[Ophthalmological imaging with ultrahigh field magnetic resonance tomography: technical innovations and frontier applications]. / Ophthalmologische Bildgebung mit Ultrahochfeld-Magnetresonanztomografie: technische Innovationen und wegweisende Anwendungen.

This review documents technical progress in ophthalmic magnetic resonance imaging (MRI) at ultrahigh fields (UHF, B(0) ≥ 7.0 T). The review surveys frontier applications of UHF-MRI tailored for high spatial resolution in vivo imaging of the eye, orbit and optic nerve. Early examples of clinical ophthalmic UHF-MRI including the assessment of melanoma of the choroid membrane and the characterisation of intraocular masses are demonstrated. A concluding section ventures a glance beyond the horizon and explores research promises along with future directions of ophthalmic UHF-MRI.

Drug-resistant epilepsy: current recommendations for diagnosis and treatment in Spain.

INTRODUCTION: Drug-resistant epilepsy (DRE) is a top-priority social health problem which requires early individual treatment due to its dramatic repercussions for the patient and society. DEVELOPMENT: The International League Against Epilepsy (ILAE) has recently defined DRE as that in which the seizures are not controlled after having correctly taken two appropriate and well tolerated anti-epileptic drugs, with lack of control being understood as the appearance of seizures within one year or in a period less than three times the inter-seizure interval before starting treatment. This International Society recommends a rapid and detailed assessment of all patients in an Epilepsy Unit. A Clinical Epilepsy Unit (CEU) is understood as a group of professionals who, acting in collaboration, have the diagnosis and treatment of the patient with epilepsy as their primary objective. CEUs in Spain may be stratified into different levels depending on the activity carried out in each of them. The specific epilepsy clinic is considered the fundamental type of CEU and includes the necessary figure of an expert in epilepsy. Prolonged video-monitoring is performed in medical CEUs. In medical-surgical CEUs epilepsy surgery with varying degrees of difficulty is also performed. CONCLUSIONS: All CEUs must cooperate with consensus protocols, and there must be a two-way flow between them. Stratification of CEUs increases efficacy and efficiency, due to there being a sufficient number of them to ensure easy access by all patients with epilepsy.

IT services in a completely digitized radiological department: value and benefit of an in-house departmental IT group.

To analyze the benefit of a departmental IT group in comparison to support by hospital IT groups or system manufacturers in a completely digitized radiological department. The departmental IT group comprises a fulltime IT specialist, two student assistants and four clinical employees participating 1 day/week. For 18 months IT problems were quantified and specified according to urgency, responsibility and affected system by use of an intranet-based reporting system. For each IT service provider the performance and duration of problem solution was evaluated. In 18 months 3,234 IT problems emerged. 88.7% were solved by the departmental IT group. In 474 cases (14.7%) a solution within 2 h was required. The departmental IT group solved 35.8% within 30 min, system manufacturers needed 18 h 38 min in mean. The departmental IT group solved 90.2% of the problems within a time limit. System manufacturers met the limit in 60.1% with a mean duration of 7 days 21 h. In 6.7% of the cases, support by system manufacturers was indispensable. A considerable proportion of IT problems in completely digitized radiological departments can be solved by a departmental IT group, providing a fast and cost-efficient first-level IT support with effective prevention of major breaks in the workflow. In a small number of cases support by system manufacturers remains necessary.

[Costs and benefits of an education program for patients with ankylosing spondylitis as part of an inpatient rehabilitation programs-study design and first results]. / Kosten und Nutzen eines Schulungsprogramms für Patienten mit Spondylitis ankylosans in der stationären RehabilitationUntersuchungsdesign und erste Ergebnisse.

The economic evaluation of a patient education program "ankylosing spondylitis"-based on a randomised controlled prospective multi-center study design-compares program costs and savings in direct and indirect follow-up costs. The collection of health services and cost data was conducted by questioning staff (education programme costs) and patients (follow-up costs). The present study results are: program costs per patient range between 117 euro (10 participants per course) and 186 euro (6 participants per course). Savings in indirect costs (unfitness to work) amount to 2500 euro and thus overcompensate program costs. Currently patient data are verified by sickness fund data and direct follow-up costs and qualitiy of life data are analysed.

[Concept for a health care economic evaluation of short- and long-term costs and effectiveness parameters of an expanded ambulatory psychosomatic rehabilitation program]. / Konzept zur gesundheitsökonomischen Evaluation kurz- und längerfristiger Kosten- und Wirksamkeitsparameter eines erweiterten ambulanten psychosomatischen Rehabilitationsprogramms.

There are only few ambulatory rehabilitation concepts for mothers with psychosomatic disorders (prevalence 5%). Also, only little is known about the evaluation of these programmes. This study compares the socioeconomic evaluations of an ambulatory rehabilitation programme with a post-assistance programme and one without a post-assistance programme. The superior programme should be determined by weighing all relevant costs and benefits. The intensive phase of the ambulatory rehabilitation programme consists of an eight-week treatment with group, single, body and art therapy. The post-assistance programme spans a period of nine-months with 36 sessions of psychoanalytic group therapy. The evaluation of both programme alternatives is made by with the evaluation tool of socioeconomic analyses. For consideration and pricing of costs all direct medical costs, direct non-medical costs and indirect costs are being monitored. Outcomes assessment is realised by cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. Utilisation of the health care system is being assessed with questionnaires. Measurements are being performed at the beginning and the end of the rehabilitation programme and three, six, nine and twelve months later. Mothers with children aged six years and younger and suffering from various psychosomatic disorders were included in this study. The costs identified for the rehabilitation programme are DM 5571.10 (intensive care and post-assistance programme) and DM 1512.40 (intensive care) per patient. Further progress of the study will show if future cost will differ between the two alternatives. For the comparison of both alternatives all costs will be linked with outcomes. It remains to be seen that additional costs of the post-assistance programme will be compensated with positive outcomes. A sensitivity analysis will show if variation of assumptions will influence the cost-benefit-ratio of the different alternatives.

Assessment of muscarinic transmission in the superior cervical and ciliary ganglion of the cat.

This study was undertaken to determine if muscarinic mechanisms are involved in synaptic transmission in the parasympathetic ciliary ganglion as has been clearly shown for sympathetic ganglia. Cats were anesthetized, and following topical ephedrine, pupillary constrictions were elicited by electrical stimulation of the intracranial oculomotor nucleus. Nictitating membrane contractions were evoked by electrical stimulation of the preganglionic cervical nerve. Frequency-response curves were repeated after infusion with hexamethonium (0.6-1.0 mg/kg min-1) and after subsequent administration of atropine (500 micrograms/kg. i.v.). In other experiments, effects of nicotinic (DMPP) and muscarinic (McN-A-343) agonists on postganglionic ciliary nerve activity were measured. Treatment with hexamethonium reduced nictitating membrane responses at all frequencies of stimulation (by about 75% at 16-32 Hz). The residual nictitating membrane contractions were subsequently blocked by the addition of atropine. In contrast, hexamethonium totally abolished miosis produced by CNS preganglionic oculomotor nerve stimulation. The nicotinic agonist, DMPP, produced nictitating membrane contractions, miosis, and increased ciliary nerve firing. In contrast, McN-A-343 contracted the nictitating membrane but failed to increase postganglionic ciliary nerve activity. These results suggest that, unlike sympathetic ganglia, a significant degree of muscarinic transmission does not occur in the parasympathetic ciliary ganglion.