[Regional coordination of paediatric oncological care in northwestern Lower Saxony, Germany--network funded by health insurance companies]. / Verbund PädOnko Weser-Ems--Regionale ambulante Versorgung pädiatrisch-onkologischer Patienten aus der Weser-Ems-Region im Rahmen einer Integrierten Versorgung.

The cure rates in pediatric oncology have been substantially improved due to standardized treatment strategies and centralization of therapy. Close clinical and hematological monitoring is mandatory for patients between periods of chemotherapy for early detection and treatment of therapy-related complications such as infections. This results in frequent and time-consuming outpatient examinations for the patient and family at the oncological center in order to evaluate clinical condition and hematological findings. In widespread regions such as the Weser-Ems area in northwest Lower Saxony, Germany, the long distances between patients' home and the oncological center lead to higher risks and impairment of quality of life (QoL) for the patients and their families. Accordingly, in 2001 pediatric hospitals and practices, patient care services and patients' support groups in Weser-Ems founded a network (Verbund PädOnko Weser-Ems). The "Verbund PädOnko" aims at coordinated, high-quality regional outpatient patient treatment in order to reduce risks of long-distance transports to reach the oncological center. Since 2005 a newly established mobile care team realized 1 443 home visits covering a total of 150 300 km. Since 2007 the network has been funded by health insurance organisations. Internal and external benchmarking was performed showing that the rate of short term inpatient treatments were reduced. Treatment quality was assured and the QoL of the patients and their families was improved through the work of the network. The "Verbund PädOnko Weser-Ems" network represents a promising prototype model for the regional coordination of outpatient treatment and care of patients with rare diseases in wide spread areas.

[Pelvic ring injuries]. / Beckenringverletzungen.

PURPOSE: Analysis of the trauma patient of fractures of the pelvic ring and classification according to AO/Tile. METHODS: 125 unselected patients (43 females, 82 males) were evaluated retrospectively by conventional x-ray, and CT examinations included follow-studies. RESULTS: Type-A fractures were seen in 36 (29%), Type-B fractures in 58 (46%), and Type-C fractures in 31 (25%) cases. Type-B and Type-C fractures mainly occurred in patients with traffic accidents and falls from great height. Type-A fractures were seen most often in patients with accidents at home or at work. However, in patients with complex fractures a classification concerning Type-B or Type-C fractures was difficult. SUMMARY: Based on CT criterias, in most patients a statement concerning the applied forces, the stability of the pelvic rim and the fracture type can be made.

[Euphoric effect of lidocaine]. / Rauschwirkung von Lidocain.

A 42 year old drug addict reported on his experiences with intravenous application of scandicaine and lidocaine. Lidocaine led to short-lasting euphoria comparable with former cocaine-induced effects. Pharmacological hypothesis to explain these mental alterations are discussed.

Brain size and morphology in miniaturized plethodontid salamanders.

In six miniaturized salamanders of the family Plethodontidae, including one of the smallest tetrapod vertebrates. Thorius pennatulus, the anatomical consequences of miniaturization for the brain were investigated. We determined (1) absolute and relative size of the brain, major parts of the brain, the tectum and tectal gray matter, (2) nerve cell size and density, and (3) the number of cells within the visual and visuomotor centers (thalamus, tectum/praetectum and tegmentum). No common compensatory strategy for the brain among the miniaturized salamanders was found. Except for the smallest species, T. pennatulus, only some of the expected compensatory processes (increase in relative size of the brain, relative size of visual centers, relative amount of gray matter or relative density of cell packing density) are found in any species, and these occur in different combinations and degrees. The most decisive factor for maximizing cell number was cell size. Miniaturized species with small cells also have many visual cells, regardless of the other factors. In contrast, the minimum number of visual neurons is found in miniaturized salamanders with large cells. It is concluded that the neuroanatomical traits investigated exert different degrees of resistance to adaptive compensatory processes. Cell size seems to be the most resistant parameter and is strictly dependent on genome size.

Cell size predicts morphological complexity in the brains of frogs and salamanders.

The morphological organization of the brain of frogs and salamanders varies greatly in the degree to which it is subdivided and differentiated. Members of these taxa are visually oriented predators, but the morphological complexity of the visual centers in the brain varies interspecifically. We give evidence that the morphological complexity of the amphibian tectum mesencephali, the main visual center, can be predicted from knowledge of cell size, which varies greatly among these taxa. Further, cell size is highly correlated with genome size. Frogs with small cells have more complex morphologies of the tectum than do those with large cells independent of body and brain size. In contrast, in salamanders brain-body size relationships also are correlated with morphological complexity of the brain. Small salamanders with large cells have the simplest tecta, whereas large salamanders with small cells exhibit the most complex tectal morphologies. Increases in genome, and consequently cell size, are associated with a decrease in the differentiation rate of nervous tissue, which leads to the observed differences in brain morphology. On the basis of these findings we hypothesize that important features of the structure of the brain can arise independently of functional demands, from changes at a lower level of organismal organization--in this case increase in genome size, which induces simplification of brain morphology.

[Surfactant therapy in severe neonatal respiratory failure--multicenter study--II. Surfactant therapy in 10 newborn infants with meconium aspiration syndrome]. / Surfactanttherapie bei schwerer neonataler Ateminsuffizienz--Multizentrische Studie--II. Surfactanttherapie bei 10 Neugeborenen mit Mekoniumaspirationssyndrom.

As a part of a west german multicenter study (424 patients, 16 hospitals) 10 term neonates ventilated because of severe meconium aspiration syndrome were treated with 1-4 doses of 50 mg/kg/BW of a bovine surfactant (Alveofact). Before treatment respiratory distress was severe (median FiO2: 1.0, median MAD 9.9 mmHg, median OI: 20). Acute improvement ("responders") was shown in 4 patients. All patients survived. Time of mechanical ventilation was 6-26 d. High frequency ventilation was applied in two nonresponders, ECMO in one.

The influence of intravenous L-tryptophan on plasma melatonin and sleep in men.

The sleep-inducing mechanisms of L-Tryptophan (L-Trp) are generally thought to be mediated by a central serotonergic activation. Evidence is presented that some effects of L-Trp on sleep may be mediated by melatonin, a Trp-metabolite with sedative properties. Trp effects on vigilance, sleep, and plasma-melatonin concentrations were measured after double-blind application of 0, 1, 3, and 5 g L-Trp in nine and five healthy probands during daytime and nighttime, respectively. A significant sleep-inducing effect was observed after L-Trp administration during daytime and nighttime. The infusions of L-Trp caused a massive elevation of plasma melatonin levels. This effect was significant both during the night and the day, indicating that the increment of circulating melatonin may be of extrapineal origin.