Permanent implantation as brachytherapy technique for prostate carcinoma-review of clinical trials and guidelines.

Brachytherapy nowadays has become a widely accepted treatment modality in the management of localized prostate cancer. With recent improvements in ultra-sound technology, imaging, treatment planning and post-implant dosimetry, permanent implantation has become minimally invasive, well tolerated, and safe and most importantly has progressed to a treatment modality comparable to external beam radiation therapy (EBRT) and radical prostatectomy. Multiple studies have proven the efficacy of brachytherapy analyzing also its superiority in health related quality of life; especially in potency preservation after treatment.

Huge mastoid congenital cholesteatoma in a 52-year-old patient.

Congenital cholesteatoma may arise in various locations within the temporal bone. The rarest site of origin is the mastoid process. We report an unusual case of a 52-year-old man with mastoid congenital cholesteatoma that manifested as a persistent ear discharge. The preoperative suspicion was based on the imaging findings and the patient's history. A simple mastoidectomy was conducted and the cholesteatoma was completely removed while using facial nerve monitoring. Although rare, mastoid congenital cholesteatoma can be considered as an alternative in the differential diagnosis of persistent otorrhea.

Structural analysis of two HLA-DR-presented autoantigenic epitopes: crucial role of peripheral but not central peptide residues for T-cell receptor recognition.

Specific and major histocompatibility complex (MHC)-restricted T-cell recognition of antigenic peptides is based on interactions of the T-cell receptor (TCR) with the MHC alpha helices and solvent exposed peptide residues termed TCR contacts. In the case of MHC class II-presented peptides, the latter are located in the positions p2/3, p5 and p7/8 between MHC anchor residues. For numerous epitopes, peptide substitution studies have identified the central residue p5 as primary TCR contact characterized by very low permissiveness for peptide substitution, while the more peripheral positions generally represent auxiliary TCR contacts. In structural studies of TCR/peptide/MHC complexes, this has been shown to be due to intimate contact between the TCR complementarity determining region (CDR) three loops and the central peptide residue. We asked whether this model also applied to two HLA-DR presented epitopes derived from an antigen targeted in type 1 diabetes. Large panels of epitope variants with mainly conservative single substitutions were tested for human leukocyte antigen (HLA) class II binding affinity and T cell stimulation. Both epitopes bind with high affinity to the presenting HLA-DR molecules. However, in striking contrast to the standard distribution of TCR contacts, recognition of the central p5 residue displayed high permissiveness even for non-conservative substitutions, while the more peripheral p2 and p8 TCR contacts showed very low permissiveness for substitution. This suggests that intimate TCR interaction with the central peptide residue is not always required for specific antigen recognition and can be compensated by interactions with positions normally acting as auxiliary contacts.

Folding of the human protein FKBP. Lattice Monte-Carlo simulations.

Monte-Carlo simulations of folding of the human protein FKBP are presented. The protein is confined in a simple cubic lattice and only nearest-neighbour interactions are considered. The evolution of protein structure, energy and diameter is followed over time. Starting from different extended conformations, compact globular forms with a hydrophobic core are reached above a critical temperature Tc, while below Tc the protein 'freezes' into high-energy, non-compact states. In the temperature range of folding, all the recorded intermediate states belong to two structural groups, where the process spends most of its time, separated by relatively fast transitions. During folding, the protein is successively composed of three and two compact fragments, whose separation occurs at loop positions. From comparisons performed on a domain of the family sharing 24% identity with FKBP, it appears that the number of fragments, and therefore their location, are sequence dependent.

The significance of rotation in fracture-separation of the articular pillar of a lower cervical vertebra. A clinical and cadaveric study.

We report 13 fracture-separations of an articular pillar at the lower cervical spine in 12 patients. There were 9 men and 3 women with a mean age at injury of 32 years, with involvement of C4, C5 and C6 vertebrae. Neurological symptoms were present in 9 patients, 2 were classified as ASIA A and 7 as ASIA D. The average magnitude of rotation of the articular pillar was 24 degrees (10 degrees-36 degrees). 4 patients with neurologic deficit and a rotated articular pillar of more than 25 degrees were operated on, while 8 patients, 3 of which had a rotation of more than 25 degrees, had closed treatment. Patients were followed from 8 months to 15 years (mean 9 years). Patients who had closed treatment and/or with a rotated fractured articular pillar of more than 25 degrees had less satisfactory results. This observation was affirmed by cadaveric studies which showed that rotation of more than 25 degrees is an additional factor of instability in a fractured articular pillar.

[Spontaneous fistulae and abscesses of the upper urinary tract (author's transl)]. / Spontane Hautfisteln und Abszesse im Bereich der oberen ableitenden Harnewege.

Spontaneous cutaneous fistulae and abscesses of the renal pelvis and ureter have become rare. Six case reports demonstrate their etiology and differential diagnostic problems. If there is no underlying urologic disease, above all no urolithiasis, other causes of fistulae and abscesses should be kept in mind, the most frequent of these being Crohn's disease.

[Considerations regarding the differential diagnosis during the angiography of non-functioning kidneys (author's transl)]. / Differentialdiagnostische Gesichtspunkte bei der Angiographie stummer Nieren.

Utilizing selective renal arteriograms and phlebograms in 7 patients, the differential diagnostic difficulties in separating poorly vascularized tumors from inflammatory lesions are discussed. Retrograde studies either offered no help, or could technically not be accomplished; arteriography proved equivocal in most cases. However, renal phlebography was found to be quite helpful, in that a non-visualized or reduced opacification of the intrarenal venous system, along with irregular extrinsic venous impressions, spoke more for a malignant tumor. When the contrast was able to fill the veins out to the periphery, a tumor could with great certainty be ruled out. Severe inflammatory conditions, while demonstrating a generalized reduction in the opacification of the venous system, did not show the bizarre venous wall irregularities seen with tumors. Retroperitoneal fibrosis and its special diagnostic difficulties are discussed.