Die laparoskopische Chirurgie des Kolonkarzinoms. Kommentar aufgrund der aktuellen Studienlage

Zusammenfassung Die genauere Bestimmung von Leitfunktionen soll das früher zum strukturdynamischen Ansatz Gesagte ergänzen, korrigieren und zum Abschluss bringen. Auf vormenschlichen Entwicklungsstufen geht es um die autopraktischen Antriebe der Lebensbewegung und ihre instinktive Hemmung und Aktivierung. Auf der menschlichen Ebene hat sich die Richtung der Antriebe differenziert. Ihre Autopraxis als das bewegende Prinzip ist geblieben. Hemmung und Aktivierung sind in die Entwicklung einer Innenwelt und ihres strukturellen Hintergrundes einbezogen worden und haben sich aus der instinktiven Abhängigkeit gelöst. An der Funktion der Aktivierung hat sich wenig geändert. Hemmung hat sich in die komplexe Funktion der Desaktualisierung ausgeweitet; sie greift als steuerndes Prinzip in das autopraktische Geschehen ein. Abschließend werden mit einem Exkurs in die Willensthematik die Funktionen von Autopraxis, Desaktualisierung und Aktivierung in ihrem Zusammenwirken erläutert.

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Rotational tomography of the normal and reconstructed middle ear in temporal bones: an experimental study

Imaging is an essential diagnostic tool in reconstructive middle ear surgery, especially in pre-operative planning. Due to ongoing improvement of imaging quality and development of new imaging techniques like e.g. rotational tomography (RT) post-operative follow-up and immediate evaluation of surgical results may become more important. The aim of this experimental study was to evaluate RT as a new tool for postoperative determination of middle ear anatomy and implant position in temporal bones. RT was performed in ten temporal bone specimen after insertion of different middle ear prostheses concerning material, shape and length (PORP; TORP; Stapes piston). An implantable hearing device (Symphonix Soundbridge®) was also implanted and visualized. For comparison some specimen additionally underwent conventional computed tomography (CT), including the newest technology. Characterization of anatomical structures of the temporal bone using RT was of comparable quality to conventional CT-scans in all investigated specimen while requiring approximately 30% of the CT’s irradiation exposure. Unlike CT the RT showed almost no problems due to metallic artefacts of the implanted prostheses. Furthermore RT enabled a 3-dimensional view of the temporal bone and angle determination of inserted prostheses towards the tympanic membrane and/or the malleus handle. Detailed imaging of the prostheses allowed determination of shape, material and localization within the specimen’s reconstructed middle ear. The new imaging technique of RT allows precise presentation of anatomical structures and middle ear implants in temporal bones. Following these experimental results it will be our future work to evaluate this method in clinical practise.     

Typ-2-Diabetes im Licht neuster klinischer Studien

Ohne Zusammenfassung

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Type 2 diabetes in the light of the most recent clinical trials

     

Spatial frequency content of the Cardiff and related acuity tests

In the Cardiff acuity test, simple pictures on an otherwise neutral grey card are defined by borders consisting of a relatively broad white band flanked by black bands each half the width of the white band. Higher levels of acuity correspond to the ability to detect figures defined by narrower borders, the figure size remaining constant. It is sometimes implied that the acuity limit corresponding to each card can be equated with different levels of grating resolution, the total width of the border corresponding to the overall grating period. It is shown that although the spatial frequency spectra of the Cardiff figures, like those of other vanishing optotypes, lack very low-frequency components, they have a complex two-dimensional form. The figures have wide spatial bandwidth and no well-defined discrete frequency components. As a result, the relationship between measured Cardiff and grating acuity will vary somewhat, depending upon the particular optical, neural or other deficits of the individual being tested.     

Effects of chelating agents on the rheological property of cervical mucus

As an ongoing effort to elucidate the mechanisms involved in the calcium-dependent fertility regulation process, the viscoelastic properties of the mucus obtained from lamb cervix and human semen, as well as their water and total protein contents after exposure to EDTA, a chelating agent, or Nonoxynol-9 (N-9), a spermicidal agent, were examined. The viscosity was measured using a Cone Plate Digital Viscometer, while the water and total protein contents were determined by the lyophilization process and the Lowry method, respectively. The significant changes in the rheological properties of mucus, such as its viscosity and the water content, upon exposure to EDTA were demonstrated. The viscosity of cervical mucus and human semen were significantly increased by EDTA treatment (as compared to the controls): lamb cervical mucus (2.9 ± 0.3 vs. 2.2 ± 0.3 cps) and human semen (5.0 ± 0.3 vs. 4.3 ± 0.3 cps), respectively. The hydration rate was decreased by EDTA treatment as compared with the control (93.6 ± 0.7 vs. 96.8 ± 0.8%). Among tested samples, the reduction in the percentage of sperm penetration through the cervical mucus was the highest in the mucus containing EDTA, which had the lowest water content (93.6 ± 0.7%), indicating that there is a positive relationship between the hydration rate of the cervical mucus and its ability to permit the penetration of spermatozoa. This result indicates that spermicidal activity exerted by high concentrations of EDTA is in part due to its effect on the rheological properties of cervical mucus or semen.     

Pineal atrophy and other neuroendocrine and circumventricular features of the naked mole-rat,heterocephalusglaber (Rüppell), a fossorial,equatorial rodent

Summary Quantitative aspects of the microanatomy of the pineal gland and other neuroendocrine and circumventricular structures were studied in a small, reproductively suppressed, female Naked Mole-rat from central Kenya, Africa. The atrophic pineal is the smallest in absolute size (0.002135 mm³) of any so far described in a species of rodent, and in size relative to body weight is second only to that of another tropical species. The subcommissural organ and posterior collicular recess are also relatively small and less well differentiated than those in most other examined rodent species. In contrast, the subfornical organ, OVLT and median eminence are large and well vascularized. It is concluded that the pineal in this species follows the previously described trend among rodents of relatively smaller size in species whose centers of distribution are in lower latitudes. Although the pineal is atrophic, the Naked Mole-rat still exhibits 24-hour and seasonally timed patterns of behavior and seasonal reproduction. However, in this species these events are probably cued by moisture, temperature and social factors rather than by photic information.     

Importance of dosimeter calibration method on nebulizer output.

BACKGROUND: We have observed that dosimeter-run nebulizers have a much smaller output when manually activated than when breath activated; however, this has not been adequately investigated. OBJECTIVE: To evaluate the effect of different calibration methods on nebulizer output. METHODS: Six healthy subjects performed all calibrations. The nebulizers were operated by 2 different dosimeters and were calibrated to produce 9 microL per actuation by breath activation followed by exhalation to the room. The nebulizers were then operated at these identical settings, and the output determined in 3 ways: (1) breath activation followed by exhalation to the room, (2) breath activation with exhalation into the nebulizer, and (3) manual activation (with no subject using the nebulizer). These 3 methods were termed regular, rebreathe, and manual, respectively. RESULTS: There was a large and statistically significant difference in nebulizer output among the 3 methods. The measured rebreathe outputs (5.6 and 5.7 microL per actuation) were approximately two thirds and the manual outputs (3.2 and 3.9 microL per actuation) were approximately one third of the regular calibration outputs (8.6 and 8.9 microL per actuation); the 2 values are for the 2 dosimeters. The results were highly statistically significant (P < .001). CONCLUSIONS: The method by which a nebulizer-dosimeter system is calibrated results in different nebulizer outputs. This has a high likelihood of influencing the concentration of methacholine causing a 20% decrease in volume in the first second of forced expiration.     

An overview of the incidences and costs of low back pain.

The basic premise of this article is that low back disorders are extremely prevalent in all societies, and probably have not increased substantially over the past two decades. What has increased is the rate of disability, the reasons for which are uncertain. Not only has this phenomenon heightened the awareness of low back pain, but it has led to an explosion in costs. Although a precise estimate is impossible, it is plausible that the direct medical and indirect costs of these conditions are in the range of more than $50 billion per annum, and could be as high as $100 billion at the extreme. Of these costs, 75% or more can be attributed to the 5% of people who become disabled temporarily or permanently from back pain--a phenomenon that seems more rooted in psychosocial rather than disease determinants. Within this overall equation, spinal surgery plays a relatively small role, although the contribution to disability probably has more than passing significance. The future challenge, if costs are to be controlled, appears to lie squarely with prevention and optimum management of disability, rather than perpetrating a myth that low back pain is a serious health disorder.