Über die Einwirkung von Coffein auf die Readaptationszeit von Kraftfahrern nach Blendung

Ohne Zusammenfassung     

Abklärung von Lungenrundherden

Pulmonary nodules are the most frequent pathological finding in low-dose computed tomography (CT) scanning for early detection of lung cancer. Early stages of lung cancer are often manifested as pulmonary nodules; however, the very commonly occurring small nodules are predominantly benign. These benign nodules are responsible for the high percentage of false positive test results in screening studies. Appropriate diagnostic algorithms are necessary to reduce false positive screening results and to improve the specificity of lung cancer screening. Such algorithms are based on some of the basic principles comprehensively described in this article. Firstly, the diameter of nodules allows a differentiation between large (>8 mm) probably malignant and small (<8 mm) probably benign nodules. Secondly, some morphological features of pulmonary nodules in CT can prove their benign nature. Thirdly, growth of small nodules is the best non-invasive predictor of malignancy and is utilized as a trigger for further diagnostic work-up. Non-invasive testing using positron emission tomography (PET) and contrast enhancement as well as invasive diagnostic tests (e.g. various procedures for cytological and histological diagnostics) are briefly described in this article. Different nodule morphology using CT (e.g. solid and semisolid nodules) is associated with different biological behavior and different algorithms for follow-up are required. Currently, no obligatory algorithm is available in German-speaking countries for the management of pulmonary nodules, which reflects the current state of knowledge. The main features of some international and American recommendations are briefly presented in this article from which conclusions for the daily clinical use are derived.     

von Hippel-Lindau综合征一例

患者 女，30岁。头痛，头晕、行走不稳2d入院，伴恶心，无呕吐。体检：心肺听诊正常，腹软，无压痛。专科检查：步态不稳。Romberg征阳性，双下肢共济失调，眼底检查无异常。     

Zertifizierung von Gef??zentren

Diagnosis and therapy of vascular diseases are increasingly being performed following a multimodal, interdisciplinary and less invasive approach. The introduction of specialized, organ-related centers is a logical consequence in view of a better treatment quality and a more effective use of resources. The German societies of radiology, vascular surgery and angiology jointly developed a process of certification, which has been successfully applied to more than 100 units in Germany. In this article the terms and results of the process are described and possible effects on the quality and structures of the healthcare system are discussed.     

von Hippel-Lindau病影像学诊断

目的 探讨von Hippel-Lindau病（VHL病）的影像学特征。资料与方法 回顾性分析7例VHL病影像学表现以及临床、病理资料。结果 7例VHL病影像学表现包括均有1处或1处以上的中枢神经系统血管母细胞瘤,5例有1处或多处包括胰腺多发囊肿、双肾多发肿瘤和囊肿以及阴囊肿瘤在内的内脏病变。结论 VHL病为家族性遗传性多系统肿瘤综合征,熟悉其影像学表现有利于正确诊断。     

Über die Ausbildung von Strommarken bei der Einwirkung von Elektrizität im Wasser

Zusammenfassung Unter besonderen Bedingungen bilden sich bei Stromdurchgang durch einen teilweise im Wasser befindlichen Körper entlang dem Wasserspiegel streifenförmige Strommarken aus. Sie können auch an der Leiche noch hervorgerufen werden. Die Voraussetzungen hierfür wurden dargelegt.Vortrag anläßlich der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin in Zürich, September 1958.     

Ein Fall von Erhängungstod

Ohne Zusammenfassung Aussprache zum Vortrag K. Reuter: HerrRücker-Hamburg,Walcher-Würzburg undWerkgartner-Wien berichten über ähnliche Beobachtungen.HerrMerkel-München demonstriert einen durch die Art der Vorbereitung grotesken Fall von bewußt durchgeführtem Selbstmord. Ein Gefangener hatte sich in Rückenlage den breiten Fuß des Klapptisches auf die vordere Halsseite aufgesetzt, den er mit Bett und Matratzenstücken belastet hatte.HerrKoopmann-Hamburg: Am 26. VII. 1937 kam in Hamburg ein Fall von unbeabsichtigter Selbsttötung zur Beobachtung, der wie der Hamburger Fall aus dem Jahre 1932 dem vonKarl Reuter-Breslau beschriebenen an die Seite zu stellen ist.Die Leiche eines 62jährigen Strangulierten wurde um 10 Uhr morgens von dem Hausmädchen gefunden. Diese hatte nachts um 2 Uhr ein dumpfes Geräusch gehört. Die Leichenschau am Tatort ergab folgendes: Die Leiche befindet sich in halbsitzender Stellung an eine Tür und zum Teil an die Wand des Zimmers gelehnt. Der Kopf der Leiche ist nach links gegen einen Heizkörper gesunken. Die Leiche ist starr. Um den Hals der Leiche findet sich eine Schnürmarke, die von vorn nach hinten oben verläuft. Die Leiche ist bekleidet mit Weste, Oberhemd, Netzherrenschlüpfer, dunklen Damenstrümpfen und hohen schwarzen Damenknopfstiefeln und trägt ein Glas. Unter dem linken Arm der Leiche liegt ein Stapel von 6 Büchern, der nach links abgerutscht ist. An der oberen Türangel ist eine dünne Schnur in einfacher Schlinge befestigt, die in der Mitte durchgerissen ist. Die Schnürenden sind aufgefasert. In etwa 1 m Abstand von der Leiche ist ein großer Spiegel an einen Stuhl gelehnt. Zu beiden Seiten der Leiche Lampen, von denen die eine bei Auffindung der Leiche noch brannte. Die Ehefrau des Strangulierten ist verreist.Nach dem Tatortbefund erschien fremdes Verschulden ausgeschlossen. Es wird angenommen, daßes sich um einen Fall handelt, in dem sexual-pathologisches Reiz- und Sensationsbedürfnis durch einen Unglücksfall (Abrutschen des Bücherstapels) in actu letal ausgegangen ist.     

Zum Nachweis von Thiophosphorsäureestern

Ohne ZusammenfassungDie ausführliche Arbeit (Fischer, u.Klingelhöller) erscheint demnächst im Archiv für Toxikologie.     

Strahlenbehandlung von follikulären Keimzentrumslymphomen

Purpose

Follicle centre lymphoma grade I, II (REAL) or centroblastic-centrocytic lymphoma (Kiel classification) present a well defined clinical entity from a clinical point of view. These lymphomas are not curable by chemotherapy in early or advanced stages. They are treated by radiation therapy in early stages, but up to now the curative potency of radiotherapy has not been confirmed by prospective clinical trials.

Patients and Method

Between January 1986 and August 1993 117 adults with follicle centre lymphoma were recruited from 24 institutions to enter the multicentric prospective, not randomised clinical trial. Patients with histologically proven nodal follicle centre lymphoma of stages I, II and limited III were included. They were treated by a standardised radiotherapy regimen, in stage I by extended field and in stages II and III by total nodal irradiation. Dose per fraction was 1.8 to 2.0 Gy, in the abdominal bath 1.5 Gy up to a total dose of 26 Gy in adjuvant situation and 36 Gy to enlarged lymphoma.

Results

All patients developed a complete remission at the end of radiotherapy. Median follow-up is 68 months. Overall survival of all patients is 86±3% at 5 and 8 years. Stage adjusted survival at 5 and 8 years was 89% for stage I, 86% for stage II and 81% for III. Patients in stages I and II <60 years had survival rates of 94% at 5 and 8 years, patients >60 years 63% (p < 0.0001). Recurrence free survival of all patients is 70% at 5 and 60±5% at 8 years. The number of recurrences is high with 29% at 5 and 41% at 8 years. All recurrences were seen within 7 years. The probability of localised nodal in-field recurrences is 11% and 22% at 5 and 8 years, respectively. Adverse prognostic factors were identified by multivariate analysis: age >60 years, treatment breaks ≥7 days and dose deviations >20% from prescribed doses Acute side effects of extended field irradiation were moderate.

Conclusions

On the basis of these results radiotherapy is a potentially curative therapeutic approach in stages I, II and limited III of follicle centre lymphoma. The optimal technique is total lymphoid irradiation with doses of 30 Gy in the adjuvant situation and 40 to 44 Gy in enlarged lymphomas. The number of local recurrences leads to the assumption that the extension of radiotherapy to the total lymphoid system might reduce their frequency.     

Der stereoselektive Nachweis von l- und d-Methadon in Blutproben von lebenden und verstorbenen Drogenabhängigen

In Germany, there is a special situation that racemic dl-methadone and the (biologically effective) l-form (levomethadone) are both used as a substitute for heroin. The therapeutic effect of methadone is stereo-specific and the metabolism is also enantioselective. Therefore an approach to the dose-effect relationship of methadone requires an enantioselective analytical separation. For this a HPLC method was optimised especially for post-mortem blood samples. After liquid/¶liquid extraction with 1-chlorobutane, the extract was separated on a column combination of 4 cm CN and 10 cm chiral AGP phases with the solvent AcN/ 0.01 M PO₄ buffer ¶pH 5.0/ dimethyloctlyamine (15/85/0.5). ¶The methadone enantiomers elute baseline separated at approx. 15 min (l-form) and ¶18 min (d-form). The two EDDP-enantiomers and drugs which are frequently consumed supplementary to methadone such as heroin, cocaine, benzodiazepines, tricyclic antidepressants, antiepileptics etc. , do not interfere with detection. With this method the methadone l/d-ratio was determined in 93 serum samples from living addicts and 106 post-mortem blood samples from drug deaths. From the l/d-ratio and the concentration of total methadone as determined by other methods (GC-MS or RP-HPLC) the l-methadone concentration was calculated. In approximately 50% of the post-mortem samples the l-methadone concentration was higher than 0.3 mg/l, whereas this level was exceeded in only one of the living persons. ¶If dl-methadone was taken, the individual l/d-ratio in blood samples from living as ¶well as deceased persons differed greatly ranging from approx. 25/75 to 75/25, with ¶a mean of 50/50. In samples from 1999, ¶l-methadone was found exclusively in approx. 20% of the cases. In some cases it was obvious that both l- and dl-methadone had been used. Fatal cases with high l-methadone concentrations (>1 mg/l) gave rise to concern, because the l/d-ratio greatly exceeded 50/50in all cases . This could be considered as an indication of an individually extremely slow metabolism of l-methadone in these cases, resulting in an accumulation of l-methadone. These examples from the forensic casework demonstrate the necessity of an enantioselective quantification of ¶l-methadone as used for therapeutic drug monitoring and in forensic cases.     

Der Einfluß der Therapie auf das Überleben von Patienten mit Pankreaskarzinom Eine Analyse von Einzelfaktoren

PURPOSE: To identify the impact of treatment factors on overall survival in patients with pancreatic carcinoma. PATIENTS AND METHODS: We performed a follow-up study on 38 patients with adenocarcinoma of the pancreas treated from 1984 to 1998. 18/38 patients were resected. Irradiated volume included the primary tumor (or tumor bed) and regional lymph nodes. Thirty-seven patients received in addition chemotherapy consisting of mitoxantrone, 5-fluorouracil and cis-platin, either i.v. (14/38) or i.a. (23/38). The influence of treatment related factors on the overall survival was tested. Biologically effective dose was calculated by the linear-quadratic model (alpha/beta = 25 Gy) and by losing 0.85 Gy per day starting accelerated repopulation at day 28. RESULTS: Treatment factors influencing overall survival were resection (p = 0.02), overall treatment time (p = 0.03) and biologically effective dose (p < 0.002). Total dose and kind of chemotherapy had no significant influence. Treatment volume had a negative correlation (r = -0.5, p = 0.06) with overall survival, without any correlation between tumor size, tumor stage, and treatment volume. In multivariate analysis only biologically effective dose remained significant (p = 0.02). CONCLUSIONS: Among with surgery, biologically effective dose strongly influences overall survival in patients treated for pancreatic carcinoma. Treatment volume should be kept as small as possible and all efforts should be made to avoid treatment splits in radiation therapy.     

Nachweis von Emulgatoren gebräuchlicher Pflanzenschutzmittel

Summary It is report upon the detection of the emulsifier of E 605 forte, Systox, and Metasystox. The emulsifier is isolated from the stomach-contend by extraction with alkohol an nitrated with nitric and sulphuric acid. The acid nitro-products are demonstrated by paper chromatography.

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Vortrag auf der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin in Zürich, September 1958.     

von Hippel－Lindau综合征一例

ｖｏｎＨｉｐｐｅｌ－Ｌｉｎｄａｕ综合征一例曹庆选，沈廷烈，谭发亮，张建光ｖｏｎＨｉｐｐｅｌ综合征是指家族性视网膜血管瘤病，若同时累及中枢神经系统即为视网膜及中枢神经血管瘤病；累及小脑时则称为ｖｏｎＨｉｐｐｅｌ－Ｌｉｎｄａｕ综合征。我们得见１例，累及小...     

Brüche von Röhrenknochen

Ohne Zusammenfassung     

Ergebnisse der Strahlentherapie von Wirbelkörperangiomen

PURPOSE: Assessment of treatment results of symptomatic vertebral hemangiomas and review of the literature (Table 3). PATIENTS AND METHODS: Ten patients treated between 1974 to 1997 were retrospectively analyzed. Efficacy of treatment was determined according to improvement of pain and/or neurological symptoms (Table 1). RESULTS: Improvement was achieved in 8 of 10 patients. The initially existing neurological symptoms of 3 patients disappeared completely in 2 cases and improved in 1 case. Acute side effects were slight. Late side effects were not seen. A dose-effect relationship could not be assessed. There was no relapse. CONCLUSION: Radiotherapy with 30 Gy for symptomatic vertebral angioma as primary therapy is indicated. In case of neurological symptoms a radiotherapy after operative therapy is recommendable even if the patient is free of symptoms to prevent progress or relapse.     

Management von Speicheldr��senerkrankungen mittels Kontrastmittelapplikation

Obstructive diseases of the salivary glands are a common problem in otorhinolaryngology. They are mostly due to sialolithiasis followed by duct stenosis and other rarer causes. Several diagnostic modalities exist which allow classification of the disease; however, in 5-10% of all cases ultrasound and conventional radiological imaging do not provide a clear diagnosis. Ultrasound examination with contrast material injected into the duct (IA-CEUS, intraductal administered contrast-enhanced ultrasound) enables improved evaluation of obstructive diseases of the salivary glands and at the same time an evaluation of the parenchyma of the glands is possible. As a complementary method to conventional investigation techniques IA-CEUS is an economic and rapid method with low side-effects which improves the diagnostic assessment of ultrasound and results in a better treatment for patients.     

Über die Verwendung von Polyviol an Stelle von Stärkelösung bei der titrimetrischen Blutalkoholbestimmung

Ohne Zusammenfassung