[Transparency of the newborn hearing screening system in Germany]. / Transparenz der Umsetzung des Universellen Neugeborenen-Hörscreenings in Deutschland.

AIM: The transparency of implementation of the newborn hearing screening system in Germany is analysed. For this purpose it has been tested whether the current state can be retained and evaluated by using public accessible information channels. METHODS: A selective document analysis with subsequent assessment of the federal states was performed. In the form of a scoring system an assessment approach has been developed based on defined comparison criteria. The selective document analysis was characterised by including only documents which were detected through the internet and medical databases by using defined search terms. RESULTS: A complete survey of the current state of guideline implementation is not available by using public accessible information. The assessment of the federal states reveals an extremely heterogeneous situation with regard to the transparency of the implementation process in Germany. Bavaria has the highest score with 37 points, while Bremen has the lowest score with 3 points. Overall, the supply of information to experts is better constituted compared to that to the population, and respectively, the newborn's parents. CONCLUSION: A meaningful evaluation of the implementation processes in the federal states up to now is urgently required. This is necessary both to optimise the process and to achieve the highest possible quality among patient-centred care structures nationwide.

Observation of polarized positrons from an undulator-based source.

An experiment (E166) at the Stanford Linear Accelerator Center has demonstrated a scheme in which a multi-GeV electron beam passed through a helical undulator to generate multi-MeV, circularly polarized photons which were then converted in a thin target to produce positrons (and electrons) with longitudinal polarization above 80% at 6 MeV. The results are in agreement with GEANT4 simulations that include the dominant polarization-dependent interactions of electrons, positrons, and photons in matter.

No morphine sparing effect of ketamine added to morphine for patient-controlled intravenous analgesia after uterine artery embolization.

BACKGROUND: Pain following embolization of the uterine arteries (UAEs) is variable and may be very severe requiring large doses of parenteral opioids for relief. The present study tested the hypothesis that the addition of ketamine to i.v. patient-controlled morphine reduces the amount of morphine required for pain-control during the first 24 h after UAE embolization. METHODS: Fifty-six patients undergoing UAE embolization for treatment of symptomatic uterine leiomyomata were randomized to receive either 2 mg/ml of morphine (Control group, n=30) or 2 mg/ml of both morphine and ketamine (Ketamine group, n=26) by i.v. patient-controlled analgesia (IV-PCA). Pump settings were bolus dose 1 ml, lockout 10 min, no background infusion. In addition, all patients received diclofenac and acetaminophen for pain relief. Pain scores, morphine consumption and adverse events like nausea, vomiting, itching, visual disturbances, anxiety, dreaming and hallucinations, if any, were recorded for 24 h after embolization. RESULTS: The mean +/- SD 24-h consumption of patient-controlled morphine was 38.3 +/- 21.0 mg in the Ketamine group vs. 33.3 +/- 18.3 mg in the Control group (NS). The difference between the means was 5.0 mg (95% confidence interval: -5.7; 15.6). One patient in the Ketamine group vs. none in the Control group experienced auditory hallucinations. CONCLUSION: Studying an unselected group of patients undergoing embolization of the UAEs for treatment of symptomatic uterine leiomyomata under conditions of basal analgesia with acetaminophen and diclofenac, we failed to demonstrate any morphine-sparing effect of IV-PCA ketamine and morphine compared with IV-PCA morphine alone.

[Low-dose hydrocortisone treatment of catecholamine refractory septic shock]. / Lavdosis hydrocortisonbehandling i katekolaminrefraktaert septisk shock.

Treatment with corticosteroids in patients with septic shock is controversial. Dosage and timing of treatment differ in clinical trials. The effect of LDHT (low-dose hydrocortisone therapy) is based on the hypothesis of a relative adrenocortical insufficiency. Two cases in which septic shock was reversed with LDHB are described.

Ductal adenocarcinoma of the head of the pancreas: incidence of tumor involvement beyond the Whipple resection line. Histological and immunocytochemical analysis of 37 total pancreatectomy specimens.

Intrapancreatic tumor spread of ductal adenocarcinoma of head of pancreas was examined histologically in 37 total pancreatectomy specimens. Five to 10 tissue blocks were prepared from grossly tumor-free tissue of each pancreas and coded by anatomic location. Step sections from each block were analyzed for carcinoma in situ lesions, invasive carcinoma, and benign ductal lesions. Immunocytochemical staining with monoclonal antibodies (MAb) against carcinoembryonic antigen (CEA) and nonspecific cross-reacting antigen 95 (NCA 95) were used to help in discriminating carcinoma in situ from papillary duct hyperplasia. In 3 of 37 pancreatectomy specimens (8%) tumor was found to spread in continuity from the primary carcinoma into the body and tail. In two of these three cases with tumor beyond the usual Whipple resection line, the tumor was present as a "carcinoma in situ" lesion along the main pancreatic duct. Since discontinuous tumor growth was not observed, multicentricity of duct type adenocarcinoma seems to occur less frequently than was previously reported.