Zwitterbildung der Äu\eren Genitalien,rudimentÄre Zwitterbildung der GeschlechtsgÄnge bei einem mÄnnlichen Individuum

Ohne ZusammenfassungVorgetragen auf der XIV. Tagung der Dtsch. Ges. f. gerichtl. u. soz. Med. in Bonn, September 1925.     

Unbegründete Ängste der Klinikärzte und der pharmazeutischen Industrie vor den Änderungen des Antikorruptionsgesetzes

Ohne Zusammenfassung     

Neue Erkenntnisse zur Ätiologie der sogenannten Strahlenkaries

Aim

In spite of a great number of relevant studies the etiology of radiation induced caries still is discussed in controversy: The assumption of direct radiation induced lesions in the hard tissue is in contrast to an indirect pathogenesis mediated via radio-xerostomia.

Methods

A systematic study is presented, comparing teeth with a manifest radiation caries (group 1, about 60 Gy, long interval to the extraction) and clinically caries free teeth (group 2, about 30 Gy, short interval) with tooth specimens after an experimental enoral (in situ) irradiation (60 Gy, group 3) and after in vitro irradiation (500 to 2.500 Gy, group 4).⁶⁰Co was the irradiation source. Sound teeth were used as a standard (group 5). For non destructive visualisation of subsurface histotomograms by confocal laser scanning microscopy (CLSM) teeth were either used as fresh sections or as Technovit embedded thin slices (sawing grinding technique).

Results

Tooth samples from radiotherapy patients (cancer therapeutic doses, long interval before extraction; group 1) showed three characteristic changes: 1. rarefication of the branching (ramification) of odontoblast processes near the junction, 2. dentine tubules end infront of the interface to the hard tissue and 3. in dentine the interface is characterised by an zone (about 10 μm wide) of low intensity of the remitted light.

Conclusions

The obliteration of the dentine tubules, preceded by a degeneration of the odontoblast processes, is obviously the result of a direct radiogenic cell damage with hampered vascularisation and metabolism particularly in the area of the terminations of the odontoblast processes. The deficit in metabolism combined with a latent damage of the parenchyma (hypo-remitting zone) is evidence for the functional symptoms (subsurface caries). The prerequisite for the micromorphological manifestation of this direct irradiation damage is a vital tooth and in consequence cannot be simulated in situ or in vivo.     

Veränderungen im visuomotorischen System während der Phase der Äthanolanflutung

Aim

The purpose of the study was to investigate the correlation between the blood alcohol concentration (BAC) and the resulting alcohol-induced alterations of neurophysiological parameters of functional brain imaging.

Material and methods

In this study 14 healthy subjects were investigated before and after forced rapid drinking of alcohol using functional magnetic resonance imaging. In order to evoke brain activity in the visual and motor cortex a visuomotor task was presented. During the measurements taken under alcoholic conditions venous blood samples were collected from the subjects at regular intervals.

Results

In the range between 0.5?‰ and 0.93?‰ no linear dependency between BAC and the blood oxygenation level-dependent (BOLD) signal was observed. The maximum alcohol-induced changes of the BOLD signals were found in the range of 0.7?‰.

Conclusion

The observed correlation between the BAC and the neurophysiological changes can be interpreted as the correlate of the influx phase after forced alcohol drinking.     

VerstÄrkung der radiotherapeutischen wirkung auf HeLa-Zellen durch gemcitabine

BACKGROUND: Gemcitabine (2'.2'-difluorodeoxycytidine; dFdC) is a new nucleoside analog with promising activity in different solid tumors in vivo and in vitro. As published up to now, combined with irradiation dFdC demonstrates a radiosensitizing effect on pancreas and colon carcinoma cell lines. We investigated the influence of dFdC on the radiosensitization of human squamous carcinoma cells of the cervix (HeLa-cells, ATCC CCL-2). MATERIAL AND METHODS: Under standardized conditions monolayer cultures of HeLa-cells were incubated in medium with dFdC for different times (4 to 24 hours) and exposed to different concentrations (0.003, 0.01 and 0.03 mumol/l). Irradiation (2 to 6 Gy, electron beam) followed immediately or 12 hours after dFdC-exposure. Cell survival was determined by colony forming assay. Using the linear-quadratic model cell survival curves were fit after correction for drug-induced cytotoxicity and the mean inactivation dose (MID) was calculated. Radiation enhancement was defined as the ratio MIDRT(= Control)/MIDRT + dFdC > 1. RESULTS: Exposed to gemcitabine for 4 and 8 hours and followed by immediate irradiation the radiation enhancement ratio (Table 1) is 1.07 to 1.14 and 1.04 to 1.22, respectively, if dFdC concentration is > or = 0.01 to 0.03 mumol/l. Further increase of the irradiation effect is demonstrated in cells exposed to > or = 0.003 to 0.03 mumol/l dFdC for 16 and 24 hours (radiation enhancement ratio 1.08 to 2.0 and 1.08 to 2.48, respectively) (Figure 3). If irradiation is applied 12 hours after 24-hour-exposure (0.01 and 0.03 mumol/l) the enhancement ratio was 1.18 and 1.7, respectively (Figure 4). CONCLUSIONS: In cell cultures the assays combining irradiation with dFdC demonstrate that dFdC is a potent radiation sensitizer of HeLa-cells. The effect of irradiation on cells pre-treated with non- and hardly cytotoxic concentrations of dFdC is increased in dependence of dose and time of exposure.     

Ärztliche Berufsgerichtsbarkeit in den Ländern der Europäischen Wirtschaftsgemeinschaft

Ohne Zusammenfassung     

Kriminologie der Abtreibung durch Ärzte mit Bemerkungen über das kommende Strafrecht

Ohne Zusammenfassung     

Änderungen der Hämoglobinkonzentration bei kombinierter Radio- und Chemotherapie lokal fortgeschrittener HNO-Tumoren

BACKGROUND: Despite multimodality treatment strategies of locally advanced head and neck cancers long-term results leave much to be desired. There is evidence that oxygenation status of head and neck tumors is directly influenced by the hemoglobin concentration. The aim of this study was to verify changes in the hemoglobin level during combined radio-chemotherapy of locally advanced head and neck tumors. PATIENTS AND METHODS: Sixty-eight patients with locally advanced head and neck cancer had primary or adjuvant radiotherapy with doses of 60 to 74 Gy in combination with cisplatin- (+/- 5-FU) or carboplatin chemotherapy in the first and fifth week of treatment. Hemoglobin levels were analyzed before and at the end of radiotherapy. RESULTS: In 41% of all patients the initial hemoglobin concentration was below normal levels. The mean hemoglobin values in all patients dropped significantly from 12.9 +/- 1.7 g/dl before to 11.6 +/- 1.6 g/dl at the end of treatment. In 12 cases (18%) allogeneic erythrocytes had to be transfused during treatment. At the end of treatment 76% of all patients had anemic hemoglobin levels. In the groups of patients with cisplatin and carboplatin chemotherapy a significant decrease in hemoglobin levels was seen without meaningful statistical difference between these 2 groups. CONCLUSIONS: In patients with locally advanced head and neck cancer a high initial rate of anemia was registered (41%): This rate was nearly doubled during chemoradiation (76%). Since several studies have shown a correlation between hemoglobin levels and local tumor control, there is evidence, that this group might benefit from correcting anemia before combined radio-chemotherapy.     

Die Fettembolie der Lungen als Todesursache. Ätiologie,Pathogenese und Beweisführung

Zusammenfassung Darstellung der Literatur zur Ätiologie, Pathogenese und Pathophysiologie der Fettembolie. Die Pathomorphologie der pulmonalen Fettembolie zeigt Ähnlichkeiten mit jener der Schocklunge. Besonders die wechselwirkenden Faktoren zwischen Fettembolie und Schock werden erörtert. Die Wirkungen der pulmonalen Fettembolie werden unterteilt in: mechanische, toxische und Schockinduzierende Wirkungskomponenten. Verfasser kommen zu der Ansicht, daß die pulmonale Fettembolie ein eigenständiges Krankheitsgeschehen darstellt. Es werden 26 Todesfälle mit und ohne Fettembolie untersucht. Die Fettembolie wird morphologisch und gravimetrisch quantifiziert. Bei geringen Graden der Fettembolie besteht eine schlechte Korrelation zwischen mikromorphologischem Grad und gravimetrischem Ergebnis. Bei hohem Grad der Fettembolie besteht scheinbar eine engere Korrelation. Zusätzlich finden sich bei hohen Fettemboliegraden Mikrohämorrhagien, Mikrothromben.Die todesursächliche Bedeutung der pulmonalen Fettembolie wird eingehend besprochen. Verfasser kommen zu dem Schluß, daß eine eingehende individuelle Beurteilung meist erforderlich sein wird. Die Diagnose Tod durch pulmonale Fettembolie ist eine Diagnose per exclusionem.

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Fat embolism of the lungs as the cause of death. Etiology, pathogenesis and reasoning

Summary A comprehensive survey is given of the most important theories of etiology, pathogenesis and pathophysiology of pulmonary fat embolism. Autopsy and microscopic examinations were performed on 26 corpses with different causes of death. The total contents of fat of the lungs was analyzed by chloroform extraction. Death due to pulmonary fat embolism was diagnosed in three cases. In those with whole fat contents of about 20 g or more the histological degree was equivalent to occlusion of half of all vessels. The histological feature resembled that of shock; hemorrhage and microthrombosis were regular findings. The functional and morphological relationships with shock are discussed. It is concluded that, at least in the initial stage, fat embolism is due to mechanical injury. This mechanism is possibly altered or enhanced by biochemical changes in later phases. Pulmonary fat embolism is a disease which may cause death if mechanical, toxic and shock-inducing effects lead to insufficiency of the cardio-respiratory system. In forensic cases death due to fat embolism should be diagnosed only after exclusion of other lethal factors. Posttraumatic cases often show competition with shock due to hemorrhage. It is important to relate the degree of fat embolism to preexisting diseases.

Wir danken Frau C. Smukowski und Frau P.S. Warkus für sorgfältige Assistenz.     

Rekonstruktive endovaskuläre Behandlungsverfahren im Bereich der A. subclavia und ihrer Äste

PURPOSE: Principles, methods and results of percutaneous therapy in acute and chronic vascular alterations of the subclavian artery and its branches. MATERIAL AND METHODS: 17 arteries in 15 patients have been treated. The patients suffered from stenoses (n = 6), occlusions (n = 7), aneurysms, (n = 2) or acute hemorrhage (n = 2). The lesions were located in the subclavian artery (n = 8), the axillary artery (n = 4) or the vertebral artery (n = 5). In all cases the procedures were performed via via a transfemoral approach. Balloon angioplasty was employed in 13 cases, in 6 cases bare stents and in 4 cases grafted stents were implanted. In one case additionally local lysis was performed. RESULTS: Primary technical success was achieved in all cases. No catheter complications did occur. In 13 Patients complete follow-up examinations could be performed. The life-threatening acute hemorrhages were stopped without recurrent bleeding. The aneurysms could be completely excluded without endoleaks. In 4 Patients of the stenosis-group re-stenosis occurred and following stent-implantation one occlusion after 6 months was observed. 8 patients are without clinical symptoms since the intervention. CONCLUSION: Stenotic and occlusive vascular alterations as well as aneurysms and the acute hemorrhage in supraaortic arteries can be effectively and safely treated by endovascular techniques using percutaneous groin access.     

Anordnung des Ruhens der ärztlichen Approbation nach x 6 Abs. 1 Nr. 3 BÄO; Sofortvollzug der Ruhensanordnung

Abstrakt Der Sofortvollzug der Ruhensanordnung der Approbation setzt voraus, dass er schon vor Rechtskraft des Hauptsacheverfahrens als Präventivmassnahme zur Abwehr konkreter Gefahren für wichtige Gemeinschaftsgüter erforderlich ist. Die Massnahme dient dem Schutz der Patienten vor einem Tätigwerden von Personen, deren Eignung zur Ausübung des Arztberufs zweifelhaft geworden ist. Die Nichtwahrnahme von angeordneten ärztlichen Untersuchungsterminen rechtfertigt im Zusammenhang mit der Vorgeschichte und der Alkoholproblematik Zweifel an der gesundheitlichen Eignung i.S. der Neufassung von x 3 Abs. 1 S. 1 Nr. 3 BÄO.     

Gesetzgebung. Ärsterecht

International Journal of Legal Medicine -     

Gesetzgebung. Ärzterecht

Ohne Zusammenfassung     

Kunstfehler. Ärzterecht

Ohne Zusammenfassung