Oriented polyvinylidene fluoride-trifluoroethylene (P(VDF-TrFE)) films by Langmuir-Blodgett deposition: a synchrotron X-ray diffraction study.

Langmuir-Blodgett films of polyvinylidene fluoride trifluoroethylene - P(VDF-TrFE)-copolymers possess substantially improved electrocaloric and pyroelectric properties, when compared with conventionally spin-cast films. In order to rationalize this, we prepared single-layered films of P(VDF-TrFE) (70 : 30) using both deposition techniques. Grazing incidence wide-angle X-ray scattering (GIWAXS), reveals that Langmuir-Blodgett deposited films have a higher concentration of the ferroelectric ß-phase crystals, and that these films are highly oriented with respect to the substrate. Based on these observations, we suggest alternative means of deposition, which may substantially enhance the electrocaloric effect in P(VDF-TrFE) films. This development has significant implications for the potential use of P(VDF-TrFE) in solid-state refrigeration.

[Treatment of a pregnant patient after multiple trauma: rare combination with thrombotic thrombocytopenic purpura]. / Versorgung einer schwangeren Patientin nach Polytrauma: Seltene Kombination mit thrombotisch-thrombozytopenischer Purpura.

Multiple trauma during pregnancy is a relatively rare situation which poses a great challenge for the team in charge of treatment. A concomitant disease, such as thrombotic thrombocytopenic purpura (TTP) with thrombocytic coagulopathy increases the complexity of the treatment problems. This article describes the case of a 36-year-old pregnant woman referred to this hospital suffering from multiple trauma with severe liver rupture. Stabilization was achieved after an emergency Caesarean section and packing of the liver. Recurrent massive bleeding from the liver occurred after depacking and was treated successfully with recombinant factor VIIa. The concomitant TTP was treated by transfusion of fresh frozen plasma and corticosteroids. Rapid initiation of therapy was the goal to achieve hemostasis and prevent aggravation of the coagulation disorder and an unfavourable outcome despite severe thrombocytopenia.

Triple-negative high-risk breast cancer derives particular benefit from dose intensification of adjuvant chemotherapy: results of WSG AM-01 trial.

BACKGROUND: This paper evaluates the prognostic and predictive impact of protein expression of various molecular markers in high-risk breast cancer (HRBC) patients with >9 involved lymph nodes, who received different chemotherapy dose-intensification strategies within a prospective randomized WSG AM-01 trial. MATERIALS AND METHODS: Paraffin-embedded tumors from 236 patients, who were randomly assigned to dose-dense conventional chemotherapy with four cycles of E(90)C(600) followed by three cycles of C(600)M(40)F(600) every 2 weeks (DD) or a rapidly cycled tandem high-dose regimen with two cycles of E(90)C(600) every 2 weeks followed by two cycles of E(90)C(3000)Thiotepa(400) every 3 weeks (HD), were available for retrospective central pathological review (116 HD/120 DD). Expression of estrogen receptor (ER), progesterone receptor (PR), MIB-1, epidermal growth factor receptor, and Her-2/neu was evaluated immunohistochemically using tissue microarrays. Results were correlated with follow-up data and treatment effects by proportional hazard Cox regression models (including interaction analysis). RESULTS: After a median follow-up of 61.7 months, 5-year event-free survival (EFS) as well as overall survival (OS) rates for the 236 patients were significantly better in the HD arm: EFS: 62% versus 41% [hazard ratio (HR) = 0.60, 95% CI 0.43-0.85, P = 0.004]; OS: 76% versus 61% (HR = 0.58, 95% CI 0.39-0.87, P = 0.007). In multivariate analysis, HD, tumor size <3 cm, positive PR, negative MIB-1 staining, and grade 1/2 were associated with favorable outcome. Interaction analysis showed that regarding predictive effects, triple negative (ER/PR/Her-2/neu) and G3 tumors derived most benefit from HD. CONCLUSION: Tandem HD improves both EFS and OS in HRBC. This therapy effect may be partly attributable to superior efficacy in the subgroup of triple-negative tumors and/or G3 with their poor prognostic marker profile.

Complications after transanal endoscopic microsurgical resection correlate with location of rectal neoplasms.

PURPOSE: Transanal endoscopic microsurgery (TEM) is a technique that has found its place in routine practice due to its minimal invasive character and associated low morbidity. The purpose of this study was to assess the influence of anatomical variables of rectal neoplasms as well as surgeon experience on postoperative complications in patients undergoing TEM at a tertiary care center. METHODS: Data from 288 patients undergoing TEM over a 16 year period were entered in a prospective data base. Anatomical data of rectal neoplasms, operative data, and early postoperative outcome were analyzed retrospectively. RESULTS: Overall surgical complications [OR 7.0 (1.5-45,5); p < 0.01] and bleeding [OR 222 (82 - 14316); p < 0.01] correlated with the localization of the neoplasm on the lateral wall of the rectum. Furthermore there was a trend for more surgical overall complications as well as bleeding in neoplasms with a diameter of >2 cm and neoplasms located >8 cm from the anal verge. Complications did not correlate with the number of TEM procedures performed. CONCLUSION: TEM resection of neoplasms located on the lateral rectal wall have a higher risk of bleeding. The learning curve for transanal endoscopic microsurgery appears to be negligible in surgeons with experience in minimal invasive surgery.

[Symptomatic abdominal aortic aneurysm and left-sided infrarenal vena cava]. / Symptomatisches Bauchaortenaneurysma und linksseitige infrarenale Vena cava.

Coincidence of an abdominal aortic aneurysm and abnormalities of the inferior vena cava is a rare condition but has significance for surgical therapy. By the preoperative use of various imaging techniques and adapted surgical procedure the risk of the operation is decreasing to a minimal level. A case of symptomatic abdominal aneurysm and left-sided infrarenal vena cava is presented and the importance of preoperative examinations and operative strategy is discussed.

[Aneurysms of the hepatic artery]. / Aneurysmen der Arteria hepatica.

A series of seven cases of hepatic artery aneurysms is reported. Guidelines for diagnosis and therapeutic approach to this rare disease are specified based on our own results and on the work of other authors. Because of high mortality, hepatic and biliary complications in cases of ruptured hepatic aneurysms elective vascular surgery is recommended in symptomatic and asymptomatic patients. In cases of intrahepatic localization percutaneous catheter embolization may be the method of choice except for some cases of false aneurysms in transplanted livers.

[Intersphincteric rectum resection with colosphincter pouch]. / Die intersphinctere Rectumresektion mit colosphincterem Pouch.

In rectal cancer the emphasis has moved towards sphincter saving resection. Tumor site and penetration depth decide the operative technique in low rectal cancer. 1) Resection at the upper confinement of the anal canal. 2) Intersphincteric resection at the level of the dentate line. Reconstruction is achieved by a colonic J-pouch. From 1991 to 1994 we operated on 35 patients with an average age of 58.1 years. An intersphincteric resection was performed in 11 patients whose tumor was situated between 0 and 2 cm upwards the dentate line. 24 cancers were situated between 2 and 6 cm of the dentate line and were resected at the upper confinement of the anal canal with a linear stapler. Tumor penetration depth was determined endosonographically (ES). Four patients had tumor stage ES T1, 13 ES T2 and 18 ES T3. A J-pouch of 7-9 cm size was sutured (11) or stapled (24) to the anal canal. In 10 patients who underwent intersphincteric resection the pre- and post-operative anal pressures were determined. We did not encounter major complications. In three patients a leakage at the colonal anastomosis postponed closure of the diverting colostomy. We had no anastomotic recurrence but one pelvic side recurrence. Four patients developed liver metastases; in one case resectable. Postoperative anal sphincter pressure was reduced in all cases but clinically relevant only in one. This patient has frequent major soiling, three patients have occasional minor leak. Two patients are incontinent of gas, 26 are perfect continent. One patient has bowel movements every two days, 15 one per day, 12 two per day and 3 three per day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Laparoscopic 2-level fusion of the lumbar spine with Bagby and Kuslich implants]. / Laparoskopische 2-Etagenfusion der lumbalen Wirbelsäule mit Bagby-and-Kuslich(BAK)-Implantaten.

In a 50-year-old female patient, presenting with permanent low lumbar back pain and intermittent neurological alterations due to degenerative disc disease L4-5 and L5-/S1 we demonstrate that two-level anterior interbody fusion can be performed via laparoscopic transabdominal instrumentation using BAK interbody implants. Intervertebral disc space L5-/S1 was stabilized approaching the spine caudally of the aortic bifurcation, while disc space L4-L5 required an approach from the left lateral aspect, mobilizing the aorta and vena cava to the right. The postoperative course was without complications and allowed discharge from the hospital on day 8. X-ray control 4 months later demonstrated restoration of adequate disc space at L4-L5 and L5-/S1 and appropriate positioning of the implants.

[Laparoscopic resections in Crohn disease]. / Laparoskopische Resektionen bei Morbus Crohn.

39 patients with Crohn's disease underwent laparoscopic bowel resections during January 1993 to May 1995 (16 female, 23 male, with an average age of 33 years). The duration of the disease ranged from one to 18 years. 21 of the 39 patients were under steroid therapy at the time of operation. Seven patients have had ileocaecal resection for Crohn's disease. The operative technique is laparoscopically assisted. We performed: small bowel resections (8), ileocaecal resections (16), hemicolectomies (11), subtotal colectomies (2), colectomies (2). Operative time ranged from 90 to 280 min for ileocaecal resections and from 330 to 420 min for colectomies. Intraoperative complications were not encountered. Postoperatively one patient developed a subhepatic abscess which was drained under sonographic guidance on day 6. One patient was reoperated for a different disease on postoperative day 2. Two patients had fever till day 9 and 13 without clinical relevance. Two patients had delayed incision site healing. Postoperative clinical stay was 11 days. The main benefit for the patients was early mobilisation due to reduced pain. Patients experienced the small abdominal incision as a ray of hope in their chronic disease.

Identification of salt responsive genes using comparative microarray analysis in Upland cotton (Gossypium hirsutum L.).

Salinity negatively impacts plant growth and productivity, and little is known about salt responsive genes in cotton. In this study, an intra-specific backcross population of cotton (Gossypium hirsutum L.) was treated with 200 mM NaCl after which differentially expressed genes were identified by comparison between salt tolerant and susceptible segregant bulks using comparative microarray analysis. Microarray analysis identified 720 salt-responsive genes, of which 695 were down-regulated and only 25 were up-regulated in the salt tolerant bulk. Gene ontology of annotated genes revealed that at least some of the identified salt responsive transcripts belong to pathways known to be associated with salt stress including osmolyte and lipid metabolism, cell wall structure, and membrane synthesis. About 48% of all salt-responsive genes were functionally unknown. Quantitative RT-PCR was used to validate 17 selected salt responsive genes. This work represents the first study in employing microarray to investigate the possible mechanisms of the salt response in cotton. Further analysis of salt-responsive genes associated with salt tolerance in cotton will assist in laying a foundation for molecular manipulation in development of new cultivars with improved salt tolerance.

[Clinical pathways -- first results of a systematic IT-supported application at a surgical department of a university hospital]. / Klinische Behandlungspfade. Erste Ergebnisse des systematischen IT-gestützten Einsatzes an einer chirurgischen Universitätsklinik.

BACKGROUND AND OBJECTIVE: In analogy to industrial process management, clinical pathways have been introduced for operational process organisation in orthopedic and interventional procedures as well as for conservative treatments. Within this study, introduction and continuous, systematic application of clinical pathways at a surgical department of a university hospital was investigated. METHODS: Analysis was performed by IT-based (SAP/i. s. h.med) evaluation of the registered data regarding pathway violations. Additionally, patients' records were matched with the computerized data for quality assurance of pathway documentation. RESULTS: 501 patients were entered in 16 clinical pathways (31 +/- 39 patients per pathway). The mean period from the introduction of a distinct pathway to the data acquisition of the present study ranged from 2 to 14 months (mean 7+/-7.5 months). Pathway violations correlated with the complexity, but not with the period since the pathway was introduced. Organisational reasons next to medical reasons (i. e. delayed gastric function or wound healing) were the most frequent causes for pathway violations. CONCLUSION: Clinical pathways may not only be realised for operative procedures or conservative treatments, but represent a clinical and administrative management instrument at a surgical department of a university hospital for daily work routine. They are suitable as an instrument for clinical quality and risk management, as an economic control instrument in reorganisation phases as well as in the routine of surgical clinics.

Adjuvant therapy with edrecolomab versus observation in stage II colon cancer: a multicenter randomized phase III study.

BACKGROUND: In a phase III study recruiting patients with stage II colon cancer the effect of adjuvant therapy with edrecolomab, a murine monoclonal antibody to the cell-surface glycoprotein 17-1A, was compared to observation alone. PATIENTS AND METHODS: From January 1997 until July 2000 a total of 377 patients were postoperatively stratified according to tumor stage (T3 vs. T4) and center, and randomly allocated to either treatment with edrecolomab (cohort A, n = 183) or observation (cohort B, n = 194). Patients in cohort A received a total of 900 mg edrecolomab. The study was terminated prematurely because of discontinuation of drug supply in Germany. RESULTS: 305 patients were eligible for the primary endpoint of overall survival and 282 patients for disease-free survival. After a median follow-up of 42 months overall survival and disease-free survival were not significantly different. Toxicity was mild. CONCLUSIONS: In the present study, postoperative adjuvant treatment with edrecolomab in patients with resected stage II colon cancer did not improve overall or disease-free survival.

Extension of a binaural cross-correlation model by contralateral inhibition. I. Simulation of lateralization for stationary signals.

Running interaural cross correlation is a basic assumption to model the performance of the binaural auditory system. Although this concept is particularly suited to simulate psychoacoustic localization phenomena, there exist some localization effects which cannot be explained by pure cross correlation. In this paper a model of interaural cross correlation is extended by a "contralateral-inhibition mechanism" and by "monaural detectors" in order to simulate a wide range of psychoacoustic lateralization data. The extended model explains lateralization of pure tones with interaural time differences as well as with interaural level differences. Multiple images are predicted for tones with characteristic combinations of interaural signal parameters and for noise signals with different degrees of interaural cross correlation. The model is also capable of simulating dynamic lateralization phenomena, such as the "law of the first wave front" which is dealt with in a companion paper [Lindemann, J. Acoust. Soc. Am. 80, 1623-1630 (1986)]. The present paper is restricted to a comparison of the model predictions for stationary signals with the results of dichotic listening experiments.

Extension of a binaural cross-correlation model by contralateral inhibition. II. The law of the first wave front.

This paper explains the "law of the first wave front" and related binaural phenomena on the basis of the model presented in the previous paper [Lindemann, J. Acoust. Soc. Am. 80, 1608-1622 (1986)] in which a contralateral inhibition mechanism was added to the well-known model of binaural cross correlation. In order to verify the predictions of the extended model, psychoacoustic experiments were performed with pairs of narrow-band impulses which were presented through headphones. The test signals consisted of a diotic primary sound and an "echo" with an interaural arrival-time difference. Lateralization was measured as a function of the time delay between primary sound and echo. For delays below the echo threshold, summing localization and the law of the first wave front were simulated; for delays above the echo threshold, the model predicts an influence of the primary sound on the lateralization of the echo.

Evaluation of interaural signal differences.

A model of binaural signal processing is discussed which is based on a running interaural cross-correlation mechanism in frequency bands. A pattern of a hypothetical "binaural neural activity distribution" is derived from the ear signals. It is assumed that the binaural activity patterns are evaluated by a central pattern-recognition processor, which extracts certain cues to form the spatial attributes of the auditory events. The model is applied to sound fields in rooms to explain a special kind of spatial impression on the listener which can be described as "spaciousness".

[Quality of the marginal seal of spark-eroded crowns using different modes of preparation]. / Der Randschluss erodierter Kronen in Abhängigkeit unterschiedlicher Praparationsformen.

Six acrylic tooth stumps were prepared for an evaluation of the marginal quality of crowns produced by spark erosion. Four different methods were used for preparation of the crown margins. Each stump had two different margin preparations. The crowns were fabricated with the aid of spark erosion. Serrated sections were then made for an analysis of marginal defects. The results have shown that the mean size of marginal openings is highly dependent on the preparation method used.

Auditory spaciousness: some further psychoacoustic analyses.

Psychoacoustic investigations have confirmed the known high correlation of auditory spaciousness and preference in concert-hall types of sound fields. Further, they have provided exploratory results which gave rise to the following interpretations: Auditory spaciousness is a multidimensional perceptual attribute, predominantly caused by early lateral reflections. Low-frequency reverberation may also contribute slightly, but is sensitive with respect to individual taste. All spectral components of early lateral reflections contribute to spaciousness. Spectral restriction of the reflections leads to less favorable judgments. Early lateral reflections which do not contain spectral components above about 3 kHz mainly create image expansion in the front-back direction, thus adding to the sense of envelopment of the listener. If components above about 3 kHz are present, image broadening is prominent. By means of a model of binaural signal processing which takes interaural arrival-time differences as well as interaural level differences into account, a quasiobjective measure of auditory spaciousness can be derived.

Spatial mapping of intracranial auditory events for various degrees of interaural coherence.

The broadening and splitting of auditory events in dichotic listening conditions with various degrees of interaural coherence are discussed. By using a psychoacoustical mapping method, it has been possible to observe broadening and splitting for a wide range of stimuli, including broadband pink noise as well as bandpass noises with different relative bandwidths and center frequencies. The spatial extents of the auditory events decrease with increasing center frequencies for bandpass stimuli of constant relative bandwidth. The number of partial events for bandpass stimuli decreases with increasing degrees of interaural coherence. These results are, for example, of interest with respect to auditory spaciousness in architectural acoustics.

[Monitoring of plasma disappearance rate of indocyanine green in a patient with necrotizing fasciitis and septic shock]. / Uberwachung der Plasmaeliminationsrate von Indocyaningrün bei einem Patienten mit nekrotisierender Fasziitis und septischem Schock.

HISTORY AND ADMISSION FINDINGS: A 45-year old man with diabetes mellitus and arterial hypertension was transferred with fever of unknown origin, suspected diabetic angiopathy and sepsis. On admission the patient presented all signs of septic shock. Livid coloured injuries on his right hand and petechial bleeding in distal extremities were observed. INVESTIGATIONS: A different origin of sepsis was not found in transesophageal ultrasound cardiography and computed tomography of cranium, chest and abdomen. DIAGNOSIS, TREATMENT AND COURSE: Immediately after admission early goal-directed therapy was initiated. Apart from calculated antibiotic therapy intensive insulin therapy and hydrocortisone substitution was begun. The patient presented a multiple organ dysfunction syndrome. Plasma disappearance rate of indocyanine green (PDR (ICG)) on admission was 20,4 %/min (normal range > 18 %/min) and fell to 6,8 %/min within 12 hours, while central venous oxygen saturation remained normal. Despite therapy according to current guidelines for severe sepsis, the patient deteriorated. Surgical debridement was performed suspecting necrotizing fasciitis and application of recombinant human activated protein C (rhAPC) started. PDR (ICG) rapidly raised to normal values; the patient recovered and was discharged after 9 days. CONCLUSIONS: Monitoring of PDR (ICG) allows for improved bedside evaluation of liver perfusion of the critically ill and is not only able to predict prognosis but may help in decision making for supportive therapies.