Mammakarzinom zwischen Krankheits- und Managementaspekten

Ohne Zusammenfassung     

Impaired modulation of motor cortex excitability by homonymous and heteronymous muscle afferents in focal hand dystonia.

A decrease of heteronymous median nerve-evoked inhibition of corticospinal projections to forearm extensor muscles was reported in a group of 10 dystonic patients by Bertolasi and colleagues in 2003. Here we tested the excitability of corticomotoneuronal connections to both wrist extensor (ECR) and flexor (FCR) muscles after conditioning stimulation of median and also radial nerve at rest in a group of 25 patients with focal hand dystonia compared to 20 healthy subjects. We also investigated the effect of the wrist dystonic posture, either in flexion or in extension, on the afferent modulation of ECR and FCR motor evolved potentials (MEPs). The heteronymous (median-induced) but also homonymous (radial-induced) inhibitions (interstimuli intervals 13-21 ms) of ECR MEP size observed in healthy subjects were decreased in patients. In addition, homonymous (median-induced) facilitation of FCR MEP size was also decreased in patients while heteronymous inhibition (radial-induced) was not. Neither the involvement of the target muscle in the dystonic posture nor the origin of the afferent volley (from a dystonic muscle) influenced the degree of impairment of afferent modulation of the MEP. These findings support the view that a global abnormal somatosensory coupling in focal hand dystonia may contribute to an inadequate motor command to wrist muscles.     

Bildgebung der Nasennebenhöhlen (NNH) in der heutigen Zeit

CT is accepted as the gold standard for pathological-anatomical evaluation of paranasal sinus disease, CT is especially considered an obligatory part of planning surgical procedures. Indications for paranasal sinus CT include trauma, malignant disease, and chronic sinusitis, which accounts for the major part of examinations. Due to the benign character of the disease and the relatively moderate age of the patients involved, the radiation dose of paranasal sinus CT plays an important role. The use of a low-dose spiral CT technique and the reformation of coronal images out of the axial CT data instead of an additional direct coronal scan allow the effective dose of paranasal sinus CT to be reduced to the order of a chest radiogram. MRI is the preferred imaging modality in malignant disease or complications of inflammatory sinus disease that extend beyond the limits of the paranasal sinuses. The clinical value of other imaging modalities, including plain film radiography, ultrasound, or scintigraphy, is limited to special indications.     

Endokrine Therapie des metastasierten Mammakarzinoms

One of the characteristics of breast cancer is its hormone dependency, which provides a number of effective approaches for treatment. Endocrine therapies usually have a good tolerability and oral application is convenient. Third generation aromatase inhibitors are well established in the treatment of metastatic breast cancer, having overtaken Tamoxifen. In the adjuvant setting, the ATAC trial is beginning to demonstrate the superiority of anastrozol compared to Tamoxifen. A new set of trials, coordinated by the International Breast Intervention Study Group, will compare the anti-hormones in healthy postmenopausal women with a moderate risk of developing breast cancer and in women after surgery for ductal carcinoma in situ. This article will discuss the various options for endocrine therapy in metastatic breast disease. The indications for endocrine manipulation as well as the various drugs will be discussed.     

Stellenwert der Rektoskopie und Koloskopie für den Internisten

The endoscopic examination of the large intestine can be considered today a routine examination in internal medicine. Since the introduction of flexible videoendoscopy, evaluating diseases in the distal colon using rectoscopy has become less important. Ano-proctoscopy is an obligatory component for a complete colon diagnostic after a flexible ileo-colonoscopy has been performed. Colonoscopy has improved significantly the diagnosis and therapy of diseases in the large intestine since it has been introduced more than 30 years ago. By introducing modern videocolonoscopy in addition to other instruments, there is today a broad spectrum of diagnostic and therapeutic indications available. Specifically, due to its frequency and prognostic relevance, colonoscopy has become the most powerful and important procedure in the early detection and prevention of colon cancer.     

Innovationen in der gynäkologischen Endoskopie

After the triumph of endoscopy in gynaecology, new developments can be seen more with the invention and optimisation of instruments than with the introduction of new surgical techniques. The endoscopic surgeon is very much dependent on sophisticated and precise instruments to perform high quality operations in an acceptable time. In hysteroscopy, optical systems have more and more been miniaturised with concomitant enhanced quality. A new and safe technique for hysteroscopic sterilisation has been developed and bipolar resectoscope systems have been created. In laparoscopy, optical systems, bipolar instruments, morcellators and a monopolar loop electrode have also been markedly improved. New modes of energy application such as the BiClamp technique and reusable ultrasound dissectors are helpful in improving the quality of coagulation and reduce operative time.     

Winkelstabile Plattenfixation

There are fundamental biomechanical differences between fixed-angle plate systems, also referred to as internal fixators, and conventional plate-screw fixation systems. Fixed-angle systems have rapidly gained widespread acceptance in recent years for almost all indications and anatomical sites. This contribution presents tips and tricks on their implantation and on the management of complications. Much of the information has already been presented elsewhere, in print or orally. Some of it is based on the authors’ own experience in their hospitals. The tips and tricks presented here are intended to help surgeons find pragmatic solutions to intraoperative problems.