Imprecise prediction of implant sizes with preoperative 2D digital templating in total knee arthroplasty.

PURPOSE: To analyze the match between preoperatively determined implant size (2D templating) and intraoperatively used implant size in total knee arthroplasty (TKA). Also examined were the factors that might influence templating accuracy (gender, surgeon experience, obesity, etc.). MATERIALS AND METHODS: The study was retrospective and conducted in a specialized ENDOCERT arthroplasty center. Digital templating was done with the MediCAD software. If the planned and implanted TKA components (both femur and tibia) were the same size, the match was classified "exact." A deviation of ± one size (at the femur or tibia or both) was classified "accurate." A deviation of ± two or more sizes (at the femur or tibia or both) was classified "inaccurate." Obesity, gender, implant type and surgeon experience were investigated for potential influence on templating accuracy. Chi-square tests and Cohen's weighted kappa test were used for statistical analysis. RESULTS: A total of 482 cases [33.6% male, 66.4% female, age 69 ± 11, body mass index (BMI) 30.3 ± 5.8] were included. When the femur and tibia were taken together, exact size match was observed in 34% (95% CI 29.9-38.3%) of cases, accurate size match in 57.5% (95% CI 53-61.8%) and inaccurate size match in 8.5% (95% CI 6.3-11.2%). Inaccurate size match prolonged operative time (p = 0.028). Regarding the factors potentially influencing templating accuracy, only gender had a significant influence, with templating being more accurate in men (p = 0.004). BMI had no influence on accuracy (p = 0.87). No effect on accuracy was observed for implant type and surgeon experience. CONCLUSIONS: The accuracy of 2D size templating in TKA is low, even in a specialized ENDOCERT arthroplasty center. The study findings challenge the usefulness of preoperative 2D size templating and highlight the importance of more reliable templating methods. LEVEL OF EVIDENCE: Level III (retrospective observational study).

Radon transfer from thermal water to human organs in radon therapy: exhalation measurements and model simulations.

The transfer of radon from thermal water via the skin to different human organs in radon therapy can experimentally be determined by measuring the radon activity concentration in the exhaled air. In this study, six volunteers were exposed to radon-rich thermal water in a bathtub, comprising eleven measurements. Exhaled activity concentrations were measured intermittently during the 20 min bathing and 20 min resting phases. Upon entering the bathtub, the radon activity concentration in the exhaled breath increased almost linearly with time, reaching its maximum value at the end of the exposure, and then decreased exponentially with time in the subsequent resting phase. Although for all individuals the time-dependence of exhaled radon activity was similar during bathing and resting, significant inter-subject variations could be observed, which may be attributed to individual respiratory parameters and body characteristics. The simulation of the transport of radon through the skin, its distribution among the organs, and the subsequent exhalation via the lungs were based on the biokinetic model of Leggett and co-workers, extended by a skin and a subcutaneous fat compartment. The coupled linear differential equations describing the radon activity concentrations in different organs as a function of time were solved numerically with the program package Mathcad. An agreement between model simulations and experimental results could only be achieved by expressing the skin permeability coefficient and the arterial blood flow rates as a function of the water temperature and the swelling of the skin.

Deposition of radon progeny on skin surfaces and resulting radiation doses in radon therapy.

In the Gastein valley, Austria, radon-rich thermal water and air have been used for decades for the treatment of various diseases. To explore the exposure pathway of radon progeny adsorbed to the skin, progeny activities on the skin of patients exposed to thermal water (in a bathtub) and hot vapour (in a vapour chamber) were measured by alpha spectrometry. Average total alpha activities on the patients' skin varied from 1.2 to 4.1 Bq/cm(2) in the bathtub, and from 1.1 to 2.6 Bq/cm(2) in the vapour bath. Water pH-value and ion concentration did affect radon progeny adsorption on the skin, whereas skin greasiness and blood circulation did not. Measurements of the penetration of deposited radon progeny into the skin revealed a roughly exponential activity distribution in the upper layers of the skin. Based on the radon progeny surface activity concentrations and their depth distributions, equivalent doses to different layers of the skin, in particular to the Langerhans cells located in the epidermis, ranged from 0.12 mSv in the thermal bath to 0.33 mSv in the vapour bath, exceeding equivalent doses to the inner organs (kidneys) by inhaled radon and progeny by about a factor 3, except for the lung, which receives the highest doses via inhalation. These results suggest that radon progeny attachment on skin surfaces may play a major role in the dosimetry for both thermal water and hot vapour treatment schemes.

Determining the Chernobyl impact on sediments of a pre-Alpine lake with a very comprehensive set of data.

Man-made and natural radionuclides in Lake Wallersee were determined in the pre-Alpine environment at the northern slope of the Alps, which was heavily affected by the Chernobyl fallout in May 1986. The objective of this study was to get knowledge of location and quantity of man-made radionuclide input (especially (137)Cs) generated in the Chernobyl accident to lake sediments. Eleven sediment cores were sampled and activity depth profiles of (137)Cs and (210)Pb were determined with 5mm depth-resolution. The Chernobyl fallout produced an extreme (137)Cs peak in the sediment cores providing an excellent time marker. The chronological interpretation of deeper sediment layers was done by radiochemical analysis of (90)Sr and (239+240)Pu, which were released during atmospheric weapons' tests in the 1950s and 1960s. This allowed a complete chronological analysis of the sediment cores with a very compact set of data.

Cryoconites from Alpine glaciers: Radionuclide accumulation and age estimation with Pu and Cs isotopes and 210Pb.

Cryoconites ("cold dust", derived from the Greek) are aeolian sediments accumulated on glacier surfaces. In cryoconites from the surface of the Stubacher Sonnblickkees, a temperate Austrian glacier, extremely high activity concentrations of artificial and natural radionuclides were found. Artificial radionuclides stem from two clearly distinguishable sources, global fallout from the nuclear weapons testing era deposited over a period of years until roughly 1966 and the fallout from Chernobyl in 1986, which was essentially deposited as a single input during one week. Anthropogenic radionuclides identified were 137Cs, 134Cs, 238Pu, 239+240Pu, 90Sr, 241Am, 60Co, 125Sb, 154Eu, and 207Bi. The naturally occurring radionuclides detected were the long-lived radon decay product 210Pb, the primordial radionuclide 4 K and the cosmogenic 7Be. Isotopic ratios of 134Cs/137Cs and 239+240Pu/238Pu were used to separate the nuclide inventory into the contributions of the two aforementioned sources, which show varying degrees of mixing and provide information on the mixing age of the cryoconites. Since isotopic ratios of Pu often have high uncertainties due to low absolute concentrations, age estimation based on this method can be quite inaccurate. Additional information about the age of cryoconites was obtained through analysis of 210Pb, which is constantly deposited over time.

137Cs and 90Sr transfer to milk in Austrian alpine agriculture.

The alpine regions of Austria were among the most contaminated territories outside of the former USSR after the Chernobyl accident. In the investigated province of Salzburg the median (137)Cs surface deposition was 31.4 kBq m(-2) with maximum values exceeding 90 kBq m(-2) (May 1986). To quantify the transfer of (137)Cs and (90)Sr from vegetation to milk in these seminatural conditions nine seasonally grazed alps were identified and vegetation and milk sampled during summer 2002 and summer 2003. Mean+/-SD milk transfer coefficients (fm) for (137)Cs and (90)Sr were 0.0071+/-0.0009 d l(-1), and 0.0011+/-0.0004 d l(-1), respectively; which for (137)Cs is markedly higher than those fm values found in intensive agricultural systems. Transfer kinetics for (137)Cs into cow milk were approximated using a 2-compartment model with a short and a long-term component. Fitting the model to empirical data results in reliable estimates of the time constant of the short-term component, biological half-life 1.06+/-0.28 d, whereas the estimates of the long-term component are subject to high uncertainties.

Activity ratios of 137Cs, 90Sr and 239+240Pu in environmental samples.

Both global and Chernobyl fallout have resulted in environmental contamination with radionuclides such as 137Cs, 90Sr and 239+240Pu. In environmental samples, 137Cs and 239+240Pu can be divided into the contributions of either source, if also the isotopes 134Cs and 238Pu are measurable, based on the known isotopic ratios in global and Chernobyl fallout. No analogous method is available for 90Sr. The activity ratios of Sr to Cs and Pu, respectively, are known for the actual fallout mainly from air filter measurements; but due to the high mobility of Sr in the environment, compared to Cs and Pu, these ratios generally do not hold for the inventory many years after deposition. In this paper we suggest a method to identify the mean contributions of global and Chernobyl fallout to total Sr in soil, sediment and cryoconite samples from Alpine and pre-Alpine regions of Austria, based on a statistical evaluation of Sr/Cs/Pu radionuclide activity ratios. Results are given for Sr:Cs, Sr:Pu and Cs:Pu ratios. Comparison with fallout data shows a strong depletion of Sr against Cs and Pu.

A note on 207Bi in environmental samples.

Traces of the radionuclide (207)Bi were identified in soil and cryoconite (glacier sediment) samples from Alpine regions of Austria. This nuclide has been produced in thermonuclear explosions mainly in the early 1960s and subsequently dispersed in the atmosphere. Activity concentrations up to 22 Bq/kg d.m. have been found. The ratio (207)Bi:(137)Cs(global fallout) equals (1.70+/-0.12)10(-3), which is in accordance with literature data. When low levels of (207)Bi are assessed by gamma spectrometry, corrections must be made for a gamma line produced in the lead shield by neutron activation due to cosmic neutrons.

Radiocaesium in flowing waters of highly contaminated Austrian alpine areas.

In this study the runoff of (137)Cs, mainly originated from the Chernobyl fallout, from highly contaminated alpine regions in Salzburg (Austria) is discussed. Twenty-five water-samples and 25 sediment-samples were taken from creeks of different size to determine the runoff of dissolved (137)Cs and Cs-binding characteristics to different particle size classes in the sediments. The hypothesis, that specific activity of the sediments depended on particle size and the surface of the particle, was proved with some modifications. Caesium activity concentration in water showed a negative correlation with electrical conductivity, while no significant correlations were detectable with other variables (pH, temperature, and altitude). Enormous differences and the variations found in the (137)Cs-concentrations in water can be explained by the electrical conductivity without any dependency on the inventory of the catchment. The sediment samples analysed showed a negative correlation between specific activity [Bq/kg] and particle-diameter, mainly explained by (137)Cs-uptake proportional to the particle surface per mass.

The effect on lymphocyte chromosomes of additional radiation burden due to fallout in Salzburg (Austria) from the Chernobyl accident.

An investigation has been carried out to determine whether chromosome aberrations in peripheral blood lymphocytes reflect the elevated environmental dose of low-LET ionising radiation, mainly due to radiocesium from Chernobyl fallout, to the population living in Salzburg city. Sixteen volunteers were sampled 1 year after the Chernobyl accident. Two of these persons were also sampled before the accident, and then in 1988 and 1990. The radioactive environment of Salzburg city and the radiation burden of its inhabitants have been frequently determined before and after the accident. The Cs-137 content of the volunteers was measured by whole-body counting. The additional external plus internal radiation doses in the year 1987 to the tested individuals ranged between 15 and 68% of the former normal environmental burden. The aberration frequencies showed a sharp increase of about a factor 6 from the pre-Chernobyl dose rate (0.9. mGy/year) to the post-Chernobyl dose rate (about 2 mGy/year total) but then decreased again with higher additional dose. In the two persons analysed before and up to 4 years after the accident the aberration yield showed a significant increase from 1984/85 to 1987, a decrease in 1988 and a further decrease in 1990. If these last 2 values are plotted against additional dose they fit the curve of the pooled 1987 values. The dose-effect curves revealed the same tendency as we found in various previous investigations and support the assumption that repair enzymes could be triggered by a certain amount of damage to the DNA.

Chromosomal aberrations of blood lymphocytes induced in vitro by radon-222 daughter alpha-irradiation.

Blood samples were irradiated in vitro with alpha-rays emitted from short-lived radon decay products dissolved in the culture medium at doses between 0.03 and 41.4 mGy. The data were collected from experiments conducted during the period 1984-1992 and comprise a total of about 64000 scored metaphases. For statistical reasons, only 60,022 metaphases were used for the subsequent analysis. The results for total chromosome aberrations and dicentrics indicate a linear dose dependence in the dose range above about 10 mGy, consistent with other experimental observations. At doses below about 10 mGy, aberration frequencies cannot be linearly extrapolated from higher doses, suggesting that there is no dependence on dose within a certain low-dose range. In addition, a statistically significant minimum has been observed at a dose of about 0.03 mGy, which is consistently lower than the related control values. The behavior of the aberration frequencies in the low-dose region seems to be influenced by the control values, which also depend on the environmental radiation burdens to the donors before blood sampling and thus were significantly affected by the Chernobyl fallout.

Results and conclusions of the Austrian radon mitigation project 'SARAH'.

The Austrian radon mitigation joint research project SARAH (supported by the Austrian Ministry of Economy and the Government of Upper Austria), a 2-year follow-up study of the Austrian National Radon Project (ONRAP), was started in 1996. The objectives of the research project were to find simple, cost-effective experimental methods for the characterisation of the radon situation in dwellings and to evaluate technically and economically the implementation of state of the art remedial actions for Austrian house types. After an intercomparison exercise of the assigned radon measuring instruments and detectors five houses were closely examined in regions with elevated radon levels in the federal state of Upper Austria. In this research work for the first time an extended Blower-Door method (which is conventionally used for determining the tightness of buildings) was successfully applied to radon diagnosis of buildings. In this paper the methods used for the radon diagnosis, the applied mitigation measures and the related technical and economical aspects are discussed. In conclusion of the results of this project a common strategy for solving the radon problem in Austria in the future is presented briefly.

137Cs concentrations in lichens before and after the Chernobyl accident.

137Cs activities were measured in a variety of epigeic and epiphytic lichens in Austria before and after contamination by the Chernobyl fallout. For comparison, the activity of the naturally occurring 40K was also determined in each lichen sample. The high 137Cs activities found after Chernobyl suggest that lichens are suitable and inexpensive biological detectors of the fallout pattern.

90Sr and 137Cs in environmental samples from Dolon near the Semipalatinsk Nuclear Test Site.

The (90)Sr and (137)Cs activities of soil, plant, and milk samples from the village of Dolon, located close to the Semipalatinsk Nuclear Test Site in Kazakhstan, were determined. The areal deposition at the nine sampling sites is in the range of <500 to 6,100 Bq m(-2) and 300 to 7,900 Bq m-2 for (90)Sr and (137)Cs, respectively. Similar values have been reported in the literature. At some of the sites both nuclides mainly have remained in the top 6 cm of the soil profiles; at others they were partly transported into deeper soil layers since the deposition. For most of the samples the (90)Sr yield after destruction of the soil matrix is significantly higher than after extracting with 6 M HCl indicating that (90)Sr is partly associated with fused silicates. The low mean (90)Sr activity concentrations of vegetation samples (14 Bq kg(-1) dw) and milk samples (0.05 Bq kg(-1) fw) suggest that this has favorable consequences in terms of limiting its bioavailability.

Determination of (137)Cs in the water system of a pre-Alpine lake.

The aim of this study was to measure the (137)Cs activity derived from the Chernobyl accident in the water system of Lake Wallersee, a pre-Alpine lake in Austria within an area highly contaminated by the Chernobyl fallout. For this purpose, water and sediment samples of the inflows and the outflow of Lake Wallersee and lake water at different depths were collected in 2005. The obtained (137)Cs activity depth profile in the water body shows an exponential increase of (137)Cs activity in the lake water with increasing depth. Inflow and outflow sediment analyses exhibit a clear negative correlation between particle size and specific activity for (137)Cs and (40)K in sediment samples following a power function. In a first approach it was tried to calculate the catchment run-off factor of (137)Cs during a period without heavy rainfalls. The result is in good agreement with run-off factors determined in other similar investigations in Austria.

Accumulation of anthropogenic radionuclides in cryoconites on Alpine glaciers.

Cryoconites are airborne sediments which accumulate on the surface of glaciers. In samples of cryoconites a temperate Austrian glacier high activity concentrations of anthropogenic radionuclides were found, which stem from global and Chernobyl fallouts. Radionuclides identified were (137)Cs, (134)Cs, (238)Pu, (239+240)Pu, (90)Sr, (241)Am, (60)Co, (154)Eu, (207)Bi, and (125)Sb. Given the approximately known isotopic ratios, Cs and Pu can be separated into the contributions of either source of origin. Published (137)Cs/(134)Cs and (239+240)Pu/(238)Pu ratios were used for the discrimination of the Dachstein-glacier cryoconites according to their origin from global or Chernobyl fallout. Two different groups of cryoconites were identified, an older population dominated by nuclear weapons fallout and a younger one with predominant Chernobyl fallout. With those data a simple model was formulated to demonstrate the transition and mixing of these two populations on the glacier surface.

Avaliacao, formulacao e planejamento comportamental. Estudo de um caso. / Evaluation, formulation and behavioral planning. Study of a case

Aborda-se o tratamento behaviorista de um jovem com ansiedade, dor e inseguranca. E enfatizada a necessidade da abordadem individualizada, especialmente para os fatores que levaram a producao e a manutencao dos problemas. O tratamento desse paciente durou sete semanas e a melhora manteve-se ate o seguimento de oito meses

O tratamento de obsessoes-compulsoes. / Treatment of absessions-compulsions

Este artigo tenta abordar resumidamente o entendimento funcional e o tratamento comportamental de obsessoes-compulsoes. Atraves do desenvolvimento da terapia comportamental, o pessimismo terapeutico em relacao as obsessoes e compulsoes foi, sem duvida, significativamente reduzido, e encontra-se na literatura um numero crescente de relatos de tratamentos bem-sucedidos Apresenta-se um caso com a finalidade de ilustrar esta abordagem complexa de terapia e divulga-la em um ambiente onde e pouco conhecida.}