Laparoscopic esophagotomy without diverticular resection for treating epiphrenic diverticulum in hypertonic lower esophageal sphincter]

INTRODUCTION: As a rule, epiphrenic diverticulum occurs in combination with most diverse forms of dysfunction in the lower esophageal sphincter (LES) and/or in the esophagus itself. The main symptoms are dysphagia, pain, and regurgitation. The operation consists in myotomy, diverticulum resection, and partial fundoplication via abdominal or thoracic approach using conventional or minimally invasive technique. The main risk is postoperative suture dehiscence after diverticular resection. The present study was therefore undertaken to establish whether the operation succeeds in risk patients even without resection of the diverticulum. PATIENTS AND METHODS: In the period from 1998 to 2001, six patients were investigated preoperatively by means of esophageal manometry, endoscopy, and radiological barium swallow. The four risk patients underwent only myotomy of the LES, if appropriate, in combination with laparoscopic partial fundoplication. Resection of the diverticulum by thoracoscopy or with conventional thoracic technique was also performed in the two patients with normal risk. RESULTS: Three of the four risk patients showed normal postoperative courses after laparoscopic myotomy and rapidly became free of symptoms and were able to eat normally. One patient died perioperatively of pulmonary complications. After thoracic diverticulum resection, both patients developed postoperative suture dehiscence with a complicated course. Altogether, freedom from symptoms with regard to dysphagia and regurgitation could be attained in five out of six patients over a follow-up period of 6 to 25 months. CONCLUSION: In patients with epiphrenic diverticulum and disorder of LES function, myotomy alone without resection of the diverticulum may be sufficient to relieve or eliminate symptoms. Laparoscopy and the combination with partial fundoplication are the preferred techniques. In our opinion, this method must be considered in order to reduce the surgical risk in multimorbid and elderly patients.     

Study on the Tongue and Groove Effect of the Elekta Multileaf Collimator Using Monte Carlo Simulation and Film Dosimetry

BACKGROUND: Nowadays, multileaf collimation of the treatment fields from medical linear accelerators is a common option. Due to the design of the leaf sides, the tongue and groove effect occurs for certain multileaf collimator applications such as the abutment of fields where the beam edges are defined by the sides of the leaves. MATERIAL AND METHODS: In this study, the tongue and groove effect was measured for two pairs of irregular multileaf collimator fields that were matched along leaf sides in two steps. Measurements were made at 10 cm depth in a polystyrene phantom using Kodak EDR2 films for a photon beam energy of 6 MV on an Elekta Sli-plus accelerator. To verify the measurements, full Monte Carlo simulations were done. In the simulations, the design of the leaf sides was taken into account and one component module of BEAM code was modified to correctly simulate the Elekta multileaf collimator. RESULTS AND CONCLUSION: The results of measurements and simulations are in good agreement and within the tolerance of film dosimetry.     

Pathomechanismen der Epilepsie

Zusammenfassung Die Epilepsieforschung ist kein neues wissenschaftliches Feld—klinische und experimentelle Untersuchungen werden seit Jahrzehnten betrieben. Trotz dieser fortw?hrenden Bemühungen sind die Pathomechanismen der Epilepsie letztlich nicht vollst?ndig gekl?rt—allerdings gelangen in den letzten Jahren auch beachtliche Fortschritte. Vor allem durch die Kombination genetischer, molekularer und funktioneller Analysen konnten wichtige Teilaspekte der Entstehungsprozesse der Epilepsie aufgekl?rt werden. Der vorliegende übersichtsartikel soll nach einer kurzen Er?rterung der grunds?tzlichen Faktoren der Erregbarkeit einzelner Zellen und des neuronalen Zellverbandes in fünf kurzen Kapiteln einen überblick über den aktuellen Forschungsstand liefern. Innerhalb der ersten drei Abschnitte werden Ver?nderungen spannungsabh?ngiger Str?me, der synaptischen Transmission und deren Modulation sowie der Expression von Gap junctions beleuchtet. Darüber hinaus widmet sich ein Abschnitt morphologischen Ver?nderungen. Der letzte Teil behandelt Aspekte spezifischer genetischer Syndrome. Dieser Beitrag ist bereits in verkürzter Form in der Zeitschrift „Klinische Neurophysiologie“, Bd. 37 (2006), S. 1–9, unter dem Titel „Pathophysiologie der Epilepsie“ erschienen.     

Social disability in different mental disorders.

ObjectiveTo assess the social disability of people with different psychiatric disorders.MethodsCross-site survey in five psychiatric hospitals (Dresden, Wrocław, London, Michalovce and Prague). Working-aged patients diagnosed (ICD-10) with schizophrenia and related disorders (F2), affective disorders (F3), anxiety disorders (F4), eating disorders (F5) and personality disorders (F6), were assessed at admission (n = 969) and 3 months after discharge (n = 753) using the Brief Psychiatric Rating Scale and the Groningen Social Disability Schedule. The main outcome measure was Interviewer-rated social disability.ResultsDuring acute episodes patients with personality, eating and schizophrenic disorders functioned less effectively than those with affective or anxiety disorders. After controlling for age and severity of psychopathology, there was no significant effect of the diagnosis (during remission), sex, education and history of disorder on disability. Site, employment and partnership were significant factors for the level of social disability in both measure points.ConclusionSeverity of psychopathological symptoms, not the diagnosis of a mental disorder, was the most significant factor in determining the level of social functioning, particularly during the remission period. Site, employment and partnership appeared as significant factors influencing the level of social disability.     

Behandlung der Pseudarthrosen des Beckens

Malunion is rare after pelvic fractures. The cardinal symptom is chronic stress-related pain in the pelvic girdle. It is necessary to investigate whether the symptom cluster is caused by malunion, posttraumatic malalignment or a combination of both. The diagnostic workup must include a physical examination with the patient undressed, provocation tests, X-ray investigations (general X-ray view of pelvis, plus views of inlet, outlet, ala, and obturator), and also computer tomography with 2D and 3D reconstructions, which is essential for the analysis of any malalignments, instabilities and malunions in the pelvic girdle. Conservative treatment is not usually adequate for chronic instabilities in the pelvic girdle. The operative procedure selected depends on the localization of the primary injury, malunion and/or malalignment. The basic principle of operative treatment is that all instabilities and/or maluinions in any region must be stabilized. Late operations for reconstruction of the pelvic girdle are challenging and technically difficult interventions, with a complication rate that is anything but negligible. Some of the complications possible are haemorrhage, wound haematomas, vascular and neural lesions, infections, incomplete correction, loss of correction, persisting malunion or symptoms and premature loosening or failure of implants.     

Internalization of sst2, sst3, and sst5 receptors: effects of somatostatin agonists and antagonists.

The uptake of radiolabeled somatostatin analogs by tumor cells through receptor-mediated internalization is a critical process for the in vivo targeting of tumoral somatostatin receptors. In the present study, the somatostatin receptor internalization induced by a variety of somatostatin analogs was measured with new immunocytochemical methods that allow characterization of trafficking of the somatostatin receptor subtype 2 (sst2), somatostatin receptor subtype 3 (sst3), and somatostatin receptor subtype 5 (sst5) in vitro at the protein level. METHODS: Human embryonic kidney 293 (HEK293) cells expressing the sst2, sst3, or the sst5 were used in a morphologic immunocytochemical internalization assay using specific sst2, sst3 and sst5 antibodies to qualitatively and quantitatively determine the capability of somatostatin agonists or antagonists to induce somatostatin receptor internalization. In addition, the internalization properties of a selection of these agonists have been compared and quantified in sst2-expressing CHO-K1 cells using an ELISA. RESULTS: Agonists with a high sst2-binding affinity were able to induce sst2 internalization in the HEK293 and CHO-K1 cell lines. New sst2 agonists, such as Y-DOTA-TATE, Y-DOTA-NOC, Lu-DOTA-BOC-ATE (where DOTA is 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid; TATE is [Tyr3, Thr8]-octreotide; NOC is [1-NaI3]-octreotide; and BOC-ATE is [BzThi3, Thr8]-octreotide), iodinated sugar-containing octreotide analogs, or BIM-23244 were considerably more potent in internalizing sst2 than was DTPA-octreotide (where DTPA is diethylenetriaminepentaacetic acid). Similarly, compounds with high sst3 affinity such as KE108 were able to induce sst3 internalization. In sst2- or sst3-expressing cell lines, agonist-induced receptor internalization was efficiently abolished by sst2- or sst3-selective antagonists, respectively. Antagonists alone had no effect on sst2 or sst3 internalization. We also showed that somatostatin-28 and somatostatin-14 can induce sst5 internalization. Unexpectedly, however, potent sst5 agonists such as KE108, BIM-23244, and L-817,818 were not able to induce sst5 internalization under the same conditions. CONCLUSION: Using sensitive and reproducible immunocytochemical methods, the ability of various somatostatin analogs to induce sst2, sst3, and sst5 internalization has been qualitatively and quantitatively determined. Whereas all agonists triggered sst2 and sst3 internalization, sst5 internalization was induced by natural somatostatin peptides but not by synthetic high-affinity sst5 agonists. Such assays will be of considerable help for the future characterization of ligands foreseen for nuclear medicine applications.     

Further characterization of theobroma oil-beeswax admixtures as lipid matrices for improved drug delivery systems.

There is an increasing interest in lipid based drug delivery systems due to factors such as better characterization of lipidic excipients and formulation versatility and the choice of different drug delivery systems. It is important to know the thermal characteristics, crystal habit, texture, and appearance of a new lipid matrix when determining its suitability for use in certain pharmaceutical application. It is line with this that this research was embarked upon to characterize mixtures of beeswax and theobroma oil with a view to applying their admixtures in drug delivery systems such as solid lipid nanoparticles and nanostructured lipid carriers. Admixtures of theobroma oil and beeswax were prepared to contain 25% w/w, 50% w/w, and 75% w/w of theobroma oil. The admixtures were analyzed by differential scanning calorimetry (DSC), small angle X-ray diffraction (SAXD), wide angle X-ray diffraction (WAXD), and isothermal heat conduction microcalorimetry (IMC). The melting behavior and microstructures of the lipid admixtures were monitored by polarized light microscopy (PLM). Transmission electron microscopy (TEM) was used to study the internal structures of the lipid bases. DSC traces indicated that the higher melting peaks were roughly constant for the different admixtures, but lower melting peaks significantly increased (p < 0.05). The admixture containing 25% w/w of theobroma oil possessed highest crystallinity index of 95.6%. WAXD studies indicated different reflections for the different lipid matrices. However, new interferences were detected for all the lipid matrix admixtures between 2theta = 22.0 degrees and 2theta = 25.0 degrees. The lipid matrices containing 50% w/w and 25% w/w of theobroma oil showed absence of the weak reflection characteristic of pure theobroma oil, while there was disappearance of the strong intensity reflection of beeswax in all the lipid matrix admixtures at all stages of the study. PLM micrographs revealed differences with regard to the thermal and optical behaviors depending on the composition of the matrix. The lipid matrix consisting of 75% w/w of theobroma oil showed a spherulite texture after 4 weeks of isothermal storage. Crystallization exotherms of lipid matrices containing 50% w/w and 25% w/w of theobroma oil showed change in modification after 30 min with the latter having a greater time-dependent crystallization. Generally, low non-integral Avrami exponents and growth rate constants were obtained for all the lipid matrices, with the admixture containing 25% w/w theobroma oil having the lowest Avrami exponent and growth rate constant. Based on the results obtained, admixtures containing 50% w/w and 75% w/w of theobroma oil could be applied in the formulation of solid lipid nanoparticles and nanostructured lipid carriers as these lipid matrices possessed crystal characteristics that favour such drug delivery systems.     

Eight-channel transmit/receive body MRI coil at 3T.

Multichannel transmit magnetic resonance imaging (MR) systems have the potential to compensate for signal-intensity variations occurring at higher field strengths due to wave propagation effects in tissue. Methods such as RF shimming and local excitation in combination with parallel transmission can be applied to compensate for these effects. Moreover, parallel transmission can be applied to ease the excitation of arbitrarily shaped magnetization patterns. The implementation of these methods adds new requirements in terms of MRI hardware. This article describes the design of a decoupled eight-element transmit/receive body coil for 3T. The setup of the coil is explained, starting with standard single-channel resonators. Special focus is placed on the decoupling of the elements to obtain independent RF resonators. After a brief discussion of the underlying theory, the properties and limitations of the coil are outlined. Finally, the functionality and capabilities of the coil are demonstrated using RF measurements as well as MRI sequences.     

Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment,with immediate full weight bearing. Design of a randomized controlled trial

Background  

We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture.