Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer.

OBJECTIVES: The aim of this study was to assess the influence of video-assisted thoracic surgery (VATS) on our treatment decisions in FIGO III and IV ovarian cancer patients. METHODS: Patients with ovarian cancer and suspected supra-diaphragmatic involvement (pleural effusions, pleural carcinomatosis, lung metastasis, or enlarged supra-diaphragmatic lymph nodes) at chest computer tomography (CT) scan underwent VATS with or without laparoscopy (LSC) to decide for primary cytoreduction or neoadjuvant chemotherapy. Operation time, VATS complications (intrapleural hematoma, secondary hemorrhage with intervention, pneumonia and empyema) and shift in the therapeutic strategy due to VATS were evaluated. RESULTS: 17 patients were included into this study (1 patient with FIGO stage IIIb, 1 with IIIc and 15 with stage IV). The median operation time for VATS only was 46.5 min (range: 20-50 min, n=3). Perioperatively, no complications occurred. After surgical staging, the tumor was confined to the abdomen in four patients in whom primary cytoreduction was attempted. All other 13 patients underwent neoadjuvant chemotherapy. VATS altered the therapeutic management in 6/17 ovarian cancer patients (3 times upstaging, 3 times downstaging). Negative predictive values (NPV) for local and diffuse pleural carcinomatosis ranged between 0.5 and 0.71. CONCLUSION: In this case series, VATS in addition to LSC showed negligible morbidity related to surgery and a short operation time. We were able to improve the accuracy of the FIGO staging and assessed operability more reliably in these patients than through imaging techniques alone.

Bilateral contrast-enhanced MR angiography of the hand: diagnostic image quality of accelerated MRI using echo sharing with interleaved stochastic trajectories (TWIST).

OBJECTIVES: To evaluate the image quality of time-resolved contrast-enhanced MRA (tr-MRA) employing echo-sharing with stochastic trajectories for the bilateral examination of the hands. METHODS: In this institutional review-board approved study, Tr-MRA was compared with multiphasic contrast-enhanced MRA (mp-MRA) featuring sub-systolic venous compression in 20 healthy volunteers at 3.0 T using the following settings: TR/TE: 2.8/1.2 ms, flip angle: 25°, acceleration factor: 4, effective voxel size: 0.9 × 0.8 × 0.9 cm, acquisition time 4.9 s per 3D volume. RESULTS: With tr-MRA the arterial first-pass contrast agent transit is clearly seen. On average the contrast agent arrived 34 s post-injection and reached the proper digital arteries after 44 s. The mean arterio-venous window was 13 s. Bilateral contrast enhancement was asynchronous in 56-62%. On a semiquantitative scale (0 = non-sufficient to 4 = excellent) tr-MRA (mp-MRA) yielded an average ranking of 2.8-3.6 (3.1-3.8) in the greater and intermediate sized segments and 1.3-2.0 (1.6-2.3) in the proper digital arteries. CONCLUSION: Compared with established multiphasic ce-MRA, time-resolved MRA allows a four times faster acquisition. It reflects the natural haemodynamics of the hand arteries with no need for sub-systolic venous compression and may be beneficial in the detection of hand circulation disorders. Image quality is comparable to mp-MRA. In both techniques depiction of the proper digital arteries is limited.

[Efficient document management by introduction of a new, dynamic quality manual application according to DIN EN ISO 9001:2000]. / Effiziente Qualitätsmanagementdokumentation durch Einführung eines neuen, dynamischen Qualitätsmanagementhandbuchs nach DIN EN ISO 9001:2000.

PURPOSE: Evaluation of the impact of a new, dynamic computer-aided quality manual application (QMA) regarding the acceptance and efficiency of a quality management system (QMS) according to DIN EN ISO 9001:2000. MATERIALS AND METHOD: The QMA combines static pages of HTML with active content generated from an underlying database. Through user access rights, a hierarchy is defined to create and administer quality documents. Document workflow, feedback management and employee survey were analyzed to compare the performance of the new QMH with the formerly used static version. RESULTS: Integration of a document editor and automated document re-approval accelerated the document process by an average of 10 min. In spite of an increase of the yearly document changes of 60%, the administration effort was reduced by approximately 160 h. Integration of the feedback management system into the QMA decreased handling time from an average of 16.5 to 3.4 days. Simultaneously the number of feedback messages increased from 160 in 2005 to 306 in 2006. Employee satisfaction was raised (old: 3.19+/-1.02, new: 1.91+/-0.8). The number of users who partook in the QMA more than once a week also increased from 29.5% to 60%. CONCLUSION: The computer-aided quality manual application constitutes the basis for the success of our QMS. The possibility to actively participate in the quality management process has led to broad acceptance and usage by the employees. The administration effort was able to be tremendously decreased as compared to conventional QMS.

Sliding multislice MRI for abdominal staging of rectal gastrointestinal stromal tumours.

Anorectal gastrointestinal stromal tumours (GISTs) are uncommon mesenchymal neoplasms. The objective of this report was to demonstrate the value of sliding multislice (SMS) as an upcoming method of continuously moving table MRI, providing detailed abdominal staging of rectal GISTs. Integration of SMS into a high-resolution pelvic MR imaging protocol allows for both detailed assessment of rectal GISTs and depiction of the entire abdomen with high image quality. The staging of liver, malignant lymph nodes and bone metastases is now possible, prolonging pelvic MRI for only one minute.

Bronchial compression following pulmonary artery stenting in single ventricle lesions: how to prevent, and how to decompress.

OBJECTIVES: To assess airway compression during pulmonary artery (PA) intervention in single ventricle (SV) palliation. BACKGROUND: SV lesions with a prominent neo-aortic root are considered a high risk for branch PA and/or bronchial stenosis. PA stenting is well established, but may result in ipsilateral bronchial compression. METHODS: Single-centre retrospective analysis of 19 palliated SV patients with branch PA stenosis and close proximity to the ipsilateral main bronchus who underwent cardiac catheterisation at a median age and weight of 8.5 years (0.5-25) and 16.5 kg (6-82) between 12/2011 and 05/2015. RESULTS: Two of the 19 patients suffered an almost-closed left-main bronchus (LMB) following PA stenting. Fortunately, LMB decompression succeeded in both those patients by re-shaping the PA stents by compressing the chest while splinting the LMB with an inflated balloon. To prevent the other 17 patients from suffering this serious complication, we adopted a thorough preparation strategy: 13 patients underwent safe simultaneous bronchoscopy and cardiac catheterisation; in the remaining 4 patients CT-angiography enabled accurate risk evaluation prior to re-catheterisation. CONCLUSIONS: In SV lesions accompanied by branch PA stenosis, thorough preparation via cross-sectional imaging is mandatory, including simultaneous bronchoscopy and cardiac catheterisation in selected cases, to rule out any airway compression before considering endovascular stent implantation. If a PA stent's compression has already caused severe bronchial obstruction, our balloon-splinted decompression technique should be considered.

[German trauma centers: level-dependent differences in polytrauma care regarding resources and diagnostic concepts]. / Polytraumaversorgung in Deutschland: Klinikabhängige Unterschiede in der Ressourcenvorhaltung und bei diagnostischen Konzepten.

BACKGROUND: The aim was to survey the radiological diagnostics and type of primary radiological examination of polytraumatized patients treated in German hospitals at various levels in the three-tiered system. MATERIAL AND METHODS: A questionnaire was sent in October 2007 to every traumatology department registered in the DGU (German Society for Trauma Surgery) databank and forms returned by January 2008 were included in this study. RESULTS: A total of 273 (54.71 %) of forms were returned and were applicable to statistical analysis. In the three-tiered hospital system 35.9 % of returned questionnaires came from third-tier hospitals, 41.02 % from second-tier and 23.08 % from highest tier (maximum care) hospitals. With a higher hospital level of inpatient care more computed tomography (CT) scans were examined by a radiologist during 24 h daily (p = 0.0014) and CT scanners were located closer to the resuscitation room (p < 0.0001). We found significant differences in the ratios of primary whole-body CTs (WBCT) performed depending on the hospital level: third-tier hospitals 44 %, second tier hospitals 67 % and maximum care hospitals 84 % (p < 0.05). CONCLUSIONS: Standardized structures regarding radiological diagnostics of polytraumatized patients do not exist at either the same level of the three-tiered hospital system or between levels of care of German hospitals..

[Low-dose computed tomography for the detection of cocaine body packs: clinical evaluation and legal issues]. / Niedrigdosis-Computertomografieprotokoll zur Detektion von Kokain-Bodypacks: Klinische Evaluation und rechtliche Aspekte.

PURPOSE: To discuss the juridical basis for CT examinations of cocaine body packers and to evaluate the clinical implementation of a tube current reduction-based low-dose CT protocol. MATERIALS AND METHODS: A literature search was performed to discuss the legal basis regarding the problem, the procedures, the potential harm and the proportionality. Retrospective evaluation of 8 patients who had undergone a low-dose CT scan (body mass index < 25 kg/m(2) 30 mAs; > 25 kg/m(2) 60 mAs) during the time period from February until October 2009 in order to exclude or to assess remaining cocaine body packs was approved by the institutional review board. The detectability and condition of the body packs were analyzed. Effective doses were calculated. RESULTS: German jurisdiction does not distinguish between plain film X-ray and CT examinations. Both plain film X-ray and CT examination require a judicial warrant. However, examination results might still remain valid if a warrant was not requested. In 8 examinations (30 mAs n = 3, 60 mAs n = 5, mean BMI 25.9 ± 3.2) a total of 34 body packs were correctly identified. The mean density of the body packs was 74.4 ± 31.9 HU (range 17-154 HU) with a cocaine content between 22.5% and 72.8%. The mean estimated radiation dose was 2.23 ± 0.72 mSv. CONCLUSION: Although medical legal aspects do not specify the diagnostic procedure to be performed, the high diagnostic accuracy and applied radiation dose reduction could establish low-dose CT as the method of choice for detecting cocaine body packs, thereby potentially avoiding future legal problems.

[CT Angiography for the pre- and postoperative evaluation of the thoracic aorta]. / CT-Angiografie zur prä- und postoperativen Evaluation in der thorakalen Aortenchirurgie.

CT angiography is the imaging modality of choice for the pre- and postsurgical evaluation of patients with pathologies of the thoracic aorta. The purpose of this review is to familiarize the reader with the technical principle, recent technical developments and requirements for specific examination protocols and image interpretation, and to highlight common pathologies and findings.

[Preoperative staging of rectal cancer]. / Präoperatives Staging des Rektumkarzinoms.

Accurate preoperative staging of rectal cancer is crucial for therapeutic decision making, as local tumor extent, nodal status, and patterns of metastatic spread are directly associated with different treatment strategies. Recently, treatment approaches have been widely standardized according to large studies and consensus guidelines. Introduced by Heald, total mesorectal excision (TME) is widely accepted as the surgical procedure of choice to remove the rectum together with its enveloping tissues and the mesorectal fascia. Neoadjuvant radiochemotherapy also plays a key role in the treatment of locally advanced stages, while the use of new drugs will lead to a further improvement in oncological outcome. Visualization of the circumferential resection margin is the hallmark of any preoperative imaging and a prerequisite for high-quality TME surgery. The aim of this article is to present an overview on current cross-sectional imaging with emphasis on magnetic resonance imaging. Future perspectives in rectal cancer imaging are addressed.

The embryotoxicity of the cyclophosphamide metabolite acrolein in rabbits, tested in vivo by i.v. injection and by the yolk-sac method.

On the 9th day of gestation the embryotoxic effects of acrolein were tested in vivo by i.v. injection in rabbits (3, 4.5 and 6 mg/kg) and by injection into the yolk sac of rabbits embryos (10, 20 and 40 microliter/blastoderm of an 0.84% acrolein solution: yolk-sac method). After i.v. injection acrolein caused mainly embryolethal effects in a dose-dependent manner. After direct injection into the rabbit embryos acrolein led to an increase of resorption and malformation rate in a dose-dependent manner. The highest dose in both investigations showed that by i.v. injection acrolein acts as an embryotoxic agent in a 50-60 times lower concentration. As acrolein plays an important role in the metabolism of cyclophosphamide the results are discussed in relation to the embryotoxicity of cyclophosphamide.

Application of the thermoluminescent dosimetry to a pion beam.

The thermoluminescent dosimetry is currently applied to radiation therapy in order to measure dose distributions on phantoms or to control the dose in vivo for special procedures or critical organs. The application of this method to the SIN's (Switzerland) pion beam has been studied. Measurements have been made on the following thermoluminescent materials: 7LiF, 6LiF, Li(nat)F, Li2B4O7, CaF2 : Mn, and CaF2 : Dy. Except for the last one a reduction (10%) of the sensitivity of the phosphors has been observed in the peak relative to the plateau region. An increase of the 6LiF sensitivity relative to that of 7LiF has been pointed out due to the neutron background through the (n, alpha) reaction on 6Li. Glow curves of the LiF phosphors have been measured. A reduction (5%) of the intensities of peak 3 and 4 relative to peak 5 has been observed for irradiation in the peak region. This effect however can't be used in order to localize the dosimeter in the beam because the intensity of the thermoluminescence peaks shows a larger variability in a batch of dosimeters.

[Technic of curietherapy in the management of prostatic cancers]. / Technique de curiethérapie dans le traitement des cancers prostatiques.

With one or serveral charges of 137 Cs placed in an ordinary indwelling catheter, one can deliver to the prostate a radiation dose in 24 hours equivalent to the same dose which could be produced by 226 Ra in five days, or 60 Co in 6 to 7 weeks using the usual methods. 10 patients in whom a carcinoma of the prostate was discovered during adenomectomy (hidden Ca, stage A) have been treated in this way with hardly any immediate disadvantages.

[Humus functioning types in evergreen coniferous forests of the French Inner Alps]. / Modes de fonctionnement d'humus des forêts sempervirentes des Alpes internes françaises.

Three humus forms that are widespread in the Inner Alps, a dysmull below Pinus sylvestris, an oligomull below Abies alba and a mor below Pinus cembra, were studied by following mineral nitrogen production and uptake and by a characterization of the pedofauna. Due to the production and uptake of nitrogen, mainly as nitrates and also due to the dominance of Lumbricids versus Arthropods, the oligomull was the sole humus form that functioned as a mull. Nevertheless relatively weak mineral nitrogen production and the dominance of endogeic soil-dwelling earthworms versus anecic earthworms demonstrated the moderate activity of this mull, which is representative of humus forms of old growth forests and cold climates. There was a discrepancy between the very low biological activity of the dysmull and its status of mull, while an observed bifunctioning between the different layers of this humus also differentiated it from the mor.