[The significance of elbow dysplasia (ED) for breeding in Bernese Mountain Dogs in Germany]. / Untersuchungen zur züchterischen Bedeutung der Ellbogendysplasie (ED) beim Berner Sennenhund in Deutschland.

Results from the elbow dysplasia screening program in Bernese Mountain Dogs of Germany were analysed in respect to its relevance for genetic evaluation and breeding. In total 2677 gradings were used. The grading was performed radiographically according to the recommendations of the International Elbow Working Group (IEWG). 75.8% of the dogs were free from visible dysplastic signs, 10.8%, 6.8% and 5.5% were classified to be of Grade 1, 2 and 3, respectively. 1.1% were classified as a borderline case between ED-free and Grade 1. A slight reduction of ED could be observed over years. Males had a 3.1 higher rate of dysplasia than females. Treating ED as a numerical trait, coded proportional to the severity of clinical relevant signs, gave a heritability estimation of 0.188 and a maternal effect of 0.07. From different mating combinations it was found, that ED average was higher in the progeny if one mate was affected but there was no increase in the prevalence with increasing grade of ED in the affected mates. About 10% more affected dogs could be observed, if one mate is affected. Heritability for dichotomic coding the trait was found to be 0.20. From these results can be suggested, that the differentiation in various grades of ED to describe the clinical relevance for the specific dog is helpfull, however, from a breeders point of view, dogs with ED should be treated equally for genetic evaluation.

Evaluating and improving the delivery of heart care: the University of Michigan experience.

With increasing pressure to curb escalating costs in medical care, there is particular emphasis on the delivery of cardiovascular services, which account for a substantial portion of the current healthcare dollar spent in the United States. A variety of tools were used to improve performance at the University of Michigan Health System, one of the oldest university-affiliated hospitals in the United States. The tools included initiatives to understand outcomes after coronary bypass operations and coronary angioplasty through use of proper risk-adjusted models. Critical pathways and guidelines were implemented to streamline care and improve quality in interventional cardiology, management of myocardial infarction, and preoperative assessment of patients undergoing vascular operations. Strategies to curb unnecessary costs included competitive bidding of vendors for expensive cardiac commodities, pharmacy cost reductions, and changes in nursing staff. Methods were instituted to improve guest services and partnerships with the community in disease prevention and health promotion.

[Present status of transurethral laser technique in the treatment of urethral strictures (author's transl)]. / Zum gegenwärtigen Stand der transurethralen Laser-Technik in der Behandlung der Harnröhrenstriktur.

The main difference between the conventional methods of urethrotomy and the laser method is that the scar tissue of the urethral stricture is not cut but removed by evaporisation. At present only neodymium: YAG and argon ion lasers are available for clinical endoscopic use. For the purpose of removing tissue neodymium: YAG lasers need irrigation with a gas in contrast to argon ion lasers that can be utilized with the well known water irrigation. Certain considerations and experiences suggest the carbon dioxide lasers to be the best ones for evaporating stricture tissue since they cause very limited zones of necrosis with immediate sealing of the wound edges. Transurethral carbon dioxide laser application, however, is still at an experimental stage, since convenient light transmission systems are not available for clinical use at the present time.

[Electric shock waves crushing stones in the exposed kidney (author's transl)]. / Fokussierte Stosswellen zur berührungsfreien Nierensteinzertrümmerung an der freigelegten Niere.

Highenergy shock waves can desintegrate human calculi of the kidney into fine fragments without direct contact. A closed reflector system which allows sterile contact with the exposed kidney is presented.

[Disintegration of kidney calculi by piezoelectrically generated high-energy sound waves. Physical principles and experimental studies]. / Die Zertrümmerung von Nierensteinen durch piezoelektrisch erzeugte Hochenergie-Schallpulse. Physikalische Grundlagen und experimentelle Untersuchungen.

The recently developed equipment for extracorporeal piezoelectric lithotripsy (EPL) represents an improvement concerning the shock-wave-induced disintegration of urinary calculi. While the usual spark gap transmitter needs a focusing reflector, the piezoelectric lithotriptor is based on a self-focusing spherical bowl transmitter. The stone is detected exclusively by ultrasound. For this purpose, an integrated sector scanner is used as well as the high-energy sound transmitter itself. With the piezoelectrically generated high-energy sound pulses we have succeeded in completely disintegrating implanted stones in the renal pelvis of dogs without injuring the morphology or function of the exposed kidneys.

[Disintegration of kidney calculi with a piezoelectric instrument system. Initial clinical experiences]. / Die Zertrümmerung von Nierensteinen mit einem piezoelektrischen Gerätesystem. Erste klinische Erfahrungen.

Since December 1985 extracorporeal piezoelectric renal lithotripsy has been tested in humans. Up to now 50 patients with renal calculi have been treated. The lithotriptor consists of a special mobile table with an opening in the surface to apply shock waves. Urinary calculi are located by integrated ultrasound location systems. As the piezoelectrically generated high-energy sound pulse does not cause pain, treatment is possible without anesthesia. Permanent ultrasonic control of the stones in the focus during lithotripsy allows effective application of shock waves. With this piezoelectric system the electrocardiogram does not have to be triggered. So far the results have been encouraging and following these tests clinical application is expected to be successful.

Building an empowered work team.

A work team taps into each member's unique talents, which allows valuable skills to be shared across medical units. As a result, continuous quality improvement efforts were more objective and systematic; leadership skills were gained, both individually and jointly. The obstacles encountered, stakeholders' responses and the team's productivity analysis are described.

The first reusable multiple-band ligator for endoscopic hemostasis of variceal bleeding, nonvariceal bleeding and mucosal resection.

A new multiband ligator is presented which is fully reusable. Experience in 67 patients (22 with varices and 45 with early cancers undergoing mucosal resection) showed good technical function and no significant complications. Use of this device may significantly reduce the costs of endoscopic ligation.

Results in the use of extracorporeal piezoelectric lithotripsy (EPL) for treatment of urinary calculi.

The Piezolith 2200 as an extracorporeal shock wave lithotripter uses piezoelectrically generated, high-energy sonic impulses for treatment of urinary calculi; the shock wave generator is self-focussing. Localization of concrements is performed by means of ultrasound imaging. Treatment with the Piezolith 2200 is painless for the patient and thus possible without anesthesia and analgesia. We report on 806 cases of treatment involving a total of 572 kidneys in 567 patients (561 adults, 6 children) suffering from calculi of various sizes in the renal pelvis (n = 126), calculi in the calyces (n = 384), partial (n = 24) or full (n = 19) staghorn calculi, as well as calculi in the upper part of the ureter (n = 19). In 88% of these cases the concrements could be removed completely. Since cardiac activity is not influenced by piezoelectrically generated high-energy impulses, this procedure is particularly suited to the treatment of patients with heart problems.