Outcome of fetuses with gastroschisis after modification of prenatal management strategies : Prenatal management and outcome of gastroschisis.

PURPOSE: To improve the outcome of fetuses with gastrochisis several studies evaluated prenatal predictors. But there are different guidelines established and therefore the prenatal care is not standardized. With our study we wanted to evaluate the outcome of fetuses with gastroschisis after modification of prenatal management strategies at the Department of Obstetrics and Gynecology of the University Hospital Münster. METHODS: In this explorative retrospective study of 39 fetuses with gastroschisis, we compare the clinical outcome between two management groups. In the first group (group 1, n = 14) prenatal indication for delivery was confirmed by a subjective evaluation of the small bowel diameter and the wall thickness without established cut-off values for these parameters. In the second group (group 2, n = 25) certain limits for the small bowel diameter (25 mm) and the wall thickness (2.5 mm) were used for fetal surveillance. RESULTS: Noticeable differences between the two groups regarding birth weight, weight centile, arterial pH, small bowel diameter, wall thickness, adverse bowel condition and re-operations could not be observed. In group 2, delivery was earlier (p = 0.011), and a lower rate of prenatal complications was observed (p = 0.016). CONCLUSION: To avoid adverse prenatal complications we recommend the observation of fetuses with gastroschisis by sonographic monitoring of the small bowel diameter and the wall thickness.

[Use of patient radiation shielding in diagnostic and interventional radiology]. / Einsatz von Patienten-Strahlenschutzmitteln in der diagnostischen und interventionellen Radiologie.

The use of patient contact shielding provides an opportunity to reduce patient radiation exposure. Recently, the use has been the subject of controversy. The Radiation Protection Committee has published a recommendation on the use of patient radiation shields by considering the recent findings on dose savings but also the risks of incorrect use. In this article, a specification for the more frequently used types of X­ray examination is given, which describes whether and which radiation contact shielding should be used. This is accompanied by a rationale for the use or non-use of patient radiation protection agents. Problems and possible errors are explained, as well as how to deal with special situations such as pregnant women and children.

CT beam dosimetric characterization procedure for personalized dosimetry.

Personalized dosimetry in computed tomography (CT) can be realized by a full Monte Carlo (MC) simulation of the scan procedure. Essential input data needed for the simulation are appropriate CT x-ray source models and a model of the patient's body which is based on the CT image. The purpose of this work is to develop comprehensive procedures for the determination of CT x-ray source models and their verification by comparison of calculated and measured dose distributions in physical phantoms. Mobile equipment together with customized software was developed and used for non-invasive determination of equivalent source models of CT scanners under clinical conditions. Standard and physical anthropomorphic CT dose phantoms equipped with real-time CT dose probes at five representative positions were scanned. The accumulated dose was measured during the scan at the five positions. ImpactMC, an MC-based CT dose software program, was used to simulate the scan. The necessary inputs were obtained from the scan parameters, from the equivalent source models and from the material-segmented CT images of the phantoms. 3D dose distributions in the phantoms were simulated and the dose values calculated at the five positions inside the phantom were compared to measured dose values. Initial results were obtained by means of a General Electric Optima CT 660 and a Toshiba (Canon) Aquilion ONE. In general, the measured and calculated dose values were within relative uncertainties that had been estimated to be less than 10%. The procedures developed were found to be viable and rapid. The procedures are applicable to any scanner type under clinical conditions without making use of the service mode with stationary x-ray tube position. Results show that the procedures are well suited for determining and verifying the equivalent source models needed for personalized CT dosimetry based on post-scan MC calculations.

IVEU: IT-based collection and reporting of radiological examination parameters.

In Germany, each site using ionising radiation in human medicine is assigned to a competent medical authority (CMA) for quality assurance. Duties of these CMAs are, e.g. the inspection of medical aspects of the use of X-rays and nuclear medicine at the sites as well as technical quality assurance of X-ray devices. The CMAs themselves have to report the collected exposure values to the ministries and the Federal Office for Radiation Protection. The IVEU (IT-gestütztes Verfahren zur Erfassung von Untersuchungsparametern) Software Framework assists CMAs and radiological departments in collecting and analysing data provided in DICOM headers.

Genetic assembly and selective toxicity of diphtheria-toxin-related polypeptide hormone fusion proteins.

The reports of Miyanohara et al. (1986) and Murphy et al. (1986) were the first to describe the genetic construction, expression, and receptor-specific selective toxicity of a chimaeric toxin. In the present report, we have extended these earlier observations and have shown that the fusion of a modified gene encoding IL-2 to a truncated diphtheria toxin gene also results in the expression of a biologically active chimaeric IL-2 toxin. In both instances we have used receptor-binding-domain substitution and have genetically coupled those portions of the diphtheria toxin structural gene that encode the ADP-ribosyl transferase activity of fragment A and lipid-associating domains of fragment B to modified genes which encode either the polypeptide hormone alpha-MSH or the T-cell growth factor IL-2. The chimaeric toxins expressed from these gene fusions have been shown to be selectively targeted to those eukaryotic cells that carry specific surface receptors for the ligand compounds of the hybrid. For example, in the case of the IL-2 toxin, it is clear that the selective action of this hybrid protein is based upon both its diphtheria-toxin and IL-2-related components. Following binding to the IL-2R on activated and/or malignant T-cell, IL-2 toxin is internalized by receptor-mediated endocytosis. Upon acidification of the endosome, diphtheria toxin fragment B portions of the chimaeric toxin facilitate the delivery of fragment A to the cytosol where it catalyses the ADP ribosylation of EF-2. The assembly of chimaeric toxins at the level of the gene offers several advantages over chemical linkage. Since chemical linkage of the toxophore and ligand components of the conjugate toxins requires activation of the epsilon-amino moiety of lysine residues with reagents that will allow for subsequent disulphide linkage, the precise site of coupling is generally not known. In addition, there has been considerable concern over the lability of the disulphide bond between the toxophore and ligand components in vivo due to the action of disulphide reductases. The assembly of chimaeric toxins at the level of the gene allows for precise linkage of the toxophore and ligand components. Since the linkage between the toxophore and ligand is a peptide bond, the chimaeric toxin should be stable in vivo. In addition, the genetic construction of chimaeric toxins also allows for further protein engineering through site-directed mutagenesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Follicular center-cell lymphoma with plasmacytic differentiation, monoclonal paraprotein, and peripheral blood involvement. Recapitulation of normal B-cell development.

A patient with a nodular and diffuse small-cleaved follicular center-cell lymphoma that exhibited definite plasmacytic differentiation, a related monoclonal gammopathy, and circulating population of small lymphocytes is presented. Aside from showing that the presence of numerous plasma cells is not a reliable criterion for the diagnosis of a reactive follicular proliferation, the case is an example of a lymphoma without a block in maturation. The "neoplastic" B-cells show development to follicular center cells and beyond, to functioning plasma cells, and probably also to recirculating "memory" cells. It also suggests that plasmacytoid lymphocytic lymphomas (Lukes-Collins classification) might represent a heterogeneous group of lymphoid neoplasms with some closely related to follicular center-cell lymphomas and others more closely related to small lymphocytic lymphoma/B-cell chronic lymphocytic leukemia.

[Prevention and treatment of chronic pain in oncologic patients]. / Zapobieganie i leczenie przewleklego bólu u chorych onkologicznych.

The rules of three step therapy of chronic pain in terminal malignant has been presented. The need of priority of non narcotic drugs in retard form, oral or enteral administration and individual schedule out-pacing the occurring of pain has been stressed.

[Laparoscopic cholecystectomy in older patients]. / Cholecystektomia laparoskopowa u chorych w podeszlym wieku.

Operational risk of laparoscopic cholecystectomy in elderly patients has been retrospectively evaluated in 600 consecutive patients. Statistical correlation between age and risk factors as: biliary duct disease, adhesions, perforation of the gall bladder, necessity of extending of the incision, duration of the procedure, body temperature after LCh, morbidity, conversion rate from LCh to open cholecystectomy, has been tested. Despite of greater technical difficulties in elderly patients morbidity was not increased significantly. LCh in aged patients with cholecystitis is a safe method of choice.

[Laparoscopic cholecystectomy--treatment outcome of 500 patients]. / Cholecystektomia laparoskopowa--wyniki leczenia 500 pacjentów.

500 patients with symptomatic biliary stones disease have been treated by laparoscopic cholecystectomy (LCh). Contraindications, such as: acute inflammation, earlier laparotomies, common duct stones or obesity were considered as relatives. In cases with duct stones, ERCP with sphincterotomy and evacuation of duct stones was performed before LCh. Small percentage of LCh failures (2.6%) and of postoperative morbidity (3.4%) by undoubted advantages as: lack of postoperative paresis of digestive tract, reduced inability time for professional activity and low risk of postoperative abdominal hernia make this procedure attractive for patients and surgeons.

Reducing false alarms of intensive care online-monitoring systems: an evaluation of two signal extraction algorithms.

Online-monitoring systems in intensive care are affected by a high rate of false threshold alarms. These are caused by irrelevant noise and outliers in the measured time series data. The high false alarm rates can be lowered by separating relevant signals from noise and outliers online, in such a way that signal estimations, instead of raw measurements, are compared to the alarm limits. This paper presents a clinical validation study for two recently developed online signal filters. The filters are based on robust repeated median regression in moving windows of varying width. Validation is done offline using a large annotated reference database. The performance criteria are sensitivity and the proportion of false alarms suppressed by the signal filters.

[Is it really not possible to use electronic personal dosimeters in clinical exposure situations?]. / Sind elektronische Personendosimeter in klinischen Expositionssituationen grundsätzlich nicht einsetzbar?

PURPOSE: Due to significant measuring inaccuracies that can occur under certain conditions, the use of electronic personal dosimeters in statutory measurements in X-ray diagnostics is currently legally restricted. The present study investigates the clinically relevant situations in which measurement errors of more then 20 % can be anticipated. MATERIALS AND METHODS: Four series of experiments were made, comparing the results of the electronic personal dosimeter EPD Mk2.3 to those of reference dosimeters (TLDs and diagnostic dosimeters). On the one hand, personal doses have been determined in the routine operation of controlled areas in various departments. On the other hand, measurements on phantoms have been conducted in extreme but realistic situations under radiation protection. Experiments were conducted in unweakened scattered radiation as well as in unattenuated and attenuated direct radiation. RESULTS: The tested electronic personal dosimeter type meets the requirements regarding measurement accuracy for "official" personal dosimeters in all of the examined clinically relevant scattered radiation fields. Only if exposed to radiation directly, an underestimation of the dose can occur and can be greater than 90 %. CONCLUSION: In the range of scattered radiation of diagnostic X-ray equipment, even in pulsed fields, the use of electronic personal dosimeters is reasonable. Considerable measurement errors can only arise in radiation fields that are not realistic under regular conditions and even in connection with most accidents.