7 major legal myths regarding end-of-life care are: (1) forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patient's actual wish; (2) withholding or withdrawing of artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal; (3) risk management personnel must be consulted before life-sustaining medical treatment may be terminated; (4) advance directives must comply with specific forms, are not transferable between states, and govern all future treatment decisions; oral advance directives are unenforceable; (5) if a physician prescribes or administers high doses of medication to relieve pain or other discomfort in a terminally ill patient, resulting in death, he/she will be criminally prosecuted; (6) when a terminally ill patient's suffering is overwhelming despite palliative care, and he/she requests a hastened death, there are no legally permissible options to ease suffering; and (7) the 1997 Supreme Court decisions outlawed physician-assisted suicide. Many legal barriers to end-of-life care are more mythical than real, but sometimes there is a grain of truth. Physicians must know the law of the state in which they practice. JAMA. 2000;284:2495-2501.

The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses. JAMA. 2000;284:1689-1695.

Unlabelled: GOAL OF THE INVESTIGATION: It was investigated (1) whether guidelines for the treatment of bronchial asthma and chronic obstructive pulmonary diseases (chronic obstructive bronchitis and lung emphysema) are distributed in Germany, (2) whether they are accepted by general practitioners and physicians for internal medicine without subspecialty, and (3) how much they are used., Methods: (1) The mostly read medical journals have been screened. (2) 1200 physicians have been questioned with regard to the main criteria of these guidelines. (3) 600 physicians were asked to write a documentation for two patients each with bronchial asthma and chronic obstructive pulmonary disease. 344 of the questionnaires (28.7%) and 544 of the documentations could be analyzed (22.7%)., Results: Guidelines for the treatment of bronchial asthma are published in all leading journals. Substantially less references were found for the therapy of chronic obstructive bronchitis. The main concepts of training, diagnosis of the disease's severity, and physical therapy are all known by the practitioners. The training plays a sufficient role in only half of the questioned physicians. The self-measurement of the patient is not every where accepted. The treatment according to a stage by stage pharmacological therapy cannot be seen in one third of the questioned physicians., Conclusions: Differential diagnosis and therapy are not sufficiently emphasized in the current guidelines. Practitioners should participate in the development of guidelines, to include the aspects of realization.

Inborn abnormalities of the lung are rarely seen by clinicians. This paper reports about the cases obeyed within a ten-years-space in a lung-clinic. Symptoms, diagnostic procedure, and treatment are described.

76 first grade children of a special school for learning disabled were tested for specific developmental disorders of motor functions (SDDM). 15 children (19.7%), boys and girls proportionately, had a SDDM. This is a substantial increase compared to the unselected population. 8 children (15.5%) suffered from a specific disorder of body coordination and low finger-eye coordination. 4 children (5.3%) were found to have specific disorders of motor functions and specific language retardations. Isolated disorders of hand coordination were not found. 31% of the children with SDDM suffered from psychiatric disorders. Roughly the same percentage of psychiatric diagnosis was found in children without disorders of motor functions. A total of 24 children (33%) had impaired physical coordination: these children had significantly higher total scores in the Child Behavior Checklist (CBCL). Though this questionnaire was not sensitive for detection of disorders of motor functions.

66 children attending first grade at a special school for educationally subnormal children were examined medically and psychologically. Classification was done according to ICD-10. In addition, the parents were asked to rate their children's behavior with the "Child Behavior Checklist" by Achenbach and Edelbrock. The most common symptoms rated in this group of 6- to 8-year-old children were lack of concentration, speech and language problems, hyperactivity, demand for attention and arguing. The mean total score (cut-off score: 30) and the number of crucial items (cut-off score: at least two crucial items) differed significantly between the children with and those without psychiatric disorders. No significant correlation was found between the mean total score or the number of crucial items and the sex of the children or the other axes of the Multi-axial Classification of Child Psychiatric Disorders.

The frequencies of specific language retardation and deficits in short term memory span are the subject of this epidemiological investigation of children attending the first grade of a special school for educationally subnormal children in Erlangen and München/Rosenheim. The children at the mean age of seven were examined according to the "Multi-axial Classification of Child Psychiatric Disorders". The following prevalences were found: 16 children (21%) of the sample from Erlangen and 24 children (33%) of the sample from München/Rosenheim had an specific language retardation, in both sample the most frequent disorders were retardations of the expressive language (11% and 21%). In both sample most children had substantially deficits in the acoustic short term memory span, while they were better on visual short term memory span. Significant correlations between acoustic short term memory span and specific language retardations were found.

The study was conducted to assess the consequences of multiple diagnoses and handicaps in children aged 6 to 8 years. Children were considered to be "multiply handicapped" if they suffered from two or more disorders or impairments included in the Multi-axial Classification Scheme. To this end children in special schools were compared with a random sample of children from three communities in Bavaria. As expected, all prevalences found in the population of children from special schools were substantially higher than those found in the random sample. Furthermore, the proportion of children with multiple handicaps in the special schools far exceeded what one would have expected based on the findings for the random sample. Most of the disturbances did not differ in respect to their comorbidity. But the mentally retarded children in the special schools were all "multiply handicapped". The importance of "multiple handicaps" for the assignment to special schools is discussed, as are the implications for the planning of services.

This article reports on four tumour patients with extensive, but cytologically innocuous pericardial effusion. In three cases, a tumour-cell-negative pleural effusion, on the left, was also present. Thoracoscopy showed that the pleura were unremarkable, whereupon, with the aid of the biopsy forceps--in one case the Nd:YAG laser--the pericardium was opened. The procedure provided diagnostically high-yielding material; in addition, pericardial tamponade was "permanently" eliminated (period of observation up to 4 years). This shows that, in addition to its diagnostic value, thoracoscopic pericardial fenestration also can be therapeutic. It represents an alternative to the surgical approach.

Between January 1982 and April 1986 a double-blind randomized placebo controlled study of mopidamol, employed as adjunct therapy to surgery in patients with non-small cell bronchial carcinoma, was performed at 7 hospitals. The main criteria were occurrence of metastases and survival. Mopidamol was given perioperatively at a dose of 2 x mg i.v. daily, and postoperatively orally at a dose of 3 x 500 mg daily. The treatment period was scheduled to at least 2 years and in some of the patients was prolonged to 3 years. The standard therapy of each individual center was given as basic therapy. A total of 270 patients were included in the study, 147 in the placebo and 123 in the mopidamol group. By the end of the study 52 deaths from metastases had occurred in the placebo group (35%) compared with only 32 (26%) in the mopidamol group. This difference is statistically significant at p less than 0.05 with the one-sided test. A comparison of life-tables according to Kaplan-Meier shows a statistically significant difference in favour of the group treated with mopidamol (savage p less than 0.05). Cox's multivariate analysis confirmed the statistically significant difference in favour of the group treated with mopidamol, the inclusion of the risk factors tumour stage and histology in the evaluation results in a p-value of 0.02. With respect to the incidence of metastases there were no appreciable differences between the treatment groups. The incidence of side effects or undesired events was equal in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Intrathoracic angiofollicular lymph node hyperplasia (Castleman's lymphoma) was found in a 32-year-old woman. The diagnosis could be established already preoperatively by endoscopic biopsy. It was a coincidental discovery as there were no clinical symptoms. Histologically the tumour was of the hyaline-vascular type. After uncomplicated surgical removal follow-up at 6 weeks was unremarkable. Aetiology and pathology of this rare disease are unknown.

Since the introduction of halothane as an anaesthetic there have been several reports about cardiac arrhythmias during application of epinephrine in combination with halothane. This complication was also reported when epinephrine was used as local haemostyptic. We describe the effect of topical epinephrine upon cardiac action during bronchoscopy in barbiturate-halothane-anaesthesia. 21 patients with an average age of 66.4 years underwent bronchoscopy mainly because of suspect bronchial carcinoma, they were monitored by lead I ECG and blood gas analysis was carried out repeatedly. Immediately following biopsies, sponses with epinephrine solution 1:1000 were applied to the bronchial mucosa - the average epinephrine dose of these sponges was 0.12 mgs as calculated before by weighting. During this procedure we could not observe significant cardiac arrhythmias following epinephrine application. We conclude this to be the result of limited dosage and maintenance of adequate ventilation and oxygenation. Thus, epinephrine can be used as a local haemostyptic during bronchoscopy in halothane anaesthesia without significant risk when the above described precautions are observed.

In a prospective study in our department, 63 consecutive patients with suspected sarcoidosis underwent combined bronchial and transbronchial biopsy during bronchoscopy with rigid instruments under general anaesthesia. Lung tissue was obtained in all cases. In 19 cases noncaseous granulomas were found only by transbronchial lung biopsy. In 9 cases they were found only by bronchial biopsy. In 30 patients noncaseating granulomas were found by both technics, that is, the lesions were found in both lung parenchyma and bronchial wall. In 5 patients, diagnosis of sarcoidosis could not be confirmed by bronchological methods, but was obtained by other biopsy procedures. From our findings, we conclude that the combination of bronchial and transbronchial biopsies during bronchoscopy with rigid instruments is a valuable procedure for establishing the diagnosis of sarcoidosis and that the bronchological methods could replace mediastinoscopy in most cases of sarcoidosis.

In a 55 years old male patient bronchoscopy was carried out because of suspected bronchial carcinoma. Chest X-ray showed a lesion in the periphery of left lung, an episode of hemoptysis was reported 4 weeks prior to the examination. During bronchoscopy we found numerous small tumours on the mucosa of distal trachea and left main bronchus. The findings suggested a widespread malignant process, whereas histological examination of biopsies showed tracheobronchopathia osteochondroplastica. In the case described we could not find amyloidosis of tracheal wall or disorders in somatotropine secretion. Pathogenesis and clinical features of the disease, which is in a high percentage detected by chance or post mortem, are discussed.