Radiation dose reduction during hysterosalpingography: an application of scanning-beam digital radiography

Hysterosalpingography was performed in 31 patients by means of a low-dose scanning-beam digital radiographic system. The technique permits adequate evaluation of gynecologic abnormalities while allowing significant reduction in radiation: 2.4-mR (6.1 X 10(-7) C/kg) exposure to the skin and 0.7-mrad (7 X 10(-6) Gy) mean dose to the ovaries per image obtained. Sixteen patients demonstrated readily recognizable and documented abnormalities, corroborated by laparoscopy, laparotomy, or other supportive evidence.     

Imaging of fluorescent neurons labelled with fluoro-gold and fluorescent axon terminals labelled with AMCA (7-amino-4-methylcoumarine-3-acetic acid) conjugated antiserum using a UV-laser confocal scanning microscope.

This paper describes the implementation of an ultraviolet (UV) laser (Spectra Physics 171-18 with 3 lines: 334, 351 and 364 nm in UV) as light source for fluorescence confocal scanning microscopy. With this instrument it is possible to use fluorophores not previously available for confocal laser microscopical imaging of fluorophores such as fluoro-gold and AMCA. In the study we show confocal laser microscopical imaging of fluorescent motoneurons labelled by retrograde transport of fluoro-gold and AMCA-fluorescent axon terminals labelled with antisera against immunogenes as thyrotropin-releasing hormone (TRH) and calcitonin gene-related peptide (CGRP). These two fluorophores may be recorded simultaneously or separately by using a filter that suppresses the emission of one of the fluorophores. The described instrument should also be useful in applications involving detection of monoamines by the Falck-Hillarp technique, as well as measurements of cytosolic free calcium by indicators such as Fura-2 and Indo-1. Measurements performed in reflected and fluorescence light indicated that the resolution along the optical axis improved by about 25% when UV (351 nm) is used instead of visible light (514 nm). This figure is close to that expected on theoretical basis. There are, however, also serious problems related to the use of UV excitation. Firstly, objectives must be selected based on their UV transmission properties. Secondly, chromatic aberration may cause a substantial focal shift between illuminating and emitted light, calling for a flexible instrumental design in order to allow for compensation. As shown here, this problem can be circumvented by using reflecting objectives but at a price of lower resolution compared with high-aperture refracting objectives.     

Synchronous colonic adenocarcinoma and extragenital malignant mixed mesodermal tumour

A synchronous occurrence of large bowel adenocarcinoma and extragenital malignant mixed mesodermal tumour (MMMT) is reported. This case represents the sixth extragenital MMMT reported in the literature.     

Langstrecken-Intensivtransport der Bundeswehr

Zusammenfassung Die Teilnahme der Bundeswehr an internationalen Missionen erfordert ein an die Bedingungen militärischer Einsätze angepasstes Konzept zur intensivmedizinischen Repatriierung. Die umfassende Transportkapazität des auf den Airbus A-310 gestützten Systems von bis zu 44 liegenden Patienten bedingte bereits mehrfach den Einsatz im Rahmen ziviler Großschadensereignisse. Der Transport der häufig vital gefährdeten Patienten erfordert sowohl eine dem Inlandsstandard anzupassende medizintechnische Ausstattung der Luftfahrzeuge als auch entsprechend qualifiziertes medizinisches Begleitpersonal, das aufgrund der Sitzplätze zahlenmäßig begrenzt ist. Dieser Umstand verlangt vom Personal Umsicht bei der Betreuung von zeitgleich mehreren Patienten sowie Befähigung zum eigenständigen Arbeiten. Die Patienten-Transport-Einheiten (PTE) entsprechen in der technischen Ausstattung dem Intensivbehandlungsplatz einer modernen Klinik und gewährleisten auch über eine längere Transportzeit eine Intensivtherapie auf höchstem Niveau. Die Arbeit mit dieser Ausrüstung, die Besonderheiten des Langstreckenlufttransportes und die spezielle Situation des militärischen Einsatzes stellen zusätzliche Anforderungen an das Personal. Um dem gerecht zu werden, erfolgt, ergänzend zur täglichen Arbeit im Rettungsdienst, in den Notaufnahmen und auf den Intensivstationen der Bundeswehrkrankenhäuser eine spezielle Schulung von Rettungsassistenten und Ärzten am Flugmedizinischen Institut der Luftwaffe.     

AIDS-free survival and overall survival in HIV infection: the new CDC classification system (1993) for HIV disease and AIDS

The clinical history of 1538 HIV positive patients was analyzed on the basis of the new CDC classification system of HIV disease and AIDS. This classification system combines three CD4 cell categories (1, 2, and 3) with three clinical categories (A, B, and C) into nine subgroups AI–C3. We examined the overall survival for all subgroups and the AIDS-free survival for subgroups Al–B3. AIDS-free survival for patients in subgroups Al, A2, and B1 was considerably longer than survival in patients from subgroups A3, B2, and B3 (P < 0.0001). According to these findings, the new CDC classification system could be simplified into three stages, stage I and II comprising the above mentioned six subgroups, and stage III comprising clinical AIDS defining categories C1, C2, and C3. These three stages correspond to different periods in the management of HIV positive patients, i.e., period of observation, period of prophylaxis, and period of treatment.Abbreviations AIDS acquired immunodeficiency syndrome - CDC Centers for Disease Control - HIV Human immunodeficiency virus Correspondence to: E.B. Helm