Intensive Care Unit-Acquired Weakness – diagnostischer Stellenwert des neuromuskulären Ultraschalls

Die Anaesthesiologie - Die Intensive Care Unit-Acquired Weakness (ICUAW) stellt eine der häufigsten neuromuskulären Komplikationen in der Intensivmedizin dar. Besonders bei...     

The Impact of IMRT and Proton Radiotherapy on Secondary Cancer Incidence

BACKGROUND AND PURPOSE: There is concern about the increase of radiation-induced malignancies with the application of modern radiation treatment techniques such as intensity-modulated radiotherapy (IMRT) and proton radiotherapy. Therefore, X-ray scatter and neutron radiation as well as the impact of the primary dose distribution on secondary cancer incidence are analyzed. MATERIAL AND METHODS: The organ equivalent dose (OED) concept with a linear-exponential and a plateau dose-response curve was applied to dose distributions of 30 patients who received radiation therapy of prostate cancer. Three-dimensional conformal radiotherapy was used in eleven patients, another eleven patients received IMRT with 6-MV photons, and eight patients were treated with spot-scanned protons. The treatment plans were recalculated with 15-MV and 18-MV photons. Secondary cancer risk was estimated based on the OED for the different treatment techniques. RESULTS: A modest increase of 15% radiation-induced cancer results from IMRT using low energies (6 MV), compared to conventional four-field planning with 15-MV photons (plateau dose-response: 1%). The probability to develop a secondary cancer increases with IMRT of higher energies by 20% and 60% for 15 MV and 18 MV, respectively (plateau dose-response: 2% and 30%). The use of spot-scanned protons can reduce secondary cancer incidence as much as 50% (independent of dose-response). CONCLUSION: By including the primary dose distribution into the analysis of radiation-induced cancer incidence, the resulting increase in risk for secondary cancer using modern treatment techniques such as IMRT is not as dramatic as expected from earlier studies. By using 6-MV photons, only a moderate risk increase is expected. Spot-scanned protons are the treatment of choice in regard to secondary cancer incidence.     

Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation

BACKGROUND: The problems associated with rectal surgery are frequently discussed with no reference being made to the distance of the tumor from the anal verge. This study examined the effect of the location of the tumor on early postoperative results. PATIENTS AND METHODS: This was a multicenter study involving 75 German hospitals and 3756 patients, of whom 1463 had rectal carcinoma. On the basis of the location of the tumor (distance from the anal verge), four groups were distinguished: <4, 4-7.9, 8-11.9, and 12-16 cm. RESULTS: Resection and abdominoperineal resection rates and the incidence of postoperative complications depended on the location of the tumor. Significantly higher resection rates and fewer specific complications, and a significant reduction in overall postoperative morbidity were found with tumor locations more than 8 cm from the anal verge. The highest anastomotic leak rate was observed with anastomoses less than 7 cm from the anal verge. The logistic regression showed that the distance of the tumor from the anal verge is an independent variable for the development of an anastomotic leak. CONCLUSIONS: Early results are greatly affected by the location of the rectal carcinoma. This applies to both abdominoperineal resection rates and specific postoperative complications, such as anastomotic leak rate and operation morbidity in general.     

Kleiner Fixateur externe bei distalen Unterarmfrakturen und Handgelenkverletzungen

The small external fixator can be used in the treatment of injuries of the wrist and the distal forearm.This fixator is indicated especially when an unstable fracture needs to be treated, when the bone concerned is affected by osteoporosis in an elderly patient,and in the early treatment of polytraumatized patients with severe soft tissue injuries.For reduction of the fracture we prefer the modular three-tube technique, which is very gentle on the soft tissue; in addition we use the advantages of ligamentotaxis.Depending on the fracture type,we use the small external fixator alone or in association with an internal osteosynthesis.With scrupulous followup checks in the outpatient clinic loosening of the Schanz screws and infection around them are very rare.     

Reproduktionsmedizin

Since the introduction of in vitro fertilization in 1978, reproductive medicine and its associated scientific fields have developed rapidly. In Germany, progress in this field is impeded by the German Embryo Protection Act. Exemplary are the prohibition of embryo selection and the ban on genetic testing of the pre-implantation embryo. Nevertheless, infertility treatment outcome has to be optimized within the framework of this law, with the aim of making treatment more efficient, lowering the incidence of multiple gestations, making ovarian hyperstimulation safer, as well as reducing the financial costs for the couple.     

Der Einsatz des Prophy-Jet®-Gerätes zur Schmelzpolitur nach der Bracketentfernung

Zusammenfassung In einer In-vitro-Studie wurde die Einsatzfähigkeit des Prophy-Jet-^®-Gerätes für die Schmelzpolitur nach Bracketentfernung untersucht. In die Studie wurden drei verschieden stark gefüllte orthodontische Kleber einbezogen: Concise^®, Genie^® und Mono Lok^®. Alle Proben wurden rasterelektronenoptisch untersucht und fotografisch dokumentiert in Vergrößerungen zwischen 20- und 10 000fach. Die Oberflächenanalyse ergab, daß das Prophy-Jet^®-Gerät allein zur Schmelzpolitur nach Bracketentfernung nicht ausreicht, um unter klinisch vertretbarem Zeitaufwand (1 Minute/Zahn) eine kunststofffreie Schmelzoberfläche zu erzielen. Nach konventioneller makroskopischer Vorreinigung mit Scalern oder rotierenden Hartmetallfinierern zeigten sich nach fünfsekündiger Prophy-Jet^®-Bestrahlung noch geringe Kleberreste. Nach zehnsekündiger Expositionsdauer waren beim Mono Lok^®-Adhäsiv keine Kleberreste mehr nachweisbar, beim Concise^®-bzw. Genie^®-Adhäsiv fanden sich noch vereinzelte geringe Kleberinseln. Das Prophy-Jet^®-Gerät erscheint zur Unterstützung der Schmelzpolitur nach Bracketentfernung sinnvoll; eine sorgfältige Vorreinigung mit Hand- oder rotierenden Instrumenten ist jedoch erforderlich, um eine weitgehende Adhäsivreduktion zu erreichen. Die konventionelle Gummi- und Bimssteinpolitur kann nach 20sekündiger Prophy-Jet^®-Bestrahlung entfallen.

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Summary The purpose of this in vitro investigation was to ascertain the effects of the Prophy-Jet^® air-powder abrasive system for enamel polishing after debonding. Three adhesives differing in filler content were included in this study: Concise^®, Genie^®, and Mono Lok^®. All specimens were examined by scanning electron microscopy and documented photographically at magnifications from 20 to 10 000. Surface analysis showed that using the Prophy-Jet^® exclusively is not sufficient to produce a clean and smooth enamel surface without residual adhesive after debonding and after one minute of exposure time, as might be justifiable in a clinical situation. After macroscopic conventional clean-up with scalers or rotary finishing instruments and five seconds of exposure time to the Prophy-Jet^® some occasional adhesive remnants could be located. After ten seconds of Prophy-Jet^® treatment all Mono Lok^®-adhesive was removed from the enamel surface; in the Concise^® and Genie^®-group few isolated adhesive remnants could be detected. The Prophy-Jet^® air-powder abrasive system was found to be efficient in supporting enamel polishing after debonding; but an accurate pretreatment with scalers or rotary finishing instruments is essential to achieve an extensive reduction of adhesive. Final polishing of the enamel surface with rubber wheels or prophy cup and pumice can be omitted after treatment with the Prophy-Jet^® for 20 seconds.

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Résumé Le but de ce travail était d'éxaminer à l'aide d'une étude in vitro, l'emploi du Prophy Jet^® pour le polissage de l'émail après l'arrachage des brackets. Dans l'étude on a analysé trois substances adhésives différentes: Concise^®, Genie^® et Mono Lok^®. Après avoir examiné les spécimens par le microscope électronique à balayage, on les a documentés à l'aide de photos d'un grossissement de 20 à 10 000. L'analyse de la surface montre que la seule application du Prophy Jet^® (après l'arrachage des brackets) ne suffit pas pour obtenir une surface d'émail sans substance adhésive en un temps clinique d'une minute par dent. Après prétraitement macroscopique selon la méthode conventionnelle (scaler ou instruments montés sur tour) il demeurait encore de petits restes de la substance adhésive après l'application du Prophy Jet^® pendant cinq secondes. Après une durée d'application de dix secondes, on ne pouvait pas déceler de restes de Mono Lok^®, tandis qu'il y avait sporadiquement des restes de Concise^® et Genie^®. Ces résultats indiquent, que le Prophy Jet^® est efficace pour le polissage de l'émail après l'arrachage des brackets, mais on a tout de même besoin d'un nettoyage précédent minutieux avec des instruments convenables (scaler ou instruments montés sur le tour) pour obtenir une réduction considérable de la substance adhésive. On peut renoncer au polissage conventionnel à l'aide de caoutchouc ou de la pierre ponce après l'application du Prophy Jet^® pendant 20 secondes.

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Vortrag auf der wissenschaftlichen Jahrestagung der Deutschen Gesellschaft für Kieferorthopädie 1985.