[Oral health status of students with and without disabilities in Erfurt, Germany]. / Mundgesundheit von Erfurter Schüler/innen mit und ohne Behinderungen.

AIM: The aim of this study was to make a comparison of the oral health status of students with and without disabilities (Sw/D, Sw/oD) aged 6-18 years from the city of Erfurt. METHODS: 328 students with mental retardation (MR), physical disability (PD) and hearing impairment (HI) were examined according to WHO standard (1997). The control group consisted of 400 age-matched Sw/oD. Data analysis was performed in age groups 6-12 and 13-18 years. RESULTS: Caries prevalence of 6- to 12-year-old Sw/D (68.7%) was significantly higher than in Sw/oD (57%) (p=0.019).The caries experience of Sw/D was 2.3 dmft/0.5 DMFT and 1.6 dmft/0.4 DMFT of Sw/oD. PD had a lower restorative index than other Sw/D (p ≥ 0.023). There was no difference in caries prevalence and caries experience among 13- to 18-year-old Sw/D (51%; 1.9 DMFT) and Sw/oD (59%; 2.1 DMFT). MR had a lower prevalence of fissure sealants and less sealed teeth (p ≤ 0.042) and their periodontal health was inferior compared to other Sw/D. CONCLUSION: Intensive preventive measures should be intensified to compensate for oral health inequalities, particularly in MR.

STARR with CONTOUR® TRANSTAR™ device for obstructed defecation syndrome: one-year real-world outcomes of the European TRANSTAR registry.

PURPOSE: Stapled transanal rectal resection (STARR) in patients with obstructive defecation syndrome (ODS) is limited by the capacity of the circular stapler used. This prospective cohort study was conducted to assess real-world clinical outcomes of STARR with the new CONTOUR® TRANSTAR™ device, shortly named TRANSTAR, at 12 months postoperatively. METHODS: From January 2009 to January 2011, consecutive patients who underwent TRANSTAR in 22 European colorectal centers were enrolled in the study. Functional outcomes and quality of life were assessed by the changes in a number of scoring systems (Knowles-Eccersley-Scott-Symptom (KESS) score, ODS score, St. Mark's score, Euro Quality of Life-5 Dimension (EQ-5D) score, and Patient Assessment of Constipation-Quality of Life (PAC-QoL) score), at 12 months as compared to baseline. All complications were recorded and analyzed. RESULTS: A total of 100 patients (98% female), mean age 60 years, were entered in the study. Statistically significant improvements were seen in the KESS (median 18 vs. 6; p < 0.01), ODS (median 15 vs. 4; p < 0.01), and PAC-Qol scores (median 2.10 vs. 0.86; p < 0.01). St. Mark's and EQ-5D scores improved nonsignificantly. Complications were reported in 11 % of patients, including bleeding (5%), staple line complications (3%), urinary retention (2%), and persistent pain (1%). No major complications or mortality occurred. CONCLUSION: TRANSTAR facilitated a tailored, real circumferential full-thickness rectal resection, leading to improved patient functional and quality of life outcomes at 12 months postoperatively. It represents a safe and effective treatment for ODS in local clinical practice, although the sustainability of real-world results needs to be proven in the long-term follow-up.

Fabrication and characterization of a biomimetic composite scaffold for bone defect repair.

For successful bone tissue engineering, scaffolds with tailored properties are a basic requirement. The combination of different available materials not only appears to be desirable but also very challenging. In this study, a composite material consisting of hydroxyapatite and collagen was produced by a biomimetic precipitation method and characterized by X-ray diffraction (XRD) and thermogravimetry (TGA). Subsequently, a suspension-quick-freezing and lyophilization method was used to incorporate the hydroxyapatite into a polymeric matrix consisting of collagen and chitosan. Before physicochemical characterization, the highly porous scaffolds were consolidated by a dehydrothermal treatment (DHT). The main attention was focused on the particle size of hydroxyapatite, which should be in the nanometer range. This is relevant to achieve a homogeneous resorption of the material by osteoclasts. Small-angle X-ray scattering (SAXS), atomic force microscopy (AFM), and environmental scanning electron microscopy (ESEM) were used to evaluate the outcome. The results suggest a successful polymeric embedding of nanoscaled hydroxyapatite particles into the matrix of the spongy construct. (c) 2010 Wiley Periodicals, Inc. J Biomed Mater Res, 2010.

[Elective termination of respiratory therapy in amyotrophic lateral sclerosis]. / Elektive Termination der Beatmungstherapie bei der amyotrophen Lateralsklerose.

BACKGROUND: Due to the growing use of artificial respiration in amyotrophic lateral sclerosis (ALS), physicians are increasingly confronted with patients seeking discontinuation of therapy. Yet there are few systematic investigations of the withdrawal of ventilation therapy. PATIENTS AND METHODS: In a retrospective investigation of nine German ALS patients, clinical data were recorded from the discontinuation of noninvasive ventilation (n=4) and mechanical ventilation (n=5). RESULTS: In cases of residual spontaneous breathing, intensified symptom control of dyspnea and anxiety was possible with intravenous morphine sulfate at a low dose rate (10 mg/h) but high cumulative dose (185-380 mg). The terminal phase after removing the mask was protracted (22:10 h to 28:00 h). In cases of minimal or absent spontaneous breathing the disconnection was realized in deep sedation, which required a moderate total dose of morphine sulfate (120 mg) but a high dosage rate (up to 300 mg/h). The terminal phase in deep sedation was short (15-80 min). CONCLUSION: The elective termination of ventilation requires differentiated pharmacologic palliative care. More controlled studies are required in order to establish evidence-based guidelines for the termination of ventilation.

Memory effect in isothermal crystallization of syndiotactic polypropylene - role of melt structure and dynamics?

The crystalline-memory effect on the crystallization of syndiotactic polypropylene is investigated by differential scanning calorimetry and solid-state NMR spectroscopy. The influence of several parameters in the thermal (pre-)treatment and the crystallization conditions is studied in detail. In agreement with previous reports, the power law behavior of the overall crystal growth rate is found to be remarkably different for melts with and without memory. This has previously been interpreted in terms of changes in the structure and/or the dynamics of the melt (disentangled state, local order), and a variety of NMR experiments is used to detect such potential changes. All our NMR results are identical for melts with and without memory, therefore excluding any large effect of the "memory" on melt structure or dynamics exceeding the percent level of the whole sample volume, and thus supporting more conventional interpretations in terms of persisting nuclei. Samples that were pre-crystallized at lower temperatures exhibit a larger memory effect, and the potential nuclei fraction is a non-equilibrium structure and is restricted to the 0.1% level if it is crystalline or highly ordered.

Functional outcome after gamma knife treatment in vestibular schwannoma.

Radiosurgery (RS) is a noninvasive, ambulatory special neurosurgical procedure for the treatment of vestibular schwannoma (VS). We treated 123 patients with unilateral schwannomas between 1994 and 2000 at the gamma knife (GK) center in Munich using a primary stereotactic procedure. These patients were followed up until June 2004 in respect to audiological, neurological, neurootological and radiological features before and after radiosurgical intervention. The actual tumor control rate of 8.2 years (mean) after GK surgery for all patients and a single treatment was calculated to be 96.7%. The impairment of hearing was on average 18% after GK, ranking from 0% gain of hearing loss up to 90%. Facial nerve function, graded according to the House-Brackmann scale, deteriorated in none of the patients; 5.8% reported a trigeminal neuralgia. Tinnitus developed in 4.1% of the patients after RS; 13.3% had vertigo for the first time after the treatment, age apparently being a predisposing factor. Radiosurgical treatment for VS is an alternative to microsurgery (MS). It is associated with a lower rate of facial and trigeminal neuropathy, postoperative complications and hospital stay. The hearing preservation rate is equivalent to MS.

[Development of an optical 3-D position measuring system for simultaneous detection of 6 degrees of freedom]. / Entwicklung eines optischen 3-D-Positionsmesssystems für die simultane Erfassung von 6 Freiheitsgraden.

A few years ago it became possible to carry out complicated surgical procedures in humans with the required precision by combining medical imaging (MRI, CT) with minimally invasive surgery. The confined space within these imaging systems and the resulting inaccuracies associated with the manual use of instruments increasingly make necessary the help of aids ranging from positioning systems to robotic devices, which themselves must be position controlled. A position sensor has been developed for a medical robotic system allowing the image-controlled insertion of injection needles and the simultaneous administration of different drugs. The 3D position coordinates are determined by a noncontact optical principle, which also enables simultaneous determination of all 6 basic degrees of freedom of the robotic system (3 translational, 3 rotational). On the basis of an area image sensor and the measurement of a geometrically defined structure in the path of the rays between sensor and light source, the position coordinates are calculated almost real time. Special emphasis was placed on designing the sensor system to cover a sufficiently large workspace to enable it to cover the entire intervention area. The sensor described herein determines the position coordinates in a volume of 10 x 10 x 10 cm at a resolution of up to 1 mm for translations and 1 degree for rotations.

Robust localization of the contralateral precentral gyrus in hemiparetic patients using the unimpaired ipsilateral hand: a clinical functional magnetic resonance imaging protocol.

Tumor related contralateral motor deficits complicate preoperative functional magnetic resonance imaging (fMRI). In plegic patients the localization of the sensorimotor cortex is often impossible. In this context we developed a clinical fMRI protocol dedicated to patients with motor deficits using the unaffected ipsilateral hand. Based on the hypothesis that selfpaced finger movements recruit more and larger neuronal populations with rising task complexity, different motor tasks were tested regarding ipsilateral localization in ten right handed volunteers. Complex finger opposition localized the ipsilateral premotor cortex (Brodman area 6) robustly and was introduced to preoperative fMRI in hemiparetic patients as functional landmark to identify the precentral gyrus on the tumors side. Additional contralateral automated tactile stimulation localized the primary somatosensory cortex and completed the protocol.

The medical engineering program of Forschungszentrum Karlsruhe.

The research activities of the Forschungszentrum Karlsruhe on minimally-invasive surgery (MIS) have for several years improved techniques and instrumentation for different types of MIS. Many types of instruments and robotic devices have been developed and new techniques implemented. In this paper we present the most recent results from our different projects, such as endoscopic heart surgery, tracking systems, a camera guidance device, telemanipulator systems, minimally-invasive breast biopsy in closed-bore MRI, endoscopic training simulators and developments using smart materials (e.g. Nitinol).

[The effect of the stimulus frequency, stimulus amplitude and blood pressure on the signal response in functional MRT: studies on an animal model]. / Einfluss von Reizfrequenz, Reizamplitude und Blutdruck auf die Signalantwort in der funktionellen MRT: Untersuchungen am Tiermodell.

PURPOSE: To examine the influence of frequency and amplitude of a stimulus and the effect of blood pressure on signal intensity changes in functional MRI. METHODS: Somatosensory stimulation of five (normotonic/hypotonic) anesthetized rats was performed with different stimulus frequencies and amplitudes. Measurements were performed with a 2.4 Tesla experimental scanner using a gradient-echo (GE) echo-planar imaging (EPI) sequence. RESULTS: The highest signal change was found at a frequency of 3 Hz and a stimulation amplitude of ten times the threshold value. A decrease of blood pressure to half the normotonic value gave rise to a decrease of the neuronal response of about 17%. CONCLUSION: Optimization of the stimulation frequency and stimulation amplitude maximizes signal changes in functional MRI of the somatosensory cortex. Even with a standardized paradigm, variations in measured neuronal activity may occur when blood pressure changes cannot be compensated by autoregulation.

Somatotopic mapping of the human primary somatosensory cortex by fully automated tactile stimulation using functional magnetic resonance imaging.

The clinical application of functional magnetic resonance imaging (fMRI) requires time-saving protocols insensitive to artifacts that provide robust localization and important information on brain function. A fully automated, pneumatically driven tactile stimulation is presented, that reproducibly localizes postcentral lip, finger and toe representations in contralateral primary somatosensory cortex (SI) with mean correlation coefficients (cc) and relative BOLD signal changes (dS) of cc approximately 0.59, dS approximately 1.95% (fingers); cc approximately 0.52, dS approximately 1.35% (lips); cc approximately 0.47, dS approximately 1.42% (toes). Bilateral somatotopic mapping requires 21 min of scanning time and has become a clinical routine fMRI application in patients with perirolandic tumors. Normative data may also be useful in monitoring cerebral plasticity and reorganization, e.g. in sensorimotor recovery after cerebral ischemia or in understanding mechanisms of supraspinal pain processing.

[Changes in life expectancy and mortality in East Germany after reunification (1989-1992)]. / Die Entwicklung von Lebenserwartung und Sterblichkeit in Ostdeutschland nach der Wende (1989-1992).

Whereas some arguments can be advanced suggesting that the life expectancy in east Germany should have declined directly after the fall of the Berlin Wall in 1989, other arguments suggest an increase. The aim of this study was to identify the actual developments and to explain the findings. Census data and mortality statistics from East and West Germany before unification were used to calculate standardized mortality ratios and life expectancies for various population groups. The differences in life expectancy between East and West were broken down according to age groups. The main finding was that the life expectancy of east German men declined in 1990 by 0.9 years, and only reached the 1989 level again in 1992. This was due solely to an increase in mortality for men under the age of 65. In 1990 and 1991, there were 3,400 more deaths among men under the age of 65 than would have been expected on the basis of the mortality rates of 1989. In contrast, the life expectancy of women hardly declined at all in 1990, and in 1992 it was already one year more than for 1989. The most important reasons for the increased numbers of deaths of men under the age of 45 were motor vehicle accidents, whereas ischaemic heart disease and cirrhosis of the liver were more significant for men between the ages of 45 and 65. Suicides did not increase after the fall of the Berlin Wall. It could be shown that the findings were not the results of artifacts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Experiences in the control of brucellosis in cattle herds in the government district of Hannover]. / Erfahrungen bei der Bekämpfung der Brucellose in Rinderbeständen des Regierungsbezirks Hannover.

Caused by imported beef cattle new outbreaks of Brucellosis (subtype III) were observed in the government district of Hannover, which was "Brucellosis free" over a long period. With the aim to interrupt the series of infections from herd to herd it seemed to be necessary to introduce a herd screening system including frequent tests. It was not possible to screen the herds by the usual way of blood serum testing because of reasons of practicability and economy. A practicable alternative was the ELISA supported tank investigation. Four of the last six outbreaks were detected by this milk sampling. The other two infected herds were detected by only clinical symptoms because the lactating cows were not infected and had no contacts to the infected separately held heifers. The required test frequency in the dairy cattle herds could only be realized applying an ELISA supported highly sensitive tank milk test method. This method offered the chance of discovering infected herds as soon as possible and prevented greater economical losses and animal health risks. The tank milk screening of the dairy cattle herds to detect antibodies against Brucellosis (and additional EBL and IBR) has now become a standard method to continue the official status "free from..." This is a safer and a more economic alternative to the previous blood sampling of cattle older than two years with a three years interval because this method guarantees a safe information about the serological status of each cow which is now tested at least once a year, depending on the time of dry standing status.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of levonorgestrel and ethinyl estradiol and their combination on biotransformation reactions]. / Zum Einfluss von Levonorgestrel und Ethinylestradiol sowie deren Kombination auf die Aktivität von Biotransformationsreaktionen.

Caffeine is mainly metabolized by 3-methylcholanthreneinducible cytochrome P-450, whereas metamizol (Analgin) is probably mainly metabolized by the phenobarbital inducible cytochrome P-450 family. Therefore the elimination of caffeine from serum and the elimination of the main metabolites of metamizol in urine reflect the activity of these two cytochrome P-450 families. Sex hormones can influence the activity of cytochrome P-450. Intake of levonorgestrel (0.125 mg) daily for 14 days reduced the metabolism of caffeine slightly, but the elimination of metamizol-metabolites is not influenced. Longterm administration of levonorgestrel (0.250 mg daily) for three months did not change the metabolisms of both model substances tested. In contrast, ethynylestradiol (0.050 mg) alone and also the combination with levonorgestrel markedly retarded the elimination rate of caffeine and metamizol-metabolites. This fact should be taken into consideration in drug therapy.

[Occlusive therapy of psoriasis--comparison of clinical effectiveness of short-term and prolonged use]. / Okklusivtherapie der Psoriasis--Vergleich der klinischen Wirksamkeit von kurzzeitiger und prolongierter Anwendung.

In an open clinical trial on stationary psoriatic plaques, we compared the effects of shortime occlusive (SO) dressing (24h) and prolonged occlusion (PO: 5-28 days). IN SO, Weinstein's index decreased from 7.3 +/- 1.7 to 3.3 +/- 1.8 (n = 21), in PO from 6.5 +/- 1.1 to 3.7 +/- 1.7 (n = 15). The results were even better in cases with optimal PO dressing (decrease from 6.8 +/- 1.4 to 2.5 +/- 0.9). The most important side effects were itching and exsudation with ensuing smell. In only one of the cases did the side effects cause a drop-out after 5 days. Regarding stationary psoriatic plaques on the extensor sides of the lower legs and forearms. We recommend continuous occlusive dressing for 8-10 days--either as an alternative mode of therapy, or as an intermediate regimen.

[Comparison of the progesterone test and uterus sonography as screening procedures in the detection of patients at risk of endometrial cancer]. / Vergleich von Progesterontest und Uterussonographie als screening-Verfahren zur Erkennung von Risikopatientinnen hinsichtlich Endometriumkarzinom.

The increasing incidence of endometrial cancer requires more attention to early detection. Postmenopausal women without symptoms were examined by progesterone challenge test (96 diabetics, 111 without diabetes) and by sonography (44 diabetics, 74 without diabetes) in order to recognize proliferation of the endometrium. The application of progesterone induced a bleeding in 4% of the women. The diagnostic curettage performed 4-6 weeks after this test revealed almost always atrophic endometrium. We found a good correspondence between abnormalities of the uterine cavity detected by sonography and the results of the pathological examination after notice pathological changes of the endometrium.

[Behavior the lipid spectrum following complete ovariectomy and subsequent substitution with estradiol valerate or norethisterone acetate]. / Zum Verhalten des Lipidspektrums nach kompletter Ovarektomie und nachfolgender Substitution mit Estradiolvalerat oder Norethisteronazetat.

In a prospective trial the effects of oophorectomy and following administration of estradiol valerate (2,0 mg/day) or norethisterone acetate (5,0 mg/day) on the blood lipids were investigated during the late postoophorectomy time. After complete ovarectomy 52 women (42-49 years old) were randomized in two groups and substituted with these steroids from the 7. to 12. month after operation. Before total estrogen excretion/24 h urine, serum levels of estradiol and testosterone and the maturation value were studied. The blood levels of total-, HDL- nnd LDL cholesterol and triglycerides were markedly higher 2 and 6 months after castration than before. Norethisterone acetate depressed transitorily the total cholesterol and longer the HDL cholesterol, the triglycerides were increased 6 months after administration. A long lasting norethisterone acetate substitution in postmenopausal women should be below 5 mg/day.