Circular test structure for the determination of piezoelectric constants of Sc x Al1-x N thin films applying Laser Doppler Vibrometry and FEM simulations.

Piezoelectric scandium aluminium nitride (Sc x Al1-x N) thin films offer a large potential for the application in micro electromechanical systems, as advantageous properties of pure AlN thin films are maintained, but combined with an increased piezoelectric actuation and sensing potential. Sc x Al1-x N thin films with x = 27% have been prepared by DC reactive magnetron sputtering to find optimized deposition parameters to maximize the piezoelectric constants d33 and d31. For the accurate and simultaneous measurement of these constants Laser Doppler Vibrometry has been applied and compared to finite element (FEM) simulations. The electrode design has been optimized to rotational symmetric structures enabling a 180° phase shifted excitation, so that a straight-forward comparison of experimental displacement curves with those obtained from FEM is feasible.

[Optimized assessment of the outcome in patients with radicular back pain of the lumbar spine. The modified NASS questionnaire]. / Bessere Verlaufsdokumentation bei Patienten mit lumboradikulären Schmerzsyndromen. Der modifizierte NASS-Fragebogen.

BACKGROUND: The purpose of the study was to present a reliable instrument with easy application to assess the outcome and improvement of therapy in patients with radicular symptoms of the lumbar spine. METHODS: Data from patients who underwent microdiscectomy because of lumbar radicular symptoms were collected and analyzed and interviews were performed using the well-known North American Spine Society (NASS) lumbar spine questionnaire (17 items) before and after the intervention. In addition patient data including comorbidities were collected. By calculating effect size (ES) and standardized response mean (SRM) for each item of the questionnaire, the questions with the highest change before and after the intervention could be selected. RESULTS: A total of 139 patients undergoing microdiscectomy for lumbar radicular symptoms due to a disc herniation were included in the analysis. Concerning the three dimensions pain, neurological symptoms and impairment of activities in daily life, the questions with best predictive value (high ES and SRM) were selected. According to their clinical relevance eight questions of the NASS questionnaire were finally selected for the short form. CONCLUSION: This short, significant and easy to use questionnaire is in our opinion a useful instrument to assess the course of patients with radicular back pain and especially to measure and monitor the outcome of therapeutic interventions, in addition to conventional clinical diagnostics and examinations. This novel instrument could be a useful tool for improving quality assurance in conventional and interventional pain management of these patients.

[Mobile intraocular pressure measurement. From palpation to initial clinical experience with the handheld dynamic contour tonometer]. / Mobile Augeninnendruckmessung. Von der Palpation bis zu ersten klinischen Erfahrungen mit dem handgehaltenen dynamischen Konturtonometer.

Goldmann applanation tonometry is still the gold standard of intraocular pressure measurement (IOP) and an essential part in the diagnosis of glaucoma. Applanation tonometry is usually performed on a sitting patient at the slit lamp. However, under certain circumstances it is necessary to measure the IOP outside the office setting. With handheld devices the measuring procedure is brought to bedside and surgery theatres, as well as to patients who are not able to sit behind the slit lamp. The dynamic contour tonometer (DCT) represents a new method of direct IOP measurement. Its physical principle is based on piezo-electronic contour matching tonometry and is claimed to be less dependent on biochemical properties of the cornea. Besides the IOP, the ocular pulse amplitude can also be measured. Until now, the DCT had been available as a slit lamp mounted device. In this report, we present a portable prototype of the device. In comparison with the Perkins tonometer and the TONO-PEN XL, the handheld DCT shows smaller intra- and inter-examiner variability. Additionally, the device offers the unique possibility to display the ocular pulse amplitude while the patient is in a horizontal position.

Acetabular bone reconstruction in revision arthroplasty: a comparison of freeze-dried, irradiated and chemically-treated allograft vitalised with autologous marrow versus frozen non-irradiated allograft.

Deficiencies of acetabular bone stock at revision hip replacement were reconstructed with two different types of allograft using impaction bone grafting and a Burch-Schneider reinforcement ring. We compared a standard frozen non-irradiated bone bank allograft (group A) with a freeze-dried irradiated bone allograft, vitalised with autologous marrow (group B). We studied 78 patients (79 hips), of whom 87% (69 hips) had type III acetabular defects according to the American Academy of Orthopaedic Surgeons classification at a mean of 31.4 months (14 to 51) after surgery. At the latest follow-up, the mean Harris hip score was 69.9 points (13.5 to 97.1) in group A and 71.0 points (11.5 to 96.5) in group B. Each hip showed evidence of trabeculation and incorporation of the allograft with no acetabular loosening. These results suggest that the use of an acetabular reinforcement ring and a living composite of sterile allograft and autologous marrow appears to be a method of reconstructing acetabular deficiencies which gives comparable results to current forms of treatment.

MAGE-C1/CT-7 expression in plasma cell myeloma: sub-cellular localization impacts on clinical outcome.

Plasma cell myelomas (PMs) have a poor prognosis. Cancer-testis (CT) antigens are immunogenic proteins, representing potential targets for tumor vaccination strategies. The expression of the CT antigens GAGE, MAGE-A4, MAGE-C1/CT-7, and NY-ESO-1 was investigated on paraffin-embedded bone marrow biopsies from 219 PM and 8 monoclonal gammopathy of undetermined significance (MGUS) patients. The frequency and prognostic impact of these CT antigens were compared with known morphological prognostic markers (i.e. Mib1 labeling index) and the presence of the translocations t(4;14)(p16.3; q32) and t(11;14)(q13;q32). We show that MAGE-C1/CT-7 is the most prevalent CT antigen, expressed in 57% of PMs in a high percentage of tumor cells. While MAGE-C1/CT-7 was absent in non-malignant plasma cells, plasma cells of patients with MGUS did express MAGE-C1/CT-7, but no other CT antigens. MAGE-C1/CT-7 was more frequently expressed in PMs with an elevated proliferation rate (Mib1 >10%) compared to PMs with a low proliferation rate (Mib1

[A novel therapeutic approach to bone replacement: vitalisation of industrial processed allogenic bone graft with autologous bone marrow]. / Das "vitalisierte" Allograft als Alternative im Knochenersatz.

AIM: Osseous defects of the human skeleton are a common problem in reconstructive orthopaedic and trauma surgery. In spite of a long-standing history of research on different organic and inorganic bone replacement materials, a clinically applicable alternative to autogenous bone transplants has not been found. METHODS: The current paper describes a novel bone replacement material, which is vitalised through injection of autologous bone marrow. Industrially processed bone allografts were used for bone replacement; the cancellous bone graft was gained from femoral heads from living human donors and processed by a French tissue bank (Banque de Tissus France, TBF). Sterile packed allogenic bone grafts can be stored at room temperature, are easy to handle and can be adapted to almost every bone defect due to their stability and versatility. RESULTS: From July 2003 to February 2006 125 patients,70 men and 55 women, underwent bone grafting with composite transplants composed of autogenous marrow cells and industrial processed bone allografts. The average age at surgery was 62 (14-84) years; the follow-up period was 11 months. The indication to use the allograft included the whole spectrum of bony defects conventionally treated with autologous cancellous bone grafts such as primary and revision surgery in THA (n = 64) and the treatment of pseudarthrosis particularly of the lower limb (n = 30). CONCLUSION: In comparison to current bone replacement materials applied in clinical use, this approach promises to replicate the biomechanical and biological properties of autogenous cancellous bone. This is an important advantage over conventional approaches to ensure successful healing and regeneration of bone defects. Hence application of vitalised bone allograft represents an important alternative to conventional autogenous cancellous bone which avoids certain complications associated with harvesting and transplantation of autogenous bone. This applies in particular in situations in which harvesting of autogenous cancellous bone is not or no longer possible.

The influence of fluoroquinolone drugs on the bacterial growth of S. epidermidis utilizing the unique potential of vibrational spectroscopy.

Increasing resistance of many antibiotics has made the design of new drugs necessary. To assist a target-oriented search for new structures and for the elucidation of the mode of action of existing drugs, powerful analytical techniques are required. In this work, vibrational spectroscopy is used to shed more light on the as-yet elusive interaction of gyrase inhibitors of the fluoroquinolone type with their biological target inside the Gram-positive bacterium Staphylococcus epidermidis by investigating whole-cell changes that occur as a result of the presence of the drug moxifloxacin. IR absorption and Raman spectra with excitation off resonance (lambda exc = 532 nm) and in resonance with the biological targets DNA and the aromatic amino acids of gyrase (lambda exc = 244 nm) were recorded for unperturbed bacteria and bacteria in varying drug concentrations (0.08, 0.16, 0.27, and 0.62 microg moxifloxacin/mL bacterial culture). The spectral changes caused by the action of the drug were analyzed with the help of statistical methods, such as hierarchical cluster analysis (HCA), principal component analysis (PCA), and Fisher's linear discriminant analysis (LDA) combined with variable selection. The wavenumbers mostly affected by the action of the drug could be assigned to protein and DNA moieties, supporting the proposed mechanisms of a tertiary complex of the fluoroquinolone, the enzyme gyrase, and DNA.

Characterization of bacterial growth and the influence of antibiotics by means of UV resonance Raman spectroscopy.

In this work we monitor the bacterial growth of a Bacillus pumilus batch culture by means of UV resonance Raman spectroscopy. Excitation with a wavelength of 244 nm especially enhances the Raman scattering of the aromatic amino acids and the nucleic acid bases and therefore is a good method to track the metabolic changes that occur during bacterial growth. Furthermore, a drug from the fluoroquinolone group is added to the bacterial suspension at the beginning of the exponential growth phase. With the help of chemometrical methods such as hierarchical cluster analysis (HCA) and principal component analysis (PCA) it is possible to visualize the small changes that occur in the UV resonance Raman spectra due to the interaction of the drug with its biological targets DNA and the enzyme gyrase within the bacterial cell.

Inferior central sulcus: variations of anatomy and function on the example of the motor tongue area.

We wanted to define the position of the primary motor tongue area (MTA) by using functional magnetic resonance imaging (fMRI) to display the MTA in relation to the inferolateral segment of the central sulcus (CS). The anatomy of the inferolateral segment was analyzed in 24 healthy subjects, using the magnetization prepared rapid acquisition gradient echo sequence. The position of the MTA was defined in 11 subjects by using fMRI to identify the sites of maximal activation for each subject in relation to that subject's own CS. The MTA was then displayed in three orthogonal planes, and in lateral surface reformations. The inferolateral segment displayed two distinct curves in 33 of 48 (69%) hemispheres, three curves in 6%, and four curves in 23%. Significant paradigm correlated activations were found in every hemisphere. Thereof 89 local maxima were determined, with 84 (94%) located in the region of the CS. Sixty-seven (80%) of the 84 CS activations lay along the two lowest curves of the CS. In 86% of cases, activations situated in the middle and deep portion of the anterior bank of the CS were encompassed within the three axial sections centered on the cella media of the lateral ventricles. In conclusion, the variability of the inferior CS segment precluded the assignment of the MTA to a specific anatomic configuration. However, the position of the MTA could be approximated by the intersection between the CS and the three axial planes through, just above, and just below the cella media of the lateral ventricles.

T-zone lymphoma with cutaneous involvement: a case report and review of the literature.

T-zone lymphoma (TZL) is a rare subtype of nodal peripheral T-cell lymphoma characterized by a clonal expansion of T-zone lymphocytes accompanied by a proliferation of other T-zone constituents. Non-specific cutaneous alterations are seen in about one-third of all cases, but specific cutaneous involvement is extremely rare. We present a case of TZL with secondary skin infiltration, review the literature on cutaneous manifestations of TZL and discuss the differential diagnosis of TZL.

Microarrays of bladder cancer tissue are highly representative of proliferation index and histological grade.

The number of genes suggested to play a role in cancer biology is rapidly increasing. To be able to test a large number of molecular parameters in sufficiently large series of primary tumours, a tissue microarray (TMA) approach has been developed where samples from up to 1000 tumours can be simultaneously analysed on one glass slide. Because of the small size of the individual arrayed tissue samples (diameter 0.6 mm), the question arises of whether these specimens are representative of their donor tumours. To investigate how representative are the results obtained on TMAs, a set of 2317 bladder tumours that had been previously analysed for histological grade and Ki67 labelling index (LI) was used to construct four replica TMAs from different areas of each tumour. Clinical follow-up information was available from 1092 patients. The histological grade and the Ki67 LI were determined for every arrayed tumour sample (4x2317 analyses each). Despite discrepancies in individual cases, the grade and Ki67 information obtained on minute arrayed samples were highly similar to the data obtained on large sections (p<0.0001). Most importantly, every individual association between grade or Ki67 LI and tumour stage or prognosis (recurrence, progression, tumour-specific survival) that was observed in large section analysis could be fully reproduced on all four replica TMAs. These results show that intra-tumour heterogeneity does not significantly affect the ability to detect clinico-pathological correlations on TMAs, probably because of the large number of tumours that can be included in TMA studies. TMAs are a powerful tool for rapid identification of the biological or clinical significance of molecular alterations in bladder cancer and other tumour types.

High-throughput tissue microarray analysis of 3p25 (RAF1) and 8p12 (FGFR1) copy number alterations in urinary bladder cancer.

Studies by comparative genomic hybridization revealed that the chromosomal regions 3p25 and 8p11-p12 are recurrently amplified in bladder cancer. To investigate the prevalence of DNA copy number alterations in these chromosomal regions and study their clinical significance, we used probes for the RAF1 (3p25) and FGFR1 (8p12) genes for fluorescence in situ hybridization. A tissue microarray containing 2317 tumors was analyzed. The analysis revealed RAF1 amplification in 4.0% and FGFR1 amplification in 3.4% of interpretable tumors. In addition, deletions were found at the 3p25 locus in 2.2% and at the 8p11-12 locus in 9.9% of interpretable tumors. Both amplifications and deletions of RAF1 and FGFR1 were significantly associated with high tumor grade (P < 0.0001), advanced stage (P < 0.0001), and poor survival (P < 0.05) if tumors of all of the stages where analyzed together. RAF1 amplifications were associated with subsequent tumor progression in pT1 carcinomas (P < 0.05). The marked differences in the frequency of all of the analyzed changes between pTa grade 1/grade 2 and pT1-4 carcinomas support the concept of these tumor groups representing different tumor entities.

Performance in picture naming and word comprehension: evidence for common neuronal substrates from intraoperative language mapping.

Correlations of naming ability and performance in the Token Test are known from aphasia; however, the mechanisms underlying these correlations are unclear. Naming tasks are commonly used in intraoperative mapping for identification of cortical areas involved in language processing. In the present study, we measured performance in an elementary Token Test task, i.e., single word comprehension, during electrical stimulation of cortical sites at which this stimulation previously had disturbed the naming process. It was found that at about half of the sites at which naming could be disturbed electrical stimulation also led to disturbances in Token Test performance, indicating that there are common neural structures critical for performance in both tasks. These findings are discussed in terms of a multilayered semantic network in which the level of the simultaneous binding of features into concepts and the level of units that are organized with respect to semantic relations may be disturbed separately.

Significantly different bcl-2 expression profiles in gastric and non-gastric primary extranodal high-grade B-cell lymphomas.

Fifty-five cases of primary extranodal high-grade B-cell non-Hodgkin's lymphoma were investigated for bcl-2 and p53 protein expression as well as for t(14;18) translocations and p53 mutations. Phenotypic and genotypic profiles were compared between tumours of gastric (27 cases) and non-gastric (28 cases) origin. bcl-2 protein expression was significantly lower in gastric (11/27) than in non-gastric (28/28) lymphomas (p<0.0001), while nuclear p53 protein expression did not differ significantly between these two groups. In the stomach, there were no significant differences in either bcl-2 or p53 expression profiles between high-grade lymphomas with (n=14) and without (n=13) evidence of a low-grade component of MALT type. However, secondary high-grade lymphomas showed a significant down-regulation of bcl-2 protein (p<0.0001) and, conversely, an up-regulation of p53 protein (p<0.0001) as compared with their low-grade tumour components. In extranodal high-grade B-cell lymphomas, bcl-2 protein expression was not associated with t(14;18) translocation. Only one gastric lymphoma had a p53 point mutation with potential alteration of the amino acid sequence. These findings indicate that primary gastric high-grade B-cell lymphomas are immunohistologically distinct from primary extranodal high-grade B-cell lymphomas of an origin other than in the stomach.

[Cause of death and autopsy findings in patients of the Swiss HIV Cohort Study (SHCS)]. / Todesursachen und Autopsiebefunde bei Patienten der Schweizerischen HIV-Kohortenstudie (SHCS).

The Swiss HIV Cohort Study (SHCS) is a prospective cohort study of HIV-infected adolescents and adults seen at 7 outpatient clinics (Swiss University Hospitals in Basle, Berne, Geneva, Lausanne, Zurich, the St. Gall Cantonal Hospital and the Civico Hospital in Lugano). The SHCS serves as an infrastructure for different research projects and includes about 70% of all patients with advanced disease in Switzerland. From April 1984 to November 1995 3120 HIV-infected patients of the SHCS died. Autopsies were performed in 314 of these patients. The aim of our study is to analyse autopsy findings as well as causes of death in those 314 HIV-infected patients. An HIV-related cause of death was found in 271 (86%) of the patients, 12 patients (4%) died of a drug overdose, and 3 (1%) of the patients committed suicide. 28 (9%) died either from an HIV unrelated or unidentified cause. The five most frequent causes of death were: bacterial pneumonia (52 patients, 17%), Pneumocystis carinii pneumonia (40 patients, 13%), lymphoma (34 patients, 11%), cytomegalovirus infection (33 patients, 11%), and toxoplasmosis (30 patients, 10%). During our study marked progress occurred in treating HIV-infected patients and preventing opportunistic infections. These improvements have further changed the natural course of acquired immunodeficiency syndrome. They are reflected in the falling rate of Pneumocystis carinii pneumonia and toxoplasmosis, as well as an increase in lymphoma as a cause of death over the period of our study.

Prostate stem cell antigen is a promising candidate for immunotherapy of advanced prostate cancer.

Immunotherapy of prostate cancer (CaP) may be a promising novel treatment option for the management of advanced CaP. However, the lack of suitable tumor antigens remains a major obstacle for the rational design of vaccines. To characterize potential CaP antigens, we determined the mRNA expression of the prostate-specific genes C1, C2, C5, PAGE-1, and prostate stem cell antigen (PSCA) in hormone-refractory CaP, benign prostatic hyperplasia, CaP cell lines, and CaP specimens. Among these gene products, only expression of PSCA appears to be retained in the majority of advanced CaP samples, as shown by reverse transcription-PCR analyses. Peptide fragments of PSCA presented in the context of major histocompatibility molecules could serve as recognition targets for CD8 T cells, provided these lymphocytes were not clonally deleted or peripherally tolerized. Our goal was to determine whether the human T-cell repertoire could recognize PSCA-derived peptide epitopes in the context of a common class I allele, HLA-A0201. Of nine peptides that, according to HLA-A0201 binding motifs, were candidate ligands of A0201 class I molecules, three peptides were able to stabilize HLA-A0201 molecules on the cell surface. One of the latter peptides, encompassing amino acid residues 14-22, was capable of generating a PSCA-specific T-cell response in a human lymphocyte culture from a patient with metastatic CaP. PSCA-specific CTLs recognized peptide-pulsed targets as well as three prostate carcinoma lines in cytotoxicity assays, indicating that this peptide could be endogenously processed. In conclusion, our findings establish PSCA as a potential target for antigen-specific, T cell-based immunotherapy of prostate carcinoma.

Visualization of cranial nerves I-XII: value of 3D CISS and T2-weighted FSE sequences.

The aim of this study was to evaluate the sensitivity of the three-dimensional constructive interference of steady state (3D CISS) sequence (slice thickness 0.7 mm) and that of the T2-weighted fast spin echo (T2-weighted FSE) sequence (slice thickness 3 mm) for the visualization of all cranial nerves in their cisternal course. Twenty healthy volunteers were examined using the T2-weighted FSE and the 3D CISS sequences. Three observers evaluated independently the cranial nerves NI-NXII in their cisternal course. The rates for successful visualization of each nerve for 3D CISS (and for T2-weighted FSE in parentheses) were as follows: NI, NII, NV, NVII, NVIII 40 of 40 (40 of 40), NIII 40 of 40 (18 of 40), NIV 19 of 40 (3 of 40), NVI 39 of 40 (5 of 40), NIX, X, XI 40 of 40 (29 of 40), and NXII 40 of 40 (4 of 40). Most of the cranial nerves can be reliably assessed when using the 3D CISS and the T2-weighted FSE sequences. Increasing the spatial resolution when using the 3D CISS sequence increases the reliability of the identification of the cranial nerves NIII-NXII.

High-throughput tissue microarray analysis of cyclin E gene amplification and overexpression in urinary bladder cancer.

Studies by comparative genomic hybridization revealed that the 19q13 chromosomal region is frequently amplified in bladder cancer. The cyclin E gene (CCNE), coding for a regulatory subunit of cyclin-dependent kinase 2, has been mapped to 19q13. To investigate the role of cyclin E alterations in bladder cancer, a tissue microarray of 2,317 specimens from 1,842 bladder cancer patients was constructed and analyzed for CCNE amplification by fluorescence in situ hybridization and for cyclin-E protein overexpression by immunohistochemistry. Fluorescence in situ hybridization analysis showed amplification in only 30 of the 1,561 evaluable tumors (1.9%). Amplification was significantly associated with stage and grade (P: < 0.0005 each). Immunohistochemically detectable cyclin E expression was strong in 233 (12.4%), weak in 354 (18.9%), and negative in 1, 286 of the 1,873 interpretable tumors. The majority (62.1%) of CCNE-amplified tumors were strongly immunohistochemistry-positive (P: < 0.0001). The frequency of protein expression increased from stage pTa (22.2%) to pT1 (45.5%; P: < 0.0001) but then decreased for stage pT2-4 (29.4%; P: < 0.0001 for pT1 versus pT2-4). Low cyclin E expression was associated with poor overall survival in all patients (P: < 0.0001), but had no prognostic impact independent of stage. It is concluded that cyclin E overexpression is characteristic to a subset of bladder carcinomas, especially at the stage of early invasion. This analysis of the prognostic impact of CCNE gene amplification and protein expression in >1,500 arrayed bladder cancers was accomplished in a period of 2 weeks, illustrating how the tissue microarray technology remarkably facilitates the evaluation of the clinical relevance of molecular alterations in cancer.

Primary gastric apoptosis-rich T-cell lymphoma co-expressing CD4, CD8, and cytotoxic molecules.

In contrast to primary gastric lymphomas of B-cell type, little is known about primary gastric T-cell lymphomas. We describe three cases with remarkably similar features: diffuse growth, epitheliotropism, medium too large cell size, high apoptotic rates, and a CD3+, CD4+, CD8+, CD45RO+ immunophenotype. Clonal TCRgamma gene rearrangement was shown in two cases. Epstein-Barr virus infection was excluded in two cases. Taking advantage of fresh-frozen material, we analyzed two cases further, revealing CD5-, CD16+, CD56-, CD57-, CD25+, CD30+, CD103 (alphaEbeta7)+, bcl-2 protein+, CD95+, CD95 ligand(L)-. CD95L, however, was detected in histiocytic and fibroblastoid by stander cells. The lymphomas expressed granzyme B, perforin, and the TIA-1 antigen in various combinations. All three cases had a very unfavorable clinical course characterized by local recurrence and/or dissemination to other epithelial sites, leading to death within 6-12 months after the initial diagnosis despite surgery and aggressive antineoplastic treatment. These data suggest a novel variant of peripheral T-cell lymphoma operationally characterized as primary gastric, apoptosis-rich, CD103+, EBV-, T-cell lymphoma co-expressing CD4, CD8, CD16 and cytotoxic molecules.

[Microsurgery of lumbar disc prolapse. Superior results of microsurgery as compared to standard- and percutaneous procedures (review of literature)]. / Mikrochirurgie lumbaler Bandscheibenvorfälle. Uberlegene Ergebnisse der Mikrochirurgie im Vergleich zu Standard- und perkutanen Verfahren (Literaturübersicht).

In a meta-analysis of 69 prospective and retrospective studies, we investigated the value of various surgical techniques in the treatment of lumbar disk herniations. This analysis includes standard diskectomy (5080 patients from nine series), microdiskectomy (5354/23), and comparison of both techniques (2494/10) and furthermore chemonucleolysis (2729/16), laser therapy (881/3), percutaneous nucleotomy (3506/18), comparisons of percutaneous techniques (942/5) with microdiskectomies (561/5) and standard diskectomies (1020/6). Outcomes were rated according to Macnab's criteria: I "excellent", II "good", III "improved", IV "same as before", V "worse", I/II "markedly improved", III "partially improved", IV/V "not improved", I-III "successful", and IV/V "unsuccessful". Results after microdiskectomy were "successful" more often (90% vs. 95%), "good/excellent" more often (82% vs. 73%), and patients left the hospital sooner than with standard diskectomy. Recurrence rates were comparable (4%). Results of both open techniques were clearly superior to those from any type of percutaneous treatment: chemonucleolysis und laser therapy were "successful" in 69% and 70% of cases respectively, with recurrence rates of 17% and 18%, endoscopic nucleotomy was "successful" in 84% of cases, and recurrence rate was 14%. Please ask the author for the reference database.