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Storungen der Bildung der V. cava inferior (VCI) in der Embryonalzeit und Thrombosen der VCI fuhren sowohl zu einem akuten als auch einem chronischen Symptomenkomplex. Dieser ist gepragt durch eine akute Gefahrdung des Patienten durch eine massive Lungenembolie und die rasche Entwicklung eines schweren postthrombotischen Syndroms (PTS). Die alleinige konservative Therapie mittels Antikoagulation und Kompression fuhrt nach Literaturangaben bei bis zu 30 % der Patienten zur Entwicklung eines schweren PTS. Dies ist auch deshalb nicht akzeptabel, weil hiervon uberwiegend junge Patienten betroffen sind. Nach Thrombektomie mit obligater Fistelanlage entwickelten 4 % der Patienten ein schweres PTS, nach VCI-Ersatz traten keine schweren PTS auf. Sowohl die venose Thrombektomie, als auch der Ersatz der VCI konnen das Risiko eines schweren PTS bei streng selektierten Patienten vermindern.

ZusammenfassungVenöse Thrombosen der unteren Extremitäten bei Kindern und in der Adoleszenz sind selten (0,07/10 000 Kindern) (1) und können verschiedene Ursachen haben. Ein ätiologischer Faktor ist die Kompression von außen. Vorgestellt wird ein 16-jähriger Junge der durch Kompression eines Osteochondroms des Femurs eine Phlebothrombose der V. poplitea erlitten hatte und durch operative Exostosenabtragung und Thrombektomie geheilt wurde.Ergänzend stellen wir die aktuelle Literatur bezüglich arterieller und venöser Gefäßkomplikation durch gleichzeitiges Vorliegen einer Exostose vor.

Background Computed tomographic angiography has become the standard evaluating method of potential living renal donors in most centers. Although incidence of fibromuscular dysplasia is low (3.5–6%), this pathology may be relevant for success of renal transplantation. The incidence of FMD in our population of LRD and reliability of CTA for detecting vascular pathology were the aims of this study. Materials and methods 101 living renal donors, examined between 7/2004 and 9/2008 by CTA, were included in a retrospective evaluation. The examinations were carried out using a 64 Multi-detector CT (Siemens Medical Solutions, Erlangen). The presence or absence of the characteristic signs of fibromuscular dysplasia, as “string-of-beads” appearance, focal stenosis or aneurysms, were assessed and graded from mild (=1) to severe (=3). Furthermore, vascular anatomy and arterial stenosis were investigated in this study. Retrospective analysis of CTA and ultrasound were compared with operative and histological reports. Results Four cases of fibromuscular dysplasia (incidence 3.9%) in 101 renal donors were diagnosed by transplanting surgeons and histopathology, respectively. Three cases could be detected by CTA. In one donor even retrospective analysis of CTA was negative. Ten accessory arteries, 14 venous anomalies and 12 renal arteries stenosis due to atherosclerosis were diagnosed by CTA and could be confirmed by the operative report. Conclusion CTA is sufficient for detection of hemodynamic relevant stenosis and vascular anatomy. Only one patient with a mild form of FMD was under estimated. Therefore, if the CTA shows slightest irregularities which are not typical for atherosclerotic lesions, further diagnostic work up by DSA might still be necessary.

Wenn geeignetes autologes Venenmaterial zur peripheren arteriellen Revaskularisation fehlt, kann der Einsatz von Homografts erwogen werden. Die aktuelle Literatur sowie eigene Erfahrungen werden anhand des Gefasmaterials, der Konservierungsmethode, der Antikoagulation sowie einer eventuell erforderlichen Immunsuppression dargestellt.

PURPOSE Contrast-enhanced MRI is considered problematic in renal allograft recipients due to the association of gadolinium administration and the development of NSF. Therefore, we assessed the clinical value of mono- and biexponential analysis of diffusion-weighted imaging (DWI). MATERIALS AND METHODS A total of 32 patients were divided into four groups: (a) patients with stable function of renal allograft for at least 6 months, (b) patients with acute deterioration of allograft function, patients who recently underwent transplantation (< 14 days) with good (c) or decreased (d) renal function. T 2w ax. and T 1w cor. and a diffusion-weighted sequence with 16 b-values (b = 0 - 750 s/mm (2)) were performed on a 1.5 T scanner (Magnetom Avanto, Siemens Medical Solutions). ROI-based analysis of the renal cortex was analyzed using the software "Table Curve 2D". RESULTS Monoexponential analysis showed an ADC (mono) of 1961 +/- 104 1801 +/- 150, 2053 +/- 169 and 1720 +/- 191 10 (-6)mm (2) /sec for patient group a, b, c and d respectively. The difference in ADC (mono) between group (a) and (b) (p < 0.006) and between group (c) and (d) (p < 0.04) was statistically significant. Biexponential analysis revealed a mean perfusion fraction of 0.21, 0.23, 0.32 and 0.24 for group (a), (b), (c) and (d), respectively. Biexponential ADC showed a higher numerical accuracy. There were no statistically significant inter-group differences in diffusion (ADC (D)) and perfusion (ADC (P)). CONCLUSION Unenhanced evaluation of renal allografts with DWI is feasible. ADC (mono) of renal cortex correlates with renal function. The significance of the higher numerical accuracy of biexponential analysis in clinical settings requires further evaluation in larger-scale studies.

Wir wollten herausfinden, welche Faktoren das Kurz- und Langzeitergebnis bei Diabetespatienten nach peripherer Bypass-Chirurgie beeinflussen. Retrospektive Analyse von 721 Patienten, die von 1/1996 bis 12/2005 mit einem Bypass fur ein einzelnes Unterschenkel- oder Fusgefas versorgt wurden. Das Gesamtkollektiv (GK) bestand aus folgenden Subgruppen: Diabetes mellitus (DM) 482 (68%), terminale Niereninsuffizienz (NI) 96 (14%), periphere arterielle Verschlusskrankheit (PAVK), Stadium III/IV, 644 (89%). 30-Tage-Ergebnisse: Bypass-Offenheit GK 85,4%/DM 87,3%, Majoramputation GK 7%/DM 6,5%, Tod GK 5%/DM 5,2%. Langzeitergebnisse aus den Kaplan-Meier-Uberlebenskurven: Sekundare Funfjahres-Bypass-Offenheit: DM 43,6%/Nicht-DM 44,4% (n.s.). Funfjahresbeinerhalt: DM 69,2%/Nicht-DM 70,6% (n.s.). Funfjahresuberleben: DM 47,7%/Nicht-DM 58,8% (p

Schwannoma are rare. We describe the clinical presentation, diagnostic workup and therapy in sympathetic chain schwannoma in a 54 year old patient. Besides the operative management the differential diagnosis of painless swelling at the carotid bifurcation are discussed.

OBJECTIVE: To analyse retrospectively from case notes and follow-up examinations the effectiveness of vascular surgery for renal artery aneurysm (RAA). PATIENTS AND METHODS: Operations for uni- or bilateral RAA were performed, between January 1978 and December 1996, on 61 patients (39 women, 22 men; mean age 47.4 years), 81% with arterial hypertension. Extracorporeal reconstruction with renal autotransplantation was performed in 4 of the patients. Clinical examination and duplex sonography or angiography were performed a mean of 58.4 months postoperatively. RESULTS: Postoperative morbidity rate related to the surgery was 13%; there were no early postoperative death. At the time of follow-up 80% of the reconstructed renal arteries were patent. 26% of hypertensive were cured of the hypertension, while the blood pressure was significantly reduced in 40%. CONCLUSIONS: Vascular reconstruction of RAA can be effective so that primary nephrectomy is no longer indicated. Reconstruction in situ can usually be successfully performed, reducing operative time and reducing surgical trauma. The operation is indicated in any RAA of greater than 2 cm diameter, in all patients with hypertension and renal artery stenosis, and also for smaller aneurysms in patients in good general health and in women of child-bearing age.

Hintergrund Die anatomische Darstellung und Erfassung moglicher Anomalien der Nierengefase und Ureteren ist fur die Planung einer Lebendnierenspende von essenzieller Bedeutung. Die vorliegende Untersuchung soll die Wertigkeit der nichtinvasiven Evaluation mit der 64-Zeilen-Multidetektor-CT untersuchen.

Der Spontanverlauf der Thrombose der V. cava inferior (VCI) und der tiefen Becken-Bein-Venen (TVT) ist gekennzeichnet durch Lungenembolien (bis zu 50%) und die Entwicklung eines postthrombotischen Syndroms (PTS) bei bis zu 30% der Patienten. Zur Behandlung stehen 3 Therapieformen zur Verfugung: die Antikoagulation (AK), die Fibrinolyse (FL) und die venose Thrombektomie (VT). Wahrend die AK nur den thrombophilen Zustand bessert und die Appositionsthrombose verhindern kann, kann die FL den Thrombus beseitigen. Bei einer derartig massiven Thrombose muss das Behandlungsergebnis zwangslaufig inkomplett bleiben. Die FL wird deshalb und wegen zahlreicher Kontraindikationen und Komplikationsmoglichkeiten nur noch selten durchgefuhrt. Die grundlegende lokal-kausale Behandlungsmethode stellt die VT dar, deren Ergebnisse durch eine adjuvante temporare arteriovenose Fistel (avF) erheblich verbessert werden. Eine Vermeidung von Rezidiven kann durch die Ermittlung des individuellen Thrombophilierisikos und einer daraus resultierenden risikoadaptierten medikamentosen Prophylaxe erreicht werden.

Significant progress has been made on ASDEX Upgrade during the last two years in the basic understanding of transport, in the extension of the improved H-mode in parameter space and towards an integrated operating scenario and in the development of control methods for major performance limiting instabilities. The important features were the understanding of particle transport and the control of impurity accumulation based on it, the satisfactory operation with predominantly tungsten-clad walls, the improved H-mode operation over density ranges and for temperature ratios covering (non-simultaneously) the ITER requirements on ν*, n/nGW and Te/Ti, the ELM frequency control by pellet injection and the optimization of NTM suppression by DC-ECCD through variation of the launching angle. From these experiments an integrated scenario has emerged which extrapolates to a 50% improvement in n T τ or a 30% reduction of the required current when compared with the ITER base-line assumptions, with moderately peaked electron and controllable high-Z density profiles.

Injection of cryogenic deuterium pellets has been successfully applied in ASDEX Upgrade for external edge localized mode (ELM) frequency control in type-I ELMy H-mode discharge scenarios. A pellet velocity of 560 m s−1 and a size of about 6 × 1019 D-atoms was selected for technical reasons, although even lower masses were found sufficient to trigger ELMs. A moderate repetition rate close to 20 Hz was chosen to avoid over-fuelling of the core plasma. Pellet sequences of up to 4 s duration were injected into discharges close to the L–H threshold, intrinsically developing large compound ELMs at a rate of 3 Hz. With pellet injection, these large ELMs were completely replaced by smaller type-I ELMs at the much higher pellet frequency, accompanied by a slight increase of density and even of stored energy. This external ELM control could be repeatedly switched on and off by just interrupting the pellet train. ELMs were triggered in less than 200 µs after pellet arrival at the plasma edge, at which time only a fraction of the pellet has been ablated, forming a rather localized, three-dimensional plasmoid, which drives the edge unstable well before the deposited mass is spread toroidally. The pellet controlled case has also been compared with a discharge at a somewhat lower density, but with otherwise rather similar data, developing spontaneous 20 Hz type-I ELMs. Despite the different trigger mechanisms, the general ELM features turn out to be qualitatively similar, possibly because of the similarity of the two cases in terms of ELM relevant parameters. The scaling with background plasma, heating power, pellet launch parameters, etc over a larger range still remains to be investigated.

Objective: The purpose of this study was to examine the safety of carotid endarterectomy (CEA) wtihin 6 weeks after a nondisabling carotid-related ischemic stroke. Endpoints were the perioperative stroke or mortality rate and the incidence rate of cerebral bleedings. Methods: This prospective observational multicenter trial was performed in community and university centers. One hundred sixty-four hospitalized patients with nondisabling carotid-related ischemic stroke were included. The patients were identified clinically with the modified Rankin scale (initial neurologic deficit grade ≥ 2, n = 160). Four patients with evidence of ischemic territorial infarction on cerebral computed tomographic (CT) scan but no persisting functional deficit were also included. CEA was performed within 6 weeks after stroke. Neurologic examinations were performed initially, before surgery, 3 days after surgery, and 6 weeks after CEA. Worsening of more than 1 grade on the Rankin scale was considered as a new stroke or stroke extension. Unenhanced CT scans of the brain were performed before and after surgery. CT scans were evaluated blind to clinical patient data. Statistical analysis included univariate and multivariate analysis. Results: The combined stroke or mortality rate within 30 days after CEA was 6.7%. Ten patients had a new ipsilateral stroke or stroke extension, and one patient died after surgery of a myocardial infarction. One patient (0.6%) had parenchymatous cerebral bleeding, and in 10 patients, hemorrhagic transformation within the preexisting ischemic infarction was detected but no infarct extension was observed. In the multivariate analysis, American Society of Anesthesiology (ASA) grades III and IV and decreasing age were significant predictors for an increased perioperative risk. Patients with a higher risk profile (ASA classification grades III and IV) had a high perioperative risk when CEA was performed within the first 3 weeks (14.6% versus 4.8% beyond 3 weeks). Patients without severe concomitant diseases (ASA grades I/II) had a low perioperative risk of 3.4% if CEA was performed within the first 3 weeks. Conclusion: Early CEA within 6 weeks after a carotid-related ischemic stroke can be performed with a perioperative stroke or mortality rate comparable with the results reported in the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial. The risk of parenchymatous bleeding is low. ASA grades III and IV and decreasing age were predictive of an increased perioperative risk, especially if CEA was performed within the first 3 weeks. Patients at low risk can undergo operation safely within the first 3 weeks. Individual patient selection in an interdisciplinary approach between neurologists, anesthesiologists, and vascular surgeons remains mandatory in these patients. (J Vasc Surg 2002;36:997-1004.)

The elements of transport into and across the scrape-off layer in the poloidal divertor tokamak ASDEX Upgrade are analysed for different operational regimes with emphasis on enhanced confinement regimes with an edge barrier. Utilizing the existing set of edge diagnostics, especially the high-resolution multi-pulse edge Thomson scattering system, in combination with long discharge plateaus, radial sweeps and advanced averaging techniques, detailed radial mid-plane profiles of diverted plasmas are obtained. Profiles are smooth across the separatrix, indicating strong radial correlation, and there is no remarkable variation across the second separatrix either. Together with measured input, recycling, pumping and bypass fluxes, a corrected separatrix position is determined and transport characteristics are derived in the different radial zones generally identified in the profile structure. Transport in the steep gradient region inside and across the separatrix shows typical ballooning-type critical electron pressure gradient scaling and, in parallel, even a clear correlation between radial electron density and temperature decay lengths (e.g. η e = d(ln T)/d(ln n) ∼ 2 for type-I ELMy H-modes). These findings indicate the importance of stiff profiles in this region, while diffusion coefficients are secondary parameters, determined essentially by the source distribution. The outer scrape-off layer wing exhibits a more filamentary structure with preferential outward drift especially in high-performance discharges, with formal diffusion coefficients far above the Bohm value in agreement with results on the old ASDEX experiment. A basic mechanism involved there seems to be partial loss of equilibrium and fast curvature-driven outward acceleration, in principle well known from theory, investigated decades ago in pinch experiments and utilized recently in high-field-side pellet fuelling.

The variation of the density profile shape of H-modes in ASDEX Upgrade is governed by time constants much larger than τE. A method to determine these time constants is presented. Especially high density discharges with moderate heating and constant gas puff show very long phases of increasingly peaking density profiles which may not reach a steady state, although the H-mode pedestal remains constant during the peaking process. If heated more centrally with ICRH the peaking is strongly reduced and a steady state is reached. The behaviour can be well modelled using D≈0.1χ and the neoclassical Ware-pinch. Strongly peaked density profiles lead to an earlier onset of neoclassical tearing modes (NTMs) in agreement with theoretical predictions of the strong influence of ∇n/n on the bootstrap current. Also for impurities an effect of the heat flux profile is observed: central heating with ECRH leads to a reduction of heavy ions in the plasma core.

Einleitung: Postoperative Durchgangssyndrome sind pyschische Storungen, die nach Operationen akut auftreten konnen und einen flukturierenden Verlauf haben. Der postoperative Verlauf ist oft deutlich protrahiert. Ziel dieser Untersuchung war es, zu analysieren, wie haufig Durchgangssyndrome bei gefaschirurgischen Patienten auftreten, und ob sich Risikofaktoren fur deren Entwicklung identifizieren lassen. Methoden: Die somatischen Befunde von Patienten, die elektiv arteriel operiert wurden, wurden erfast. Daruber hinaus wurden die Patienten praoperativ psychiatrisch untersucht. Intraoperativ wurden der Infusions- und Transfusionsbedarf, Blutgase und Blutdruckverhalten sowie Narkose- und Operationszeiten dokumentiert. Postoperativ wurden die Patienten taglich von Tag 1–7 psychiatrisch und chirurgisch untersucht. Ein Durchgangssyndrom wurde nach dem Diagnostischen und Statistischen Manual Psychischer Storungen DSM IV diagnostiziert und in leichte, mittlere und schwere Formen unterteilt. Ergebnisse: 54 Patienten gingen in die Studie ein. Davon entwickelten 21 (38,9 %) ein Durchgangssyndrom (11 leicht, 2 mittelschwer, 8 schwer). Deutliche Unterschiede zeigten sich zwischen Patienten mit aortalen Operationen( n = 27, 55,5 % Durchgangssyndrom) und solchen mit nichtaortalen Eingriffen (n = 27, 22,2 % Durchgangssyndromen). Bestimmte Begleiterkrankungen (Horstorung), nicht jedoch ein hoheres Lebensalter erhohten die Wahrscheinlichkeit eines postoperativen Durchgangssyndromes. Sowohl allgemein psychopathologisch auffallige Patienten als auch solche mit einer depressiveren Grundstimmung entwickelten haufiger Durchgangssyndrome als psychiatrisch unauffallige. Patienten, deren intraoperativer Verlauf kompliziert war, entwickelten haufiger ein Durchgangssyndrom. Dabei war die Schwere des Verlaufes nicht an der absoluten Operationszeit, dem Blutdruck oder den Blutgasen abzulesen. Aussagekraftiger waren ein intra- oder postoperativ erniedrigter Hamoglobinwert (Hb < 10 g %), ein erhohter intraoperativer Infusionsbedarf und eine intraoperative Acidose. Patienten mit Durchgangssyndromen entwicklten haufiger postoperative Komplikationen (8/21 = 38,1 % vs 6/33 = 18,2 %) und musten langer intensivmedizinisch behandelt werden (2,7 vs 2,1 Tage, nur aortale Eingriffe 3,2 vs 2,4 Tage). Schlusfolgerungen: Postoperative Durchgangssyndrome sind nach gefaschirurgischen Operationen haufig. Vor allem Patienten mit aortalen Operationen, mit bestimmten Begleiterkrankungen, psychopathologischen Auffalligkeiten und solche mit einem komplizierten intraoperativen Verlauf sind gefahrdet, eine derartige Komplikation zu entwickeln.

Die vorliegende Kasuistik schildert den Fall eines 38-jahrigen Patienten mit einer Aortenisthmusstenose. Die Diagnose wurde durch eine Aortographie gestellt, bei der unmittelbar postduktal eine hochgradige Stenose nachgewiesen wurde. Bekannt war seit dem 18. Lebensjahr des Patienten eine ausgepragte arterielle Hypertonie mit systolischen Blutdruckwerten von uber 200 mmHg bei gleichzeitig bestehender Claudicatio intermittens. Die operative Sanierung der Aortenisthmusstenose erfolgte durch Implantation eines Aorta-ascendens-Aorta-abdominalis-Bypass (AAAAB). Diskutiert werden unterschiedliche Operationsverfahren und ihre Indikationen sowie die grose Bedeutung des Operationsalters bei der Diagnose Aortenisthmusstenose.

The divertor geometry on ASDEX-Upgrade has changed from an open to a more closed configuration. The effects of this change on midplane scrape-off layer profiles for temperature and density are discussed. Investigations concerning the accuracy of separatrix positions are described. The relation between neutral gas flux density in the divertor and midplane density is analysed and scalings are presented. No decrease in the maximum achievable density in the H-mode with the new closed divertor in comparison to the former open one has been found. For comparable discharges the scrape-off layer density for the closed divertor has been found to be higher or at least as high as for the open divertor.

Eine Diskussion uber die Therapie der tiefen Venenthrombose findet in der aktuellen Literatur nicht statt. Die Therapie mittels niedermolekularer Heparine und die Kompressionstherapie werden allgemein als Standard akzeptiert und werden als ambulante und stationare Therapie durchgefuhrt. Der Spontanverlauf der Thrombose der V. cava inferior (VCI) und der tiefen Becken-Bein-Venen (TVT) ist gekennzeichnet durch Lungenembolien (bis zu 50%) und die Entwicklung eines postthrombotischen Syndroms (PTS) bei bis zu 30% der Patienten. Die Lysetherapie ist aufgrund der fatalen Nebenwirkungen nach ihrer Hochphase Ende der 1980er Jahre aus der klinischen Routine verschwunden. Der operativen Therapie wird aus angiologischer und phlebologischer Sicht nur eine Indikation beim Vorliegen einer Phlegmasia coerulea dolens zugestanden.

History and clinical findings A 39-year-old woman complained of dyspnoea and increasing abdominal pressure sensation. A Greenfield filter had been implanted into her inferior vena cava (IVC) 4 years previously because of pulmonary embolism from a deep vein thrombosis after a hysterectomy with abscess formation. Physical examination revealed neck vein congestion, jaundiced sclerae, a tense abdominal wall, ascites and a soft machinery murmur in the paraumbilical region. Investigations Transaminase activities were slightly raised (GOT 38 U/I, GPT 20 U/I), but total bilirubin and direct bilirubin were markedly elevated (2.9 mg/dl and 1.1 mg/dl, respectively). There was no evidence of cholestasis or decreased liver synthesis. Ultrasound showed marked dilatation of the IVC and hepatic veins, and echocardiography revealed right ventricular enlargement with grade II tricuspid regurgitation. Calculated pulmonary arterial systolic pressure averaged 50 mmHG. Colour-coded Doppler sonography demonstrated an aorto-caval shunt at the level of the filter in the IVC and penetration of a filter strut into the aortic lumen. Treatment and course After removing the ascitic fluid by fluid and sodium restriction, and administration of an aldosterone antagonist and a loop diuretic, the A-V fistula was closed surgically and the filter removed. Three months after operation she was put on phenprocoumon (Quick value 20-30%). At the latest outpatient examination, 6 months after the operation, she was free of symptoms. Conclusion As filter implantation in the IVC may produce severe complications, indications for it need to be demonstrated by further studies of its efficacy.

Das WILKIE-Syndrom wurde 1921 von D. Wilkie im „British Journal of Surgery“ beschrieben und von demselben Autor 1927 uber 75 Patienten berichtet. Morphologisch entspricht das Wilkie-Syndrom einer Kompression der Pars horizontales inferior des Duodenums zwischen Aorta und spitzwinklig abgehender A. mesenterica superior. Im englischen Sprachraum ist das Syndrom als Superior mesenteric artery Syndrome bekannt. Klinisch steht chronisches Erbrechen wie bei einem hohen Ileus und eine damit verbundene Gewichtsabnahme, sowie permanent Schmerzen im Vordergrund. Die konservative Therapie besteht in dem Versuch, den erlittenen Gewichtsverlust wieder aufzuholen um durch ein Fettpolster zwischen A. mesenterica superior und Aorta eine Spreisung des Winkels der abgehenden A. mesenterica superior zu erreichen – eine Masnahme die so gut wie nie zum Erfolg fuhrt. Die gangige operative Therapie besteht in der Durchtrennung des distalen Duodenums am Ubergang zum Jejunum, Ubernahung des oralen Darmanteils und Anastomosierung des aboralen Anteils in den Magen. Damit ist das gesamte duodenale C ausgeschaltet und die Verdauungssekrete mussen rucklaufig fliesen. In der Literatur klagen in retrospektiven Analysen 50% der Patienten uber fehlende Besserung und Weiterbestehen der geklagten Beschwerden bzw. neue Beschwerden. Vor 6 Jahren bin ich einen anderen Weg gegangen. Die A. mesenterica superior wurde von der Aorta abgetrennt, die Abtrennungsstelle ubernaht und das ansonsten gesunde Gefas kaudal des Abgangs der Nierenarterien in die Aorta reimplantiert. Auf diese Weise wurde der Winkel fur den Abgang der A. mesenterica superior und dadurch der Raum fur das Duodenum erheblich erweitert. Bislang wurden 7 Patienten, 1 Mann und 6 Frauen operiert. Samtliche Patienten waren im jungeren Alter (15 Jahre bis 42 Jahre). Alle Patienten litten unter chronischem Erbrechen und Gewichtsverlust, die jungste Patientin wurde 11 Monate uber eine naso-jejunale Sonde ernahrt. Alle konservativen Therapieversuche waren fehlgeschlagen. Den meisten weiblichen Patienten glaubte man die Beschwerden nicht, Uni Sono wurde die Empfehlung zu einer psychologisch/psychiatrischen Therapie gegeben. Alle Patienten wurden durch Transposition der A. mesenterica superior in den intrarenalen Aortenabschnitt behandelt. Alle Patienten waren 14 Tage postoperativ in der Lage normal zu essen und wurden zunehmend beschwerdefrei. In Einzelfallen war der Dickdarm nicht mehr an ein entsprechendes Nahrungsangebot gewohnt, die Umstellung dauerte bis zu 3 Monate. An und fur sich ist die Transposition der A. mesenterica superior ein gangiges Verfahren bei der Behandlung von aterieller Verschlusserkrankung im Visceralaterienbereich, in solchen Fallen wird die A. mesenterica superior abgetrennt, eine Eversionsdesobliteration durchgefuhrt und das rekonstruierte Gefas sodann infrarenal implantiert. Zur Behandlung des Wilkie-Syndroms ist dieses Verfahren erstmalig von mir an der Universitat Dusseldorf angewendet worden und sollte meines Erachtens als Standard-Therapie zur Behandlung des Wilkie-Syndroms eingesetzt werden. Die jungste Patientin in diesem Krankengut litt auserdem an Ehlers-Danlos-Syndrom, welches bekanntlich eine Aufbaustorung des arteriellen Gefaswandsystems darstellt. Insofern mussten besondere Vorsichtsmasnahmen fur den festen Sitz der Gefasnahte verwendet werden. Diese Patientin kam aus den USA, weil dort wegen der Kombination beider Erkrankungen eine Operation als zu risikoreich abgelehnt wurde. Ein Jahr nach der Operation ist die Patientin um 10 cm gewachsen und hat ein normales Korpergewicht erreicht.

The completely detached high confinement (CDH) regime established recently in high power ASDEX-Upgrade single null divertor discharges is described. The standard CDH mode scenario with feedback controlled external deuterium and neon puffing is analysed in detail with respect to its divertor detachment and confinement properties. Impurity transport and pumping effects and the density operation windows of the CDH mode are outlined. First results with other impurity radiators (N,Ar) are given. Finally the CDH mode operation space is discussed in terms of main chamber and scrape-off layer plus divertor radiation and possible consequences for future fusion experiments are outlined.

In the ASDEX Upgrade, X-point marfe formation and its behaviour up to the density limit is investigated in gas-fuelled ohmically-heated single-null discharges over a wide range of parameters: Ip=0.6-1.2 MA, BTF=1.35-2.4 T, a plasma elongation of 1.6 and Zeff

A quinoxalinone fluorescent tag is evaluated as a carboxylic acid derivatizing reagent for detection by peroxyoxalate chemiluminescence. The synthetic procedure for the quinoxalinone was modified to give a yield that is significantly increased over that reported previously. The new conditions use less hazardous reagents, and produce a final product greater than 97% pure, without the need for intermediate clean-up steps. The derivatization reaction is also modified to give increased yields of greater than 85% compared to 74% obtained previously. The post-column chemiluminescence reaction conditions are optimized to give detection limits of 500 attomole/injection—10 times lower than the fluorescence previously obtained. The reagent is used for the first time on a plasma sample extract. Typical method precision is 4%.

A detection scheme based upon peroxyoxalate chemiluminescence, which utilizes two post-column pumps and two stages of depressurization is investigated. The chemiluminescent detection limit for perylene is 23 times lower than determined by fluorescence, and is in the attomole range. This detection technique is investigated for packed column supercritical fluid chromatography (SFC). Due to the interface design used and the chemical band narrowing effects of chemiluminescence, an apparent increase in efficiency is observed. The interface design affords a wide range of pressures to be used for a separation. During pressure programming the column effluent changes flow rate. Because of a back-pressure regulator, the reaction and detection take place at nearly constant pressure. Therefore pressure gradient work is possible without concern for post-column reagent solubility (which is a concern for high-performance liquid chromatography). The effects of the expanded CO2 from the SFC on the chemiluminescence signal and background are studied. The post-column detection is optimized for pH, photomultiplier voltage, concentrations and flow rates of the peroxide and oxalate ester.

The ASDEX Upgrade programme is directed towards physics input to critical elements of the ITER design and the preparation of ITER operation, as well as addressing physics issues for a future DEMO design. After the finalization of the tungsten coating of the plasma facing components, the re-availability of all flywheel-generators allowed high-power operation with up to 20 MW heating power at I p up to 1.2 MA. Implementation of alternative ECRH schemes (140 GHz O2- and X3-mode) facilitated central heating above n e = 1.2 × 1020 m−3 and low q 95 operation at B t = 1.8 T. Central O2-mode heating was successfully used in high P/R discharges with 20 MW total heating power and divertor load control with nitrogen seeding. Improved energy confinement is obtained with nitrogen seeding both for type-I and type-III ELMy conditions. The main contributor is increased plasma temperature, no significant changes in the density profile have been observed. This behaviour may be explained by higher pedestal temperatures caused by ion dilution in combination with a pressure limited pedestal and hollow nitrogen profiles. Core particle transport simulations with gyrokinetic calculations have been benchmarked by dedicated discharges using variations of the ECRH deposition location. The reaction of normalized electron density gradients to variations of temperature gradients and the T e/T i ratio could be well reproduced. Doppler reflectometry studies at the L–H transition allowed the disentanglement of the interplay between the oscillatory geodesic acoustic modes, turbulent fluctuations and the mean equilibrium E × B flow in the edge negative E r well region just inside the separatrix. Improved pedestal diagnostics revealed also a refined picture of the pedestal transport in the fully developed H-mode type-I ELM cycle. Impurity ion transport turned out to be neoclassical in between ELMs. Electron and energy transport remain anomalous, but exhibit different recovery time scales after an ELM. After recovery of the pre-ELM profiles, strong fluctuations develop in the gradients of n e and T e. The occurrence of the next ELM cannot be explained by the local current diffusion time scale, since this turns out to be too short. Fast ion losses induced by shear Alfvén eigenmodes have been investigated by time-resolved energy and pitch angle measurements. This allowed the separation of the convective and diffusive loss mechanisms.

ASDEX Upgrade is a poloidal divertor experiment very similar to ITER with respect to magnetic field properties and especially to the plasma boundary geometry. A large part of the programme on ASDEX Upgrade is therefore dedicated to investigating and optimizing reactor-relevant plasma boundary issues. This contribution is concerned with H-mode studies and edge physics in general. The L/H-power threshold, H-mode confinement, details of ELM dynamic and 'dithering' L/H-transitions will be discussed. The edge physics investigations are concerned with model calculations and validations, the characteristic 'approach' to the density limit (DL), target plate sputtering and the influence of hydrocarbons, asymmetries and drifts depending on the direction of the toroidal magnetic field, and finally first results of high-Z material experiments.

We report on a numerical analysis of luminescence signals observed during pellet injection into magnetically confined plasmas. Data from the ASDEX tokamak and the Wendelstein W7-AS advanced stellarator are considered in the form of a comparative study. We investigate how far the safety factor q and other plasma parameters influence the luminescence signals. Thus, we try to clarify the validity of the so-called neutral gas shielding model and an extension of it that takes into account the influence of resonant surfaces on the ablation process. Resonant values play only a minor role in the appearance of minima in the luminescence signals.

Coral reef aorta (CRA) is described as rock-hard calcifications in the visceral part of the aorta. These heavily calcified plaques grow into the lumen and can cause significant stenoses, leading to malperfusion of the lower limbs, visceral ischaemia or hypertension due to renal ischaemia.From 1/1984 to 11/2008, 80 patients (26 m, 54 f, mean age 61.6, range 14 to 86 years) underwent treatment in the Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Hospital for CRA. The present study is based on a review of patient records and prospective follow-up in our outpatient clinic.The most frequent finding was renovascular hypertension (n=33, 41.3%) causing headache, vertigo and visual symptoms. Intermittent claudication due to peripheral arterial occlusive disease was found in 35 cases (43.8%). 15 patients (18.8%) presented with chronic visceral ischaemia causing diarrhoea, weight loss and abdominal pain. 79 patients (98.7%) underwent surgery; in 73 (93.7%) aortic reconstruction was achieved with thromboendarterectomy, on an isolated suprarenal segment in 7 (9.3%), an infrarenal segment in 21 (26.6%), and the supra- and infrarenal aorta in 45 cases (60%). Desobliteration of renal arteries was performed in 47 (one-sided n=8, 10.1%; both arteries n=39, 49.4%); the aortic bifurcation was desobliterated in 37 (46.8%), extension into iliac arteries was necessary in 29 cases (one-sided n=4, 5.1%; both arteries n=25, 31.6%). The coeliac trunk was desobliterated in 43% (n=34), the superior mesenteric artery in 44.3% (n=35) and the inferior mesenteric artery in 20.3% (n=16). In 15 cases additional revascularisation (bypass, transposition, graft interposition) was necessary. Surgical access was via a left-sided thoracoabdominal incision in 56.4% (n=45) and via laparotomy in 41.8% (n=33). The 30-day lethality was 8.7% (n=7). Postoperative complications requiring corrective surgery occurred in 11 patients (13.9%). Almost ⅓ of the patients (n=19, 27.5%) returned for follow-up after a mean of 52.6 months (range 3 to 215 months). Of these, there was significant clinical and diagnostic improvement in 16 (84.2%) and 3 (15.8%) were unchanged. Impairment was not observed.In spite of the existing and improving surgical techniques for the treatment of CRA, procedures are challenging and should be performed in centres with expertise.

Axillary artery pseudoaneurysms are rare. We report on a 30-year-old patient with a 6.5-cm post-traumatic pseudoaneurysm of the left axillary artery two months after a knife stab wound of the shoulder. The patient showed axillary fullness and signs of severe brachial plexus compression. A surgical repair was undertaken. The aneurysm was excluded and a saphenous vein interposition was performed. The early and late postoperative periods were uneventful. This is probably not only the largest axillary artery pseudoaneurysm ever reported, but also the first secondary to a stab wound.

This addendum applies to papers authored by contributors from the Axially Symmetric Divertor Experiment (ASDEX) Upgrade Team published in Review of Scientific Instruments. This addendum provides the full list of ASDEX Upgrade Team contributors and their affiliations.

Density limit investigations on ASDEX have been performed under a variety of conditions: ohmically heated and neutral injection heated plasmas in H2, D2 and He have been studied in different divertor configurations, after various wall coating procedures, with gas puff and pellet fuelling, and in different confinement regimes with their characteristically different density profiles. A detailed description of the parametric dependence of the density limit, which in all cases is a disruptive limit, is given. This limit is shown to be a limit to the density at the plasma edge. Therefore, the highest densities corresponding to neRqa/Bt>30*1019 m-2.T-1 are obtained with centrally peaked ne profiles. Radiation from the main plasma at the density limit is always significantly below the total input power. The plasma disruption is due to an m=2 instability which for medium and high qa is preceded by one or more minor disruptions. In this range of qa, the disruptive instability is initiated by the occurrence of a Marfe on the high field side as a consequence of strong plasma cooling in this region. The duration of the Marfe increases with increasing distance between the plasma edge and the q=2 surface. After penetrating onto closed flux surfaces the Marfe leads to a current contraction and a subsequent destabilization of the m = 2 mode. In helium plasmas a strongly radiating, poloidally symmetric shell is observed before the density limit instead of a Marfe. An instantaneous destabilization of this mode is observed at low qa. Detailed measurements of plasma edge and divertor parameters close to the density limit indicate the development of a cold, dense divertor plasma before the disruption. Models describing the scrape-off layer and the divertor region predict an upper limit to the edge density at low divertor temperatures according to power balance considerations. Their relations to the experimental findings, especially the low field side cooling, ar

In the therapy for peripheral arterial occlusive disease there remain inadequacies in the use of alloplastic material concerning thrombogenicity and biological compliance. In the 1960s, Sparks tried to combine the advantages of alloplastic prostheses with those of autologous reconstructions by using incorporated prostheses. No extensive myointimal hyperplasia was noted, but besides infections aneurysmatic dilatation were limiting factors in clinical practice.The incorporation of modern alloplastic prostheses without connection to circulation concerning the thickness of neointima as well as the percentage of smooth muscle cells was examined in a dog model.The thickness of the neointima increased significantly in Dacron grafts with a peak on day 70 (p = 0.022), additionally a significantly greater percentage of smooth muscle cells was noted in Dacron grafts after 44 and 58 days (p = 0.008, p = 0.036).Due to the decreased thickness of the incorporating matrix as well as the lower percentage of smooth muscle cells, PTFE grafts should be preferred for peripheral arterial revascularisation.

Contrast-enhanced MRI is considered problematic in renal allograft recipients due to the association of gadolinium administration and the development of NSF. Therefore, we assessed the clinical value of mono- and biexponential analysis of diffusion-weighted imaging (DWI).A total of 32 patients were divided into four groups: (a) patients with stable function of renal allograft for at least 6 months, (b) patients with acute deterioration of allograft function, patients who recently underwent transplantation (14 days) with good (c) or decreased (d) renal function. T 2w ax. and T 1w cor. and a diffusion-weighted sequence with 16 b-values (b = 0 - 750 s/mm (2)) were performed on a 1.5 T scanner (Magnetom Avanto, Siemens Medical Solutions). ROI-based analysis of the renal cortex was analyzed using the software "Table Curve 2D".Monoexponential analysis showed an ADC (mono) of 1961 +/- 104 1801 +/- 150, 2053 +/- 169 and 1720 +/- 191 10 (-6)mm (2) /sec for patient group a, b, c and d respectively. The difference in ADC (mono) between group (a) and (b) (p0.006) and between group (c) and (d) (p0.04) was statistically significant. Biexponential analysis revealed a mean perfusion fraction of 0.21, 0.23, 0.32 and 0.24 for group (a), (b), (c) and (d), respectively. Biexponential ADC showed a higher numerical accuracy. There were no statistically significant inter-group differences in diffusion (ADC (D)) and perfusion (ADC (P)).Unenhanced evaluation of renal allografts with DWI is feasible. ADC (mono) of renal cortex correlates with renal function. The significance of the higher numerical accuracy of biexponential analysis in clinical settings requires further evaluation in larger-scale studies.