Patients with autoimmune thyroiditis. Prevalence of benign lymphadenopathy.

UNLABELLED: The prevalence of cervical lymphadenopathy in autoimmune thyroiditis (AIT) patients is actually unknown. The aim of the study was the detailed retrospective evaluation of 6 index-patients with lymphadenopathy in Robbins level VI and a prospective study with high resolution ultrasound of lymphadenopathy in AIT patients compared with controls in all compartments of the neck, accessible to sonographic evaluation. PATIENTS, METHODS: The retrospective study comprises six patients with AIT, evaluated for enlarged Robbins level VI-LN. We report the findings of fine-needle aspiration Cytology, clonal analysis, histology, and serological testing. The prospective study evaluated the prevalence of lymphadenopathy in 49 consecutive patients with AIT (group 1) and 49 consecutive patients with normal thyroids or nontoxic goiter (group 2). RESULTS: In the retrospective study, cytology of paratracheal LN revealed reactive lymphoid hyperplasia in 5/6 of the cases and a centroblastic lymphoma in one patient. The presence of monoclonal lymphatic cells was excluded in 5/6 patients and proven in 1/6 patients. Actual viral-infections were ruled out. In the prospective study AIT-patients showed significantly more enlarged LN in Robbins level II-IV and VI compared to controls. We found no correlation between lymphadenopathy, age, thyroid volume and nodularity, or autoantibody levels. During follow-up in 34 group 1-patients, lymphadenopathy remained stable in 28 patients, and decreased in 6 patients. CONCLUSION: Lymphadenopathy in Robbins level II-IV and VI is common in AIT-patients and most probably related to the autoimmune process.

[35-year old patient with severe thromboembolism]. / 35-jähriger Patient mit ausgeprägter Thromboembolie.

We report a case of a 35 year old male with severe deep vein thrombosis of the lower limb on both sides and pulmonary embolism. A Klinefelter's mosaic (47,XXY [81%]/48,XXXY [19%]) was diagnosed. Because no other cause for this thromboembolism was found, we assume that in part, it was caused by the Klinefelter's mosaic. In all male patients presenting with thromboembolism, especially those with an unusual habitus, a Klinefelter's syndrome should be considered as differential diagnosis. Testosterone substitution therapy should be started in all patients with Klinefelter's syndrome to prevent further disease.

[Comparison of two navigation systems for CT-guided interventions under special consideration of the ergonomic properties of the used systems]. / Vergleich zweier Navigationshilfen für CT-gesteuerte Interventionen unter besonderer Berücksichtigung der Nutzungseigenschaften der verwendeten Systeme.

PURPOSE: Investigation of the influence of CT-based navigation systems on the success of an intervention, assessment of the advantages and disadvantages of the utilized systems, and evaluation of the ergonomic system properties. MATERIALS AND METHOD: A simple guiding system PatPos Invent and the computer-based navigation system PinPoint were employed on two CT systems. In order to investigate the influence of the navigation aids on the success of the interventions, 96 prospective, randomized, and standardized punctures were performed on a specifically developed, rigid phantom. 16 examiners punctured 6 targets with 3 degrees of difficulty with the navigation aids. RESULTS: Irrespective of the experience of the examiner, both navigation systems guided the target with an equal degree of certainty. PinPoint significantly reduced the length of the examination time (12 - 25 min) as compared to PatPos Invent (20 - 40 min). The expectation conformity and comprehensibility of PatPos Invent were assessed significantly more positively than PinPoint with regard to the general handling of the system. In contrast, the assessment of the usability during preoperative setup favored PinPoint. The type of navigation system has no influence on the precision of the implementation of a puncture procedure. CONCLUSION: In the overall assessment of the handling of the systems, PatPos Invent was determined to be easier to comprehend and to provide greater conformity with expectations. With regard to the self-descriptive capacity and usability, PinPoint was assessed more positively. Both systems enable safe puncturing at all degrees of difficulty. The weak point of both systems is the failure to take patient movement into account.

Decontamination of the digestive tract and oropharynx in ICU patients.

BACKGROUND: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting. METHODS: We evaluated the effectiveness of SDD and SOD in a crossover study using cluster randomization in 13 intensive care units (ICUs), all in The Netherlands. Patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible. In each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. Mortality at day 28 was the primary end point. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics. Monthly point-prevalence studies were performed to analyze antibiotic resistance. RESULTS: A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively. CONCLUSIONS: In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.)

[Osteodensitometry in children and adolescents with inflammatory bowel disease]. / Osteodensitometrie bei Kindern und Jugendlichen mit chronisch entzündlichen Darmerkrankungen.

PURPOSE: To evaluate the quantity and severity of bone disorders in children and adolescents with inflammatory bowel diseases (IBD) and to examine the correlation to whole body growth. MATERIALS AND METHODS: In this study 89 bone mineral density measurements were performed and retrospectively analyzed. RESULTS: Under consideration of growth retardation, over 65.2 % of the patients with Cohn's disease showed a reduced bone mineral density. Osteopenia/Osteoporosis is seldom seen in patients with ulcerative colitis, i. e., only 34.8 % showed a reduction in bone mineral density. Growth retardation and reduced bone mineral density are correlated. Patients with Cohn's disease and a body length below the 25th height percentile showed a reduced bone mineral density in 78.1 % of the cases. Patients with a body length below the 10th height percentile had a reduced bone mineral density in 83.3 % of the cases. CONCLUSION: These results demonstrate the value of osteodensitometric measurements in patients with chronic diseases, especially in children and adolescents with inflammatory bowel disease.

[Enamel damage depending on the method of bracket removal]. / Uber die Schmelzchädigung in Abhängigkeit von der Methode der Bracketentfernung.

Two different methods of removing brackets, on the one side by torsion and on the other by bending, were compared for the purpose of analyzing the respective enamel lesions. Each test group consisted of 19 extracted human molars with metal brackets attached to the molars by means of the "concise etching technique". Bracket removal was standardized through the use of a Wolpert "Universalprüfmaschine TZZ 707" with modified torsion and bending mechanism. A scanning electron microscope was used to analyze the enamel surface. When using the torsion method, the mean extension of the enamel lesions was 48.3% of the adhesive free enamel surface. These lesions often reached into the deeper enamel layers and were mainly to be found on the broad side of the bonded area. On the other hand, when using the bending method, the enamel lesions were less frequent. They were mainly superficial and were confined almost exclusively to the pressure zones. The stress required to remove the brackets and the stress distribution were calculated on mechanical models and these results corresponded well with the enamel lesions observed on the molars. It can thus be concluded that the method of removing brackets is clinically relevant in relation to enamel lesions.

The influence of occupational and non-occupational factors on chronic fatigue in women.

The aim of the present study was to assess the significance of different types of loads to which working women are subjected in relation to reported chronic fatigue. The investigation involved 255 women workers from two different occupational groups. The first group was employed at knitting and the second at assembly lines. Their level of chronic fatigue was assessed. We also analysed the influence of 30 variables on fatigue level. These variables concerned: a) physical and psychological workload, b) organizational (social) climate of work, and c) demographic and family factors. It was found that the most important factor influencing chronic fatigue was "experiencing emotional tension" resulting from family problems. Other factors, having substantial significance for the development of increased fatigue level were also associated with emotional tension and resulted from the social climate in the workplace.

[The stereognathograph PC--test results with the new version of the device]. / Der Stereognathograph PC--Testergebnisse der neuen Geräteversion.

The PC stereognathograph was investigated for measurement errors in laboratory experiments on an optical bench as well as on an articulator. The values obtained were compared with the data of the predecessor model. A substantial reduction in the linearity in transverse measurements has been effected, so that these are now within acceptable limits. A variation of linearity factors which can be avoided by electronic fine adjustment still arises owing to incongruence of the six measurement channels. The hinge axis can be localized very well on the articulator. By and large, the announced correction of the projection error which we have demanded has not been implemented up to now. In view of the clear imaging of condylar movement in space and time on the monitor and the adequate precision of the clinical measurements effected, the PC stereognathograph appears to be a valuable system for instrumental diagnostics.

[The effect of the interocclusal space on temporomandibular recordings. A study with the use of the Stereognathograph PC]. / Uber den Einfluss des Interokklusalabstandes auf das Kiefergelenkregistrat. Eine Studie unter Verwendung des Stereognathographen PC.

1536 recordings of the condylar movement of 32 patients were made by means of the Stereognathograph PC. The test persons performed mediotrusive and protrusive movements. These movements were recorded with tooth contact and with increased interocclusal space, with and without the clinician's supportive guidance. The objective of the study was to analyse the effects of increased interocclusal space on the recording of the condylar path. Statistical evaluation showed that neither procedure has any real advantage over the other. Both, the occlusal tray as well as the paraocclusal tray may, depending on clinical situation of the ligaments, lead to erroneous recordings. The reproducibility of the recording of the condylar path is only slightly decreased by increased interocclusal space. Considering, however, the amount of work involved in each procedure, the occlusally fixated tray should probably be given preference, when there is no intention of recording occlusal guided movements.

[Effect of different enamel structures on bonding of glass ionomer cements]. / Schmelzhaftung von Glasionomerzementen bei unterschiedlichem Schmelzaufbau.

In the present study, the adhesive strength of glass-ionomer cement (GIC) for bracket bonding is analysed in relation to the surface characteristics of the enamel. The bonding of brackets to the enamel of impacted teeth as well as erupted teeth of adolescents and adults is determined in shear force experiments. The results of our investigation shows that GIC attaches to adult enamel to a significantly better extent than to the teeth of adolescents. The poorest values were shown in impacted teeth. It is shown with reference to scanning electron micrograms that surface lesions occur especially frequently in use of conventional etching technique on enamel in adults after debonding the bracket. GIC thus appears to be a promising alternative material for bracket fixation which does not damage the enamel, especially in adult orthodontics. In view of the result, its suitability should be checked in clinical studies.

[Fluorine distribution in the enamel in the use of glass ionomer cements as bonding materials]. / Fluorverteilung im Schmelz bei Einsatz von Glasionomerzementen als Befestigungswerkstoff.

The rise in the fluorine content of dental enamel after bonding orthodontic attachments with glass ionomer cement (GIC) was analysed in an in vitro study. Twenty-four freshly extracted caries-free premolars from adolescent patients were available for investigation. The teeth were cleaved longitudinally in the oro-vestibular direction to obtain a test specimen and reference sample. The GIC Aquacem was used as bonding material. The fluorine was measured with an electron beam microprobe (Camebax SX 50) 10, 20, 40 and 80 days after bonding. A rise of fluorine in dental enamel of more than 120% was observed after the bonding procedure. This rise was especially rapid in the first ten days, and a saturation value was reached after 40 days. The depth of penetration into the dental enamel was 20 microns, and the surface spreading was at least 3 mm. An equilibrium state is attained between the 40th and 80th day. A preventive action on caries in the vicinity of attachments bonded with glass ionomer cement is to be expected owing to the accumulation of fluorine in the dental enamel.

[Linearity and error correction of the Meyer/dal Ri hinge axis measurement system]. / Uber die Linearität und Fehlerkorrektur des Scharnierachsenschreibsystems nach Myer/dal Ri.

Measurement errors inherently related to the instrument and those due to external factors were analysed for the SAS hinge axis measurement system in conjunction with the digital recording system. An optical bench served as measurement apparatus. Linearity errors are substantially less than 0.1 mm and thus of no clinical relevance. A slight reduction in the size of the movement coordinates imaged with slight incongruences of the six measurement canals results from erroneous calibration. The recording system proves to be insusceptible to interference by external factors in practical application. The projection error correction we investigated experimentally was satisfactory. Merely the processing quality of the electrical wiring attached to the measuring foils was not fully satisfactory.

[Reproducibility of hinge axis localization by stereognathography]. / Uber die Reproduzierbarkeit der Scharnierachsen-Lokalisation mit dem Stereognathographen.

The program of the Stereognathograph V for localization of the hinge axis has been experimentally verified. Auxiliary recording devices have been mounted on an articulator and the process of localization has been simulated. On an average, the joint axis can be located in the articulator with an accuracy of 0.6 mm. In individual cases, errors may be up to 1.5 mm.

[Error sources in recording three-dimensional mandibular movements. An in vitro study using the V-type stereognathograph]. / Fehler bei der Aufzeichnung von Unterkeiferbewegungen mit dem Stereognathographen V.

The instrument-induced measurement errors in V-type stereognatography have been analyzed. An optical bench was used as a measurement apparatus. In measuring not too small movement distances, the linearity errors remained within acceptable limits. The variations in linearity due to calibration errors were almost negligible. In practical applications, the stereognatography proved to be insensitive to external factors such as type of illumination, room temperature and voltage fluctuations. Factors affecting the effectiveness of the projection error correction system, such as tilting of the filter, different sites of measurement of the six optoelectronic canals, and mandibular protrusion during mediotrusive movements, might be reduced by slight modifications of the measurement system.

[Fatigue in women performing work with predominantly dynamic effort. II. The social working environment and the feeling of fatigue]. / Zmeczenie kobiet wykonujacych prace z przewaga wysilku dynamicznego. Cz. II. Spoleczne srodowisko pracy a poczucie zmeczenia.

The relations between the sense of fatigue and evaluation of social factors demonstrated in the so called organizational climate of a workplace have been investigated. The test groups involved women performing major knitting industry jobs: knitters (94 persons) and sorters (44 persons). A multiple regression analysis demonstrated numerous relationships between the subjective symptoms of fatigue and social climate indices (10 indices have been observed). Among the social factors, especially work organization and interpersonal relationships (among workers themselves and workers in relation to their managers) may affect the magnitude of fatigue in knitting industry-employed women.