Surgical management of major pancreatic injury in children.

INTRODUCTION: Major or complicated pancreatic trauma in children is uncommon and management strategies remain controversial. The aim of this study was to evaluate our experience with both early and delayed surgery in these pediatric cases. METHODS: We carried out a retrospective analysis of data of pediatric patients with major or complicated pancreatic injury operated on between January 1994 and December 2005 in our pediatric trauma center. RESULTS: Thirteen children (9 boys and 4 girls) with a mean age of 8.5 years (range 3 - 16 years) were operated for major or complicated pancreatic injury. The extent of injury was: grade II (major contusion without duct injury or tissue loss) in 4 children; grade III (distal transection) in 5 children and grade IV injury (proximal transection) in four patients. Pseudocyst developed in 8 children: 4 with grade II injury, 2 with grade III injury and 2 with grade IV injury (one with abdominal pseudocyst and one with an abdominal and a mediastinal pseudocyst). Early diagnosis and operation was achieved in 5 cases, while delayed diagnosis and operation occurred in 8. Three children underwent cystogastrostomy; 6 had a spleen-sparing distal pancreatectomy and 4 had resection with Roux-en-Y jejunostomy drainage. Endoscopic retrograde cholangiopancreaticography (ERCP) was the most useful diagnostic tool in assessing ductal injury. There were no deaths or long-term morbidity in our group of patients. CONCLUSIONS: Our results support the view that early operation is important in ductal pancreatic injury. We recommend transferring children with a suspected ductal injury to a tertiary center with experience in both pediatric ERCP and pancreatic surgery.     

Thyroid diseases in advanced age

Nearly all diseases of the thyroid, such as nodular goitre, thyroid carcinoma, non-immunogenic hyperthyroidism and idiopathic hypothyroidism, exhibit an increase in frequency with age. Their recognition is rendered more difficult by the often oligosymptomatic, ambiguous clinical picture, but it is the timely treatment that is of particular prognostic importance to an organism weakened due to polymorbidity. In all hard nodular alterations, a malignoma must be ruled out by sonography, scintigraphy and cytopuncture. In all iodine-deficient regions such as the GDR, a frequent occurrence of thyroid autonomy with manifestation of hyperthyroidism following iodine contamination has to be taken into account. Hypothyroidism is often misinterpreted as age-related changes. By employing adequately modern in vitro methods and imaging procedures it will be possible to further improve diagnosis and prognosis of the thyreopathy in the old age ranges.     

Computer-assisted LISS plate osteosynthesis of proximal tibia fractures: feasibility study and first clinical results.

Fluoroscopy is the most common tool for the intraoperative control of long-bone fracture reduction. Limitations of this technology include high radiation exposure for the patient and the surgical team, limited visual field, distorted images, and cumbersome verification of image updating. Fluoroscopy-based navigation systems partially address these limitations by allowing fluoroscopic images to be used for real-time surgical localization and instrument tracking. Existing fluoroscopy-based navigation systems are still limited as far as the virtual representation of true surgical reality is concerned. This article, for the first time, presents a reality-enhanced virtual fluoroscopy with radiation-free updates of in situ surgical fluoroscopic images to control metaphyseal fracture reduction. A virtual fluoroscopy is created using the projection properties of the fluoroscope; it allows the display of detailed three-dimensional (3D) geometric models of surgical tools and implants superimposed on the X-ray images. Starting from multiple registered fluoroscopy images, a virtual 3D cylinder model for each principal bone fragment is constructed. This spatial cylinder model not only supplies a 3D image of the fracture, but also allows effective fragment projection recovery from the fluoroscopic images and enables radiation-free updates of in situ surgical fluoroscopic images by non-linear interpolation and warping algorithms. Initial clinical experience was gained during four tibia fracture fixations that were treated by LISS (Less Invasive Stabilization System) osteosynthesis. In the cases operated on, after primary image acquisition, the image intensifier was replaced by the virtual reality system. In all cases, the procedure including fracture reduction and LISS osteosynthesis was performed entirely in virtual reality. A significant disadvantage was the unfamiliar operation of this prototype software and the need for an additional operator for the navigation system.     

Social relations and smoking behavior: Results from the first MONICA survey Augsburg

Summary This study examines the relationship between various aspects of social relations and the prevalence of smoking, using data from the first MONICA Survey, Augsburg, FRG, 1984/85. Study population of the survey was a two-stage cluster sample of 5312 men and women aged 25 to 64. The response was 79.4%. The measurement of social relations included a modified form of the Syme/Berkman social network scale, as used in the Alameda County Study. Analyses were carried out separately for the total four-level social network index in relation to smoking, and for specific components of that index (marital status, contacts with friends and relatives, activities in informal groups). The results showed for both men and women, that there was a significant association between the social network index and the prevalence of smoking: the more social ties and contacts, the lower the percentage of smokers. The results from multiple logistic regression analyses indicated an effect of social relations on smoking, that is at least partly independent of age, gender and educational level. In general, the findings may contribute to a better understanding of risk groups, and the possible pathways leading from social relations to health and disease.

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Soziale Beziehungen und Rauchverhalten. Ergebnisse der ersten MONICA-Augsburg- Querschnittsstudie

Zusammenfassung Mit Daten der ersten MONICA-Querschnittsstudie Augsburg, 1984/ 85, wurden die Zusammenhänge zwischen verschiedenen Merkmalen des «sozialen Netzwerks» und dem individuellen Rauchverhalten untersucht. Die Studienpopulation umfasste 5312 Männer und Frauen einer zweistufigen Zufallsstichprobe im Alter zwischen 25 und 64 Jahren. Die Teilnahmerate betrug 79,4%. Die sozialen Beziehungen wurden in einem Fragebogen zum Selbstausfüllen mit Hilfe eines «Sozialen Netzwerk Indexes» (SNI) erfasst, der sowohl den Familienstand, die Kontakte zu Verwandten und engen Freunden als auch Aktivitäten in Gruppen und Vereinen beinhaltete. Die Ergebnisse zeigten für Männer und Frauen statistisch signifikante Zusammenhänge zwischen den Gesamtscores des SNI und der Prävalenz des Rauchens: Je mehr soziale Beziehungen und Kontakte, desto geringer war der Anteil Raucher. Die Analysen einzelner Komponenten des SNI ergaben: Es fanden sich keine konsistenten Zusammenhänge zwischen den Aktivitäten in Freizeitclubs und dem Rauchverhalten, jedoch zwischen familiären Beziehungen, Kontakten zu engen Freunden oder Verwandten und der Häufigkeit des Rauchens. Besonders auffallend war der hohe Anteil Raucher bei den geschiedenen oder getrenntlebenden Männern. 70% von ihnen waren Raucher im Vergleich zu 37% der verheirateten Männer. Die entsprechenden Anteile bei den Frauen waren 42% bzw. 22%. Die Ergebnisse der multiplen logistischen Regressionen zeigten einen Effekt der interpersonellen Beziehungen auf das Rauchverhalten, der unabhängig war von den Faktoren Alter, Geschlecht, Bildungsstand und (bei Frauen) von der Erwerbstätigkeit. Die Resultate könnten zu einer besseren Erklärung und Identifizierung von Risiko-Gruppen und damit zu einer erfolgreicheren Bekämpfung des Rauchens beitragen.

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Rapports sociaux et consommation de la cigarette

Résumé Les relations entre les différentes propriétés du «réseau social» et les habitudes individuelles en ce qui concerne la consommation de la cigarette ont été examinées à l'aide des données d'une première étude transversale, faite en région augsbourgeoise, dans le cadre du projet MONICA. L'échantillon aléatoire, divisé en deux étapes, comportait une population de 5312 hommes et femmes âgés de 25 à 64 ans. 79,4% des personnes interrogées participaient à l'enquête. Le recensement des rapports sociaux s'effectuait au moyen d'un questionnaire individuel à «l'Index du Réseau Social» (IRS) qui englobait aussi bien les données sur l'état civil que les sujets relatifs aux contacts sociaux et familiaux. Les résultats ont montré qu'il y avait une correspondance significative entre les valeurs totales du IRS et la prévalence de la consommation de la cigarette. Plus une personne avait de contacts sociaux, moins elle fumait de cigarettes. L'analyse des divers composants du IRS révèle un manque de relations cohérentes entre les activités dans les clubs de loisirs et la consommation de la cigarette. Cependant, la correspondance entre les rapports de famille, les contacts avec amis et parents et la fréquence de la consommation du tabac s'avérait révélatrice. Particulièrement frappant était le taux élevé de fumeurs chez les hommes divorcés ou vivant séparés. 70% d'entre eux étaient fumeurs par rapport à 37% des hommes mariés. Le taux correspondant chez les femmes était de 42% resp. 22%. Les résultats de la régression logistique multiple signalaient un effet des relations interpersonnelles sur la consommation de la cigarette, un effet qui était indépendant des facteurs tels que l'âge, le sexe, le niveau d'instruction et (chez les femmes) des activités professionnelles. Ces résultats pourraient contribuer à une meilleure identification et caractérisation des groupes à risque, et par la suite à combattre d'une manière plus efficace la consommation de la cigarette.

     

Temporomandibular joint: morphology and signal intensity characteristics of the disk at MR imaging

Magnetic resonance (MR) imaging has been used in the temporomandibular joint (TMJ) primarily to define the disk position. This report examines altered morphology and signal intensity characteristics of the TMJ disk as they relate to the severity of internal derangement. Two hundred sixteen joints in 133 patients with a history of such derangement. were imaged with MR. Disk position, signal intensity, morphology, and the presence of osteoarthritis were determined for each joint. The normal disk was not anteriorly displaced and had a normal "bow-tie" shape. A grade 1 disk was anteriorly displaced and had a normal shape; a grade 2 disk was anteriorly displaced and had an abnormal shape. Forty (19%) joints were considered normal; none of these exhibited osteoarthritis. One hundred thirty-nine (64%) joints were grade 1; osteoarthritis was found in 17%. Thirty-seven (17%) were grade 2; osteoarthritis was found in 95%. All forty normal joints had high or intermediate signal intensity in the disk. Osteoarthritic joints had a higher percentage of disks with diminished intensity (P less than .0001). Severe or untreated osteoarthritis is known to be a complication of TMJ internal derangements; hence this grading system seems to correlate with the severity of internal derangement.     

Comparison of dietary intakes in four selected European populations

Summary The composition of diet and food intakes in four selected European populations were compared. Dietary data (from the World Health Organization Project on Monitoring Trends and Determinants in Cardiovascular Disease) were measured by record methods and were available for middle-aged men in Finland (n = 653), France (n =1128), Northern Ireland (n = 356), and southern Germany (Augsburg region; n = 899). Nutritional variables — which are independent of the absolute energy intake, such as the percentage supply of energy from macronutrients and the ratio of polyunsaturated to saturated fatty acids — were on the whole similar. However, striking differences were found in food intake and in the percentage supply of fat from different foods. The results indicate that detailed knowledge of consumption figures is necessary to develop prudent and acceptable nutrition intervention programs.Abbreviations CHD coronary heart disease - MONICA monitoring trends and determinants in cardiovascular disease - MUFA monounsaturated fatty acids - P/S ratio ratio of polyunsaturated fatty acids/saturated fatty acids - PUFA polyunsaturated fatty acids - SFA saturated fatty acids     

Steady-state visual evoked potentials reveal frontally-mediated working memory activity in humans

Steady-state visual evoked potentials (SSVEPs) reflect power changes at the stimulus driving frequency and have been used to assess brain activity reflecting cognitive processing. Only one study has demonstrated SSVEP modulation associated with working memory (WM), and none have compared the spatial localization of SSVEP modulations during WM performance with other brain imaging methods. Here we examined WM-related activity recorded with dense-array SSVEPs, analyzed using low resolution electromagnetic tomography, and compared the results to our previous findings using functional magnetic resonance imaging (fMRI). WM was associated with increased SSVEP activity over the right dorsolateral prefrontal cortex, paralleling our previous fMRI findings. Frontal WM-related SSVEP power correlated selectively with task performance. These results demonstrate the utility of SSVEPs for studying representational aspects of cognition.