Comparison of 96-kV and 120-kV cone-beam CT for the assessment of cochlear implants.

BACKGROUND: To compare the diagnostic value of 120-kV with conventional 96-kV Cone-Beam CT (CBCT) of the temporal bone after cochlear implant (CI) surgery. METHODS: This retrospective study included CBCT scans after CI surgery between 06/17 and 01/18. CBCT allowed examinations with 96-kV or 120-kV; other parameters were the same. Two radiologists independently evaluated following criteria on 5-point Likert scales: osseous spiral lamina, inner and outer cochlear wall, semi-circular canals, mastoid trabecular structure, overall image quality, metal and motion artefacts, depiction of intracochlear electrode position and visualisation of single electrode contacts. Effective radiation dose was assessed. RESULTS: Seventy-five patients (females, n = 39 [52.0%], mean age, 55.8 ± 16.5 years) were scanned with 96-kV (n = 32, 42.7%) and 120-kV (n = 43, 57.3%) protocols including CI models from three vendors (vendor A n = 7; vendor B n = 43; vendor C n = 25). Overall image quality, depiction of anatomical structures, and electrode position were rated significantly better in 120-kV images compared to 96-kV (all p < = 0.018). Anatomical structures and electrode position were rated significantly better in 120-kV CBCT for CI models from vendor A and C, while 120-kV did not provide improved image quality in CI models from vendor B. Radiation doses were significantly higher for 120-kV scans compared to 96-kV (0.15 vs. 0.08 mSv, p < 0.001). CONCLUSIONS: 120-kV and 96-kV CBCT provide good diagnostic images for the postoperative CI evaluation. While 120-kV showed improved depiction of temporal bone and CI electrode position compared to 96-kV in most CI models, the 120-kV protocol should be chosen wisely due to a substantially higher radiation exposure.

Vitreous cytokine levels following the administration of a single 0.19 mg fluocinolone acetonide (ILUVIEN®) implant in patients with refractory diabetic macular edema (DME)-results from the ILUVIT study.

PURPOSE: To investigate the changes in vitreous inflammatory and angiogenic cytokine levels, primarily interleukin-(IL)-6, following intravitreal injection of the 0.19 mg fluocinolone acetonide (FAc, ILUVIEN®) implant in patients with diabetic macular edema. METHODS: A single-center phase IV study involving 12 patients' eyes with diabetic macular edema. Vitreous fluid samples were obtained prior to intravitreal injection of the fluocinolone acetonide implant and then again over a 6-month period. Vitreous samples were examined using a cytometric bead array to measure IL-6, IL-8, IP-10, MCP-1, VEGF, and CD54. PIGF and PEDF were measured using an enzyme-linked immunosorbent assay. Changes in the cytokine and chemokine expression patterns were analyzed. Clinical parameters such as BCVA and center point thickness (CPT) were also examined. RESULTS: There were mean reductions in all parameters between baseline and month 6. Significant changes (p < 0.05 versus baseline) were observed in the expression of IL-6, IP-10, MCP-1, and CD54 following the administration of fluocinolone acetonide implant. VEGF and PIGF increased at month 1 before declining at month 6, though this trend was not significant. CPT decreased rapidly between screening and the first follow-up visit, and this decrease was sustained. BCVA remained relatively stable throughout. CONCLUSION: This study demonstrated changes in vitreous inflammatory and angiogenic cytokine levels following intravitreal injection of the FAc implant in patients with diabetic macular edema. Data show that the fluocinolone acetonide implant led to rapid and sustained reductions of some inflammatory cytokines with improvement of the overall clinical picture.

Electronically monitored occlusion therapy in amblyopia with eccentric fixation.

PURPOSE: Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. METHODS: In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. RESULTS: The study included 12 participants with strabismic and combined amblyopia aged 2.9-12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6-9.9) and median daily received occlusion was 5.2 h/day (range 0.7-9.7). At study end, median acuity gain was 0.6 log units (range 0-1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0-1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1-6). Three patients (> 6 years) did not gain central fixation. CONCLUSION: Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.

Implementation of microsurgery simulation in an ophthalmology clerkship in Germany: a prospective, exploratory study.

BACKGROUND: Microsurgery is a growing field which requires significant precision and skill. Eyesi Surgical, which is usually introduced during residency or fellowship, is an ophthalmologic microsurgery simulator which allows users to practice abstract microsurgical skills and more specialized skills. The purpose of this study was to assess the inclusion of microsurgical simulation training during medical school. METHODS: Seventy-nine German medical students in their 10th semester of education completed up to two days of training on the simulator during their ophthalmology clerkship. They received an objective numeric score based on simulator performance and completed pre and post training subjective questionnaires. RESULTS: There was no relationship found between students' Eyesi Surgical performance scores and their specialty interests (p = .8). The majority of students (73.4%) rated their microsurgical skills to be higher after simulator training than before training (p < 0.001). 92.4% of students found the Eyesi Surgical to be a useful component of the ophthalmology clerkship. Objective scores from Navigation Training Level 1 showed that students achieved better results in the criteria categories of Completing Objects and Tissue Treatment than in the categories of Instrument and Microscope Handling. The mean Total Score was 25.7 (± 17.5) out of a possible 100 points. CONCLUSION: The inclusion of surgical simulation in the ophthalmology clerkship led to increased confidence in the microsurgical skills of medical students. Offering surgical simulation training prior to residency can help to expose students to surgical fields, identify those that have particular talent and aptitude for surgery, and assist them in deciding which specialty to pursue.

The controversial debate about daylight saving time (DST)-results of a retrospective forensic autopsy study in Frankfurt/Main (Germany) over 10 years (2006-2015).

Worldwide, many people are exposed to biannual time changes. The benefit of Daylight Saving Time (DST) is controversially discussed and its impact on human health is largely unknown. The present study examines, whether effects of these time changes are seen in a forensic autopsy database. The mortality study is based on autopsy protocols provided by the Institute of Legal Medicine, University Clinic of the Goethe-University Frankfurt/Main, covering a period of 10 years (2006-2015). Data regarding mode and cause of death, age, and gender were evaluated for 4 weeks around the transition to and from DST in spring and autumn. A significant (p = 0.04) elevation in the number of autopsies was observed in the first week following the switch to DST in spring, but no significant changes were noted in autumn. Gender-specific analysis indicated that the autopsy rate of females showed a significant (p = 0.01) peak in the first and a decline (p = 0.05) in the second week following the switch to DST. Differences in non-natural death cases primarily included traffic accidents and suicides, in natural death cases fatal cardiac diseases like cardiac insufficiency and acute myocardial infarction. The number of suicides was low (p = 0.05) before, but high (p = 0.07) in the weeks after the introduction of DST. The present evaluation confirmed a potential effect of DST, such as a significant higher autopsy rate in spring during the first week after the introduction to DST. Moreover, a relation between the introduction to DST in spring and an increase in suicide cases was observed.

Microwave Ablation (MWA) of Pulmonary Neoplasms: Clinical Performance of High-Frequency MWA With Spatial Energy Control Versus Conventional Low-Frequency MWA.

OBJECTIVE. The objective of our study was to evaluate the clinical performance of a new high-frequency (HF) microwave ablation (MWA) technology with spatial energy control for treatment of lung malignancies in comparison with a conventional low-frequency (LF) MWA technology. MATERIALS AND METHODS. In this retrospective study, 59 consecutive patients (mean age, 58.9 ± 12.6 [SD] years) were treated in 71 sessions using HF spatial-energy-control MWA. Parameters collected were technical success and efficacy, tumor diameter, tumor and ablation volumes, ablation time, output energy, complication rate, 90-day mortality, local tumor progression (LTP), ablative margin size, and ablation zone sphericity. Results were compared with the same parameters retrospectively collected from the last 71 conventional LF-MWA sessions. This group consisted of 56 patients (mean age, 60.3 ± 10.8 years). Statistical comparisons were performed using the Wilcoxon-Mann-Whitney test. RESULTS. Technical success was 98.6% for both technologies; technical efficacy was 97.2% for HF spatial-energy-control MWA and 95.8% for LF-MWA. The 90-day mortality rate was 5.1% (3/59) in the HF spatial-energy-control MWA group and 5.4% (3/56) in the LF-MWA group; for both groups, there were zero intraprocedural deaths. The median ablation time was 8.0 minutes for HF spatial-energy-control MWA and 10.0 minutes for LF-MWA (p < 0.0001). Complications were recorded in 21.1% (15/71) of HF spatial-energy-control MWA sessions and in 31.0% (22/71) of LF-MWA sessions (p = 0.182); of these complications, 4.2% (3/71) were major complications in the HF spatial-energy-control MWA group, and 9.9% (7/71) were major complications in the LF-MWA group. The median deviation from ideal sphericity (1.0) was 0.195 in the HF spatial-energy-control MWA group versus 0.376 in the LF-MWA group (p < 0.0001). Absolute minimal ablative margins per ablation were 7.5 ± 3.6 mm (mean ± SD) in the HF spatial-energy-control MWA group versus 4.2 ± 3.0 mm in the LF-MWA group (p < 0.0001). In the HF spatial-energy-control MWA group, LTP at 12 months was 6.5% (4/62). LTP at 12 months in the LF-MWA group was 12.5% (7/56). Differences in LTP rate (p = 0.137) and time point (p = 0.833) were not significant. CONCLUSION. HF spatial-energy-control MWA technology and conventional LFMWA technology are safe and effective for the treatment of lung malignancies independent of the MWA system used. However, HF spatial-energy-control MWA as an HF and high-energy MWA technique achieves ablation zones that are closer to an ideal sphere and achieves larger ablative margins than LF-MWA (p < 0.0001).

Evaluation of a Computer-Aided Diagnosis System for Automated Bone Age Assessment in Comparison to the Greulich-Pyle Atlas Method: A Multireader Study.

OBJECTIVE: The aim of this study was to investigate a novel version of a computer-aided diagnosis (CAD) system developed for automated bone age (BA) assessment in comparison to the Greulich and Pyle method, regarding its accuracy and the influence of carpal bones on BA assessment. METHODS: Total BA, BA of the left distal radius, and BA of carpal bones in 305 patients were determined independently by 3 blinded radiologists and assessed by the CAD system. Pearson product-moment correlation, Bland-Altman plot, root-mean-square deviation, and further agreement analyses were computed. RESULTS: Mean total BA and BA of the distal radius showed high correlation between both approaches (r = 0.985 and r = 0.963). There was significantly higher correlation between values of total BA and BA of the distal radius (r = 0.969) compared with values of total BA and BA of carpal bones (r = 0.923). The assessment of carpal bones showed significantly lower interreader agreement compared with measurements of the distal radius (κ = 0.79 vs κ = 0.98). CONCLUSION: A novel version of a CAD system enables highly accurate automated BA assessment. The assessment of carpal bones revealed lower precision and interreader agreement. Therefore, methods determining BA without analyzing carpal bones may be more precise and accurate.

Evaluation of microwave ablation of liver malignancy with enabled constant spatial energy control to achieve a predictable spherical ablation zone.

OBJECTIVES: To evaluate the clinical performance of a new microwave ablation (MWA) system with enabled constant spatial energy control (ECSEC) to achieve spherical ablation zones in the treatment of liver malignancies. MATERIALS AND METHODS: In this retrospective study, 56 hepatic tumours in 48 patients (23 men, 25 women; mean age: 59.6 years) were treated using a new high-frequency MWA-system with ECSEC. Parameters evaluated were technical success, technical efficacy, tumour diameter, tumour and ablation volume, complication rate, 90-day mortality, local tumour progression (LTP) at the 12-month follow-up, ablative margin and ablation zone sphericity. These parameters were compared using the Kruskal-Wallis test with the same parameters collected retrospectively from cohorts of patients treated with conventional high-frequency (HF) MWA (n = 20) or low-frequency (LF) MWA (n = 20). RESULTS: Technical success was achieved in all interventions. The technical efficacy was 100% (ECSEC) vs. 100% (LF-MWA) vs. 95% (HF-MWA). There were no intra-procedural deaths or major complications. Minor complications occurred in 3.57% (2/56), 0% (0/20) and 0% (0/20) of the patients, respectively. The one-year mortality rate was 16.1% (9/56), 15% (3/20) and 10% (2/20), respectively. The LTP was 3.57% (2/56), 5% (1/20) and 5% (1/20), respectively. The median deviation from ideal sphericity (1.0) was 0.135 (ECSEC) vs. 0.344 (LF-MWA) vs. 0.314 (HF-MWA) (p < 0.001). The absolute minimal ablative margin was 8.1 vs. 2.3 vs. 3.1 mm (p < 0.001). CONCLUSIONS: Microwave ablation of liver malignancies is a safe and efficient treatment independent of the system used. Hepatic MWA with ECSEC achieves significantly more spherical ablation zones and higher minimal ablative margins.

Assessment of salivary gland tumors using MRI and CT: impact of experience on diagnostic accuracy.

RATIONALE AND OBJECTIVES: To analyze the accuracy of radiological diagnosis in MRI and CT studies of salivary gland tumors depending on the radiologist's experience. MATERIALS AND METHODS: Three radiologists with differing experience (R1 > 20, R2 > 11, and R3 > 7 years, respectively) retrospectively reviewed 128 cases (116 MRI, 12 CT studies) with suspected salivary gland tumors regarding dignity and classification using histopathology as a reference standard. Sensitivity, specificity, positive/negative predictive value and inter-observer agreement (using Cohen's κ) were calculated to compare diagnostic performance. RESULTS: Lesions were benign in 87 and in 23 cases malignant. Neoplasia was absent in 18 cases (15 cases without neoplasia and 3 cases without disease). The highest inter-observer agreement for determining dignity using CT was found between R1 and R2 (κ = 0.74, p < 0.001), and the lowest between R2 and R3 (κ = 0.28, p < 0.001). MRI sensitivity/specificity for classifying pleomorphic adenomas was as follows: R1 (100%/100%), R2 (76.92%/87.01%), R3 (43.53%/67.53%), and for CT: R1 (100%/100%), R2 (100%/88.89%), R3 (66.67%/88.89%; for Warthin's tumor using MRI: R1 (100%/97.44%), R2 (68.42%/83.33%), R3 (50.00%/67.95%), and using CT: R1 (100%/100%), R2 (50.00%/100%), R3 (100%/100%; for squamous cell carcinomas using MRI: R1 (100%/100%), R2 (75.00%/97.12%), R3 (75.00%/99.04%), and using CT: R1 (100%/100%), R2 (66.67%/88.89%), R3 (66.67%/66.67%). The highest agreement was found between R1 and R2 for MRI (κ = 0.62, p < 0.001), and the lowest between R1 and R3 at MRI (κ = 0.28, p < 0.001). CONCLUSION: Diagnostic accuracy in the assessment of salivary gland tumors strongly depends on the observer's expertise and increases with higher experience.

Combined p16 and p53 expression in cervical cancer of unknown primary and other prognostic parameters : A single-center analysis.

BACKGROUND AND PURPOSE: Cervical cancer of unknown primary (CUP) represents an uncommon and heterogeneous subentity of head and neck cancer. However, both optimal diagnostics and therapy remain unclear. An improved understanding of the underlying pathology is essential to enable future tailored therapies and optimized outcomes. MATERIALS AND METHODS: We retrospectively analyzed 53 patients with head and neck CUP and 48 available cervical lymph node specimens. All patients have received radiotherapy between 2007 and 2015. Preradiotherapy involved lymph node specimens were analyzed for p16 and p53 immunoreactivity. The prognostic relevance of the combined p16 and p53 status and other clinical parameters were examined by univariate and multivariate analyses. RESULTS: Median patient age was 61.5 years and median irradiation dose to the involved nodal levels was 66 Gy. Of the 48 evaluated specimens, 13 (27%) were p16-positive and 31 (64.6%) p53-positive. After a median follow up of 32.9 months, patients with p16-negative and simultaneously p53-positive tumors showed a significantly inferior tumor-specific survival (TSS) compared to those with either p16+/p53-, p16+/p53+, or p16-/p53- (univariate: p = 0.055, multivariate: p = 0.038). Other factors with an adverse impact on TSS in the univariate analysis were smoking history (p = 0.032) and nodal stage (p = 0.038). CONCLUSIONS: The combined p16- and p53-expression status in cervical metastases of CUP may represent a simple method for risk stratification. Further validation of these biomarkers in large prospective trials is essential to design rational trials for CUP treatment optimization.

Intraprocedural blood volume measurement using C-arm CT as a predictor for treatment response of malignant liver tumours undergoing repetitive transarterial chemoembolization (TACE).

PURPOSE: To evaluate feasibility of measuring parenchymal blood volume (PBV) of malignant hepatic tumours using C-arm CT, test the changes in PBV following repeated transarterial chemoembolization (TACE) and correlate these changes with the change in tumour size in MRI. METHODS: 111 patients with liver malignancy were included. Patients underwent MRI and TACE in a 4- to 6-week interval. During intervention C-arm CT was performed. Images were post-processed to generate PBV maps. Blood volume data in C-arm CT and change in size in MRI were evaluated. The correlation between PBV and size was tested using Spearman rank test. RESULTS: Pre-interventional PBV maps showed a mean blood volume of 84.5 ml/1000 ml ± 62.0, follow-up PBV maps after multiple TACE demonstrated 61.1 ml/1000 ml ± 57.5. The change in PBV was statistically significant (p = 0.02). Patients with initial tumour blood volume >100 ml/1000 ml dropped 7.1% in size and 47.2% in blood volume; 50-100 ml/1000 ml dropped 4.6% in size and 25.7% in blood volume; and <50 ml/1000 ml decreased 2.8% in size and increased 82.2% in blood volume. CONCLUSION: PBV measurement of malignant liver tumours using C-arm CT is feasible. Following TACE PBV decreased significantly. Patients with low initial PBV show low local response rates and further increase in blood volume, whereas high initial tumour PBV showed better response to TACE. KEY POINTS: Parenchymal blood volume assessment of malignant hepatic lesions using C-arm CT is feasible. The parenchymal blood volume is reduced significantly following transarterial chemoembolization. Parenchymal blood volume can monitor the response of tumours after transarterial chemoembolization. Although not significant, high initial parenchymal blood volume yields better response to TACE.

Long-Term Changes in Aortic Length after Thoracic Endovascular Aortic Repair.

PURPOSE: To study long-term changes to the thoracic aorta following thoracic endovascular aortic repair (TEVAR) for treatment of different aortic pathologic conditions. MATERIALS AND METHODS: This retrospective study included 53 consecutive patients (mean age, 58.8 y ± 14; 13 female and 40 male) in whom TEVAR was performed between October 2002 and May 2010. The mean duration of follow-up was 21.1 months (range, 0.5-96 mo). Statistical analysis was performed with the Friedman test and Conover-Iman test. RESULTS: Nineteen patients with aortic aneurysm (group 1), 25 patients with type B dissection (group 2), and 9 patients with other pathologic conditions (group 3) were treated with TEVAR. The mean overall aortic lengths (from the origin of the left subclavian artery to the origin of the celiac trunk) before TEVAR were 271.4 mm, 268.6 mm, and 233.6 mm in groups 1, 2, and 3, respectively. At 12-month follow-up, the lengths were 282.8 mm, 294.4 mm, and 237.5 mm in groups 1, 2, and 3, respectively. The changes in aortic lengths following TEVAR were statistically significant (P < .001). A second intervention was required in 14 patients, and 6 patients died during follow-up. CONCLUSIONS: A significant change in the overall aortic length was observed following TEVAR. The changes in aortic length reached statistical significance after 12 months.

High-frequency versus low-frequency microwave ablation in malignant liver tumours: evaluation of local tumour control and survival.

PURPOSE: To compare local tumour control and survival rates in patients with liver metastases treated with microwave ablation (MWA), using either a low-frequency (LF) (915 MHz) or high-frequency (HF) system (2.45 GHz). MATERIALS AND METHODS: The retrospective study included 221 patients (mean age: 61.7 years) with 356 malignant hepatic lesions. Ninety-four patients with 133 lesions underwent LF-MWA between September 2008 and February 2011, while 127 patients with 223 lesions were treated with HF-MWA between March 2011 and July 2013. MRI was performed after 24 h from each procedure and at 3, 6, 9, 12, 18 and 24 months post-ablation. Both groups were compared with the Fisher's exact test. Survival rates were calculated using the Kaplan-Meier test. RESULTS: The mean initial ablation volume of LF-MWA was nearly half of HF-MWA (19.1 mL vs. 39.9 mL). The difference in volume between both systems was significant (p < .0001). With LF-MWA, 39/133 lesions (29.32%) progressed at follow-up while the number of lesions which progressed with HF-MWA was 10/223 (4.5%). The mean time to progression was 5.03 and 5.31 months for the lesions treated with LF-MWA and HF-MWA, respectively. The difference between both systems was significant (p = .00059). The 1-, 2- and 4-year overall survival rates for curative indication were 98.9%, 95.7% and 82.9% for LF-MWA, respectively, and were 100%, 97.6% and 92.9% for HF-MWA, respectively. The difference in survival rates was not significant (p > .05). CONCLUSION: Both LF- and HF-MWA systems are effective treatment options for oligonodular liver malignant lesions, but significantly higher ablation volumes, longer time to progression and lower progression rates were observed in HF-MWA.

Globalization in Urology: A Bibliographical Analysis of Cross-Continent Publication between 2002 and 2012.

INTRODUCTION: Asian scientists have now increasingly begun to contribute to globalization; yet it is not clear whether publishing in the field of urology is paralleled by elevated cross-continental scientific publishing. MATERIALS AND METHODS: An exemplary bibliometric analysis of urologic journals from 3 different continents was conducted between 2002 and 2012. Based on the ISI Web of Knowledge Journal Citation Reports, 2 urologic journals with similar impact factors (IFs) in 2013 were selected from Europe ('British Journal of Urology International', 'World Journal of Urology'), Asia ('International Journal of Urology', 'Asian Journal of Andrology') and North America ('Urologic Oncology-Seminars and Original Investigations', 'Urology'). The home continent of the journal, the workplace continental affiliation of the last author, article type (clinical, experimental or review) as well as the IF were documented. RESULTS: Most authors published their manuscripts in journals from the same continent in which they worked. However, a significant increase in cross-continental publishing was apparent from 2002 to 2012. Asians publishing in North America increased from 17% in 2002 to 35% in 2012. Europeans also increased the number of articles they published in North American journals, while publications from North American authors were shifted towards both European and Asian journals. Experimental and clinical articles showed significant increases in cross-continental publishing, while review publishing showed no significant change. The average IF for authors from all 3 continents increased from 2002 to 2012 (p < 0.001). The largest increase in the IF was found for Asian authors (0.11 per year). CONCLUSIONS: Cross-continental publication significantly increased during the period from 2002 to 2012. The impact that the Asian authors have experienced was found to be gradually impacting the North American and European colleagues.

Diagnostic performance of CE-MRA in grading stenosis and therapy planning with TASC II classification.

OBJECTIVES: To assess to what extent results of CE-MRA coincide with DSA in grading of stenosis and planning of therapy in patients with PAOD. MATERIALS AND METHODS: Retrospectively, images of 71 PAOD-patients were studied by three observers. For evaluation, the lower limb was subdivided into 31 segments and categorized with TASCII-score. RESULTS: In grading stenosis, both modalities agreed in 93.26%. CE-MRA achieved sensitivity of 92.69% and specificity of 96.87% (κ = 0.88). The concordance of TASCII-classification was almost perfect. CONCLUSION: CE-MRA is an excellent method for the evaluation of PAOD with some tendency to overrate the grade of stenosis.

Transarterial chemoembolization of unresectable systemic chemotherapy-refractory liver metastases from colorectal cancer: long-term results over a 10-year period.

The aims of the study were to evaluate therapeutic efficacy and to determine the prognostic factors for treatment success in patients with liver metastases from colorectal cancer (CRC) treated with transarterial chemoembolization (TACE). A total of 564 patients (mean age, 60.3 years) with liver metastases of CRC were repeatedly treated with TACE. In total, 3,384 TACE procedures were performed (mean, six sessions per patient). The local chemotherapy protocol consisted of mitomycin C alone (43.1%), mitomycin C with gemcitabine (27.1%), mitomycin C with irinotecan (15.6%) or mitomycin C with irinotecan and cisplatin (15.6%). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated using magnetic resonance imaging or computed tomography. The change in tumor size was calculated and the response was evaluated according to the RECIST-Criteria. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank test. Evaluation of local tumor control showed partial response in 16.7%, stable disease in 48.2% and progressive disease in 16.7%. The 1-year survival rate after chemoembolization was 62%, the 2-year survival rate was 28% and the 3-year survival rate was 7%. Median survival from the start of chemoembolization treatment was 14.3 months. The indication (p = 0.001) and initial tumor response (p = 0.015) were statistically significant factors for patient's survival. TACE is a minimally invasive therapy option for controlling local metastases and improving survival time in patients with hepatic metastases from CRC. TN stage, extrahepatic metastases, number of lesions, tumor location within the liver and choice of chemotherapy protocol of TACE are none significant factors for patient's survival.

Topogram-based automated selection of the tube potential and current in thoraco-abdominal trauma CT - a comparison to fixed kV with mAs modulation alone.

OBJECTIVE: To investigate the impact of automated attenuation-based tube potential selection on image quality and exposure parameters in polytrauma patients undergoing contrast-enhanced thoraco-abdominal CT. METHODS: One hundred patients were examined on a 16-slice device at 120 kV with 190 ref.mAs and automated mA modulation only. Another 100 patients underwent 128-slice CT with automated mA modulation and topogram-based automated tube potential selection (autokV) at 100, 120 or 140 kV. Volume CT dose index (CTDI(vol)), dose-length product (DLP), body diameters, noise, signal-to-noise ratio (SNR) and subjective image quality were compared. RESULTS: In the autokV group, 100 kV was automatically selected in 82 patients, 120 kV in 12 patients and 140 kV in 6 patients. Patient diameters increased with higher kV settings. The median CTDI(vol) (8.3 vs. 12.4 mGy; -33%) and DLP (594 vs. 909 mGy cm; -35%) in the entire autokV group were significantly lower than in the group with fixed 120 kV (p < 0.05 for both). Image quality remained at a constantly high level at any selected kV level. CONCLUSION: Topogram-based automated selection of the tube potential allows for significant dose savings in thoraco-abdominal trauma CT while image quality remains at a constantly high level. KEY POINTS: • Automated kV selection in thoraco-abdominal trauma CT results in significant dose savings • Most patients benefit from a 100-kV protocol with relevant DLP reduction • Constantly good image quality is ensured • Image quality benefits from higher kV when arms are positioned downward.

Simulator-Based Versus Traditional Training of Fundus Biomicroscopy for Medical Students: A Prospective Randomized Trial.

INTRODUCTION: Simulation training is an important component of medical education. In former studies, diagnostic simulation training for direct and indirect funduscopy was already proven to be an effective training method. In this prospective controlled trial, we investigated the effect of simulator-based fundus biomicroscopy training. METHODS: After completing a 1-week ophthalmology clerkship, medical students at Saarland University Medical Center (n = 30) were block-randomized into two groups: The traditional group received supervised training examining the fundus of classmates using a slit lamp; the simulator group was trained using the Slit Lamp Simulator. All participants had to pass an Objective Structured Clinical Examination (OSCE); two masked ophthalmological faculty trainers graded the students' skills when examining patient's fundus using a slit lamp. A subjective assessment form and post-assessment surveys were obtained. Data were described using median (interquartile range [IQR]). RESULTS: Twenty-five students (n = 14 in the simulator group, n = 11 in the traditional group) (n = 11) were eligible for statistical analysis. Interrater reliability was verified as significant for the overall score as well as for all subtasks (≤ 0.002) except subtask 1 (p = 0.12). The overall performance of medical students in the fundus biomicroscopy OSCE was statistically ranked significantly higher in the simulator group (27.0 [5.25]/28.0 [3.0] vs. 20.0 [7.5]/16.0 [10.0]) by both observers with an interrater reliability of IRR < 0.001 and a significance level of p = 0.003 for observer 1 and p < 0.001 for observer 2. For all subtasks, the scores given to students trained using the simulator were consistently higher than those given to students trained traditionally. The students' post-assessment forms confirmed these results. Students could learn the practical backgrounds of fundus biomicroscopy (p = 0.04), the identification (p < 0.001), and localization (p < 0.001) of pathologies significantly better with the simulator. CONCLUSIONS: Traditional supervised methods are well complemented by simulation training. Our data indicate that the simulator helps with first patient contacts and enhances students' capacity to examine the fundus biomicroscopically.

Multidrug-resistant bacteria in geriatric clinics, nursing homes, and ambulant care--prevalence and risk factors.

Colonization/infection with multidrug-resistant bacteria (MDRB) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, is an increasing problem not only in hospitals but also in long-term care facilities. The aim of this study was to determine the prevalence as well as the risk factors of colonization/infection with MRSA, VRE, and ESBL producing Enterobacteriaceae in geriatric clinics, nursing homes, and ambulant care in Frankfurt am Main, Germany. 288 patients from 2 geriatric clinics (n=46), 8 nursing homes (n=178), and 2 ambulant care facilities (n=64) as well as 64 staff members were screened for MDRB in the time period from October 2006 to May 2007. 58 patients (20.1%) and 4 staff members (6.2%) were colonized with MDRB. Among patients, 27 (9.4%) were colonized with MRSA, 11 (3.8%) were screened positive for VRE, and 25 (8.7%) were found to be colonized with ESBL producing Enterobacteriaceae. Prevalence of MDRB in geriatric clinics, nursing homes, and ambulant care facilities were 32.6%, 18.5%, and 15.6%, respectively. Significant risk factors for MDRB were immobility (OR: 2.7, 95% CI: 1.5-4.9; p=0.002), urinary catheter (OR: 3.1, 95% CI: 1.7-5.9; p<0.001), former hospitalization (OR: 2.1, 95% CI: 1.1-4.0; p=0.033), and wounds/decubiti (OR: 2.3, 95% CI: 1.5-4.9; p=0.03). Finally, the high level of MDRB in geriatric clinics, nursing homes, and ambulant care points to the importance of these institutions as a reservoir for dissemination.

Anthropometrical differences between suicide and other non-natural death circumstances: an autopsy study.

BACKGROUND: In international epidemiological studies, associations between suicides and body height, or body mass index (BMI) were found. Because of the recently growing number of suicides in Germany, a closer look on different anthropometric measures of suicide victims autopsied at the Institute of Forensic Medicine of the Goethe-University in Frankfurt/Main, Germany, was taken. METHOD: A retrospective analysis of 1,271 non-natural death cases autopsied between 2006 and 2010 was performed. A total of 566 other than suicide (control group) and 245 suicide cases (study group) with a given body height and weight aged between 18 and 96 years were examined. RESULTS: Body mass indices of the 18-59-year-old male and 60-79-year-old female suicide victims were significantly lower. Old-aged women who committed suicide exhibited beside a significant lower body mass a significantly slender body shape measured as smaller pelvic circumference, waist circumference, and waist-to-tallness ratio. Self-poisoning was by far the leading suicide method in both genders. The victims of the suicide method hanging were the youngest on average, and this method was most common in the male underweight and female lightly normal weight BMI categories, whereas old, overweight, and obese men killed themselves predominantly with firearms. CONCLUSION: The analysis showed that body measures of suicide cases in comparison to other non-natural death circumstance cases differ. For criminal procedural reasons, all suicide cases should be autopsied. But high autopsy rates are also needed for scientific research and to ensure a high level of patient safety.