Production and separation of positron emitters for hadron therapy at FRS-Cave M.

The FRagment Separator FRS at GSI is a versatile spectrometer and separator for experiments with relativistic in-flight separated short-lived exotic beams. One branch of the FRS is connected to the target hall where the bio-medical cave (Cave M) is located. Recently a joint activity between the experimental groups of the FRS and the biophysics at the GSI and Department of physics at LMU was started to perform biomedical experiments relevant for hadron therapy with positron emitting carbon and oxygen beams. This paper presents the new ion-optical mode and commissioning results of the FRS-Cave M branch where positron emitting 15O-ions were provided to the medical cave for the first time. An overall conversion efficiency of 2.9±0.2×10-4 15O fragments per primary 16O ion accelerated in the synchrotron SIS18 was reached.

Power of Judgment: The Significance of Kant's Philosophy for the Medical System Today.

The ways of thinking in the manufacturing sciences are increasingly determining the rationality within medicine as a practical or action-based science. This "technological paradigm" infiltrates the field of medicine with the promise of increasing efficiency while simultaneously improving quality at various points in the system. Simple linear causal relationships generally need to be taken into account when manufacturing products. Even complex manufacturing processes can be broken down into the smallest units and, therefore, also be automated. The situation in complex systems such as the human body, however, is completely different. In order for doctors to be able to carry out their actions within this complex system, medicine as a science provides the physician with rules on the means that should be used to decide which remedy should be used, when and how. This judgment of which remedy should be used, when and how, what is known as the indication, is a central medical moment. This requires a power of judgment sharpened by experience. The indication, in turn, essentially determines the course of a disease and thus the quality of the treatment or the quality of result so often referred to these days.

[Trust and reliability in surgery]. / Vertrauen und Verlässlichkeit in der Chirurgie.

Social interactions are hardly possible without trust. Medical and in particular surgical actions can change the lives of people directly and indirectly existentially. Thus, the relationship between doctor and patient is a special form of social interaction, and will be hard to find anywhere else. The nature of the doctor-patient relationship also determines the success of a treatment. The core and the importance of trust, as a central part of this relationship, will be reconstructed in the present paper. The increasing possibilities of information acquisition in modern societies, and the ever-present need for transparency, impact more and more on the doctor-patient relationship. At first glance, concepts of trust seem to be of secondary importance. The current developments regarding the remuneration of services in the medical system likewise bear the risk to increasingly determine the importance of trust in the doctor-patient relationship. However, it is necessary to delineate reliability from trust. Due to the conditions which are constitutive for the operational disciplines, a climate of trust, even in a modern information society, is more necessary than ever.

[Causes, injuries, therapy and possibilities of prevention of equine-related accidents. Results of a 2-center-study]. / Ursachen, Verletzungen, Therapie und Präventionsmöglichkeiten von Unfällen im Reitsport. Ergebnisse einer 2-Center-Studie.

BACKGROUND: Horse riding is associated with a high rate of injuries. The possibilities of prevention are limited because of deficient knowledge about the causes and mechanisms of equine-related accidents. In the present study 198 equine-related accidents were analyzed and based on these data risk groups were identified and guidelines to improve safety in horse riding were formulated. MATERIAL AND METHODS: In this 2-center study the accidents of 169 riders over a period of 12 months were analyzed. Data on equine-related patterns of injury and the resulting treatment were collated from the clinical records. Additionally, a questionnaire was completed on the day of trauma by the patients, which covered age, gender, the cause and mechanism of injury and the use of safety equipment at the time of the accident. RESULTS: There were 169 (85.5%) female and 29 (14.5%) male riders with a median age of 27.2 years (range 5-74 years). Of the riders 55 (27.8%) were aged 18 years or younger, 134 (67.7%) riders were treated as outpatients while 64 (32.3%) required hospitalization, 51 (25.8%) required surgical treatment, 66 (33.3%) used a helmet and 14 (7.1%) a body protector at the time of accident. DISCUSSION: Equestrians wear helmets increasingly more when riding but the willingness to wear body protectors is disappointing. Protective headgear has been proven to reduce the risk of injuries but based on these data a positive effect of body protectors could not be shown. In this study safety vest users suffered from injuries of the upper body more often than those who did not wear a body protector. Children and adolescents often overestimate their skills; therefore, teaching and supervision of inexperienced young riders along with the use of protective equipment can prevent major injuries.

Effectiveness of safety vests in pediatric horseback riding.

BACKGROUND: Despite the benefit of safety vests to the reduction of torso injuries in children and adolescents is unclear, its' use is recommended. The aim of the present study is to determine the effectiveness of safety vests actually used in pediatric equestrian activities. PATIENTS AND METHOD: In this case-control-study, we analyzed the accidents of 92 riders aged 18 or younger who fell off a horse onto his/her torso during a period of 18 months. Data were gathered from the clinical records. Additionally, a questionnaire was administered on the day of trauma by the patients and/or their parents. RESULTS: The cases comprised 31 patients who sustained torso injuries. The controls were 61 riders with injuries of other body parts than to the torso. Safety vest use was not associated with a lower risk of torso injuries (OR=1.18, 95% CI (0.50, 2.81), p=0.707). Post hoc power analysis revealed that within such a setting an odds ratio of 0.266 could be found with a power of 80%. CONCLUSION: This study is not able to show an association between wearing a torso protector and protection from torso injuries, probably due to confounding. We did not detect a high effect of safety vest usage in our study population. Whether the development of a new generation of safety vests might be more effective remains unclear. An effective vest should be adapted to the requirements of children and adolescents and should protect the thorax and abdomen, but also the cervical and the lumbar spine.

[The question of safety in horse-riding sports]. / Zur Frage der Sicherheit im Reitsport.

INTRODUCTION: To reduce the number of equine-related injuries, knowledge about causes of accidents is of great importance. In the present study the causes of equine-related accidents were evaluated by a questionnaire survey. Based on our results options for prevention of equine-related accidents were formulated. MATERIAL AND METHODS: The working-group "safer riding, Hamburg" and the "German riding association (FN)" created a questionnaire to evaluate causes of equine-related accidents. This questionnaire was published in the print media "Cavallo" and "St. Georg" as well as on the online portal www.hamburger-ag-reitersicherheit.de. The questionnaire was intended for all equestrians who had suffered a horse-riding accident in the past. RESULTS: 371 female and 18 male equestrians returned a completed questionnaire. At the time of the accident the average age of the casualties was 32.5 years (range: 5 - 68 years). 86 % of the casualties wore a helmet while only 14 % used a body protector. 61 % of the equestrians were amateur riders and 66 % of the accidents occurred during leisure riding. 44 % of the horses were professional sport horses. 83 % of the equestrians had known the horse for over 6 months at time of injury. DISCUSSION: The qualification of the horse as well as the familiarity between rider and horse do not seem to have an effect of reducing of the number of accidents in equestrian activities. On the other hand a good education of the rider can contribute to decrease the accident rate. While the employment of helmets in riding sports has increased in recent years the use of preventive measures such as body protectors and safety education programmes are being used too rarely.

Correlation between the severity of neurological deficits in patients with symptomatic spinal metastases and short-term postoperative functional neurological improvements.

OBJECTIVE: The correlation between the severity of neurological deficit of patients with symptomatic spinal metastases and short-term, postoperative, functional improvements after surgery is unclear. The aim of this clinical trial was to determine the influence of neurological deficit severity on short-term functional outcomes after surgery, and to devise optimal treatment strategies for this patient population. METHODS: Between 01/1999 and 12/2004, 194 patients with symptomatic spinal metastases were surgically treated. Each patient underwent neurological examination pre- and postoperatively. The results were ranked according to the Frankel score. The pre- and postoperative Frankel score was compared in order to assess the development of neurostatus following a surgical procedure. RESULTS: Complete postoperative remission was seen in 27% of all patients (27/101) with a preoperative Frankel score D, as well as in 5% of all patients (4/77) with a preoperative Frankel score C. Improvement of the preoperative neurologic deficits occurred in 27% of all patients (27/101) with a preoperative Frankel score D, 58% of all patients (45/77) with a preoperative Frankel score C, 36% of all patients (5/14) with a preoperative Frankel score B, and 50% of all patients (1/2) with a preoperative Frankel score A. CONCLUSION: Surgical treatment of patients suffering from neurological deficits caused by spinal metastases results in neurological function improvements. The probability of neurological improvement does not correlate with the severity of the preoperative neurologic deficit. As a consequence, the decision to operate on these patients should not depend on the severity of pre-operative neurological symptoms alone.

[Spine injuries due to horse riding accidents - an analysis of 30 cases]. / Reitunfallbedingte Wirbelsäulenverletzungen - eine Analyse von 30 Fällen.

INTRODUCTION: Horseback riding entails several risk factors that predispose the participant to injury. Especially craniocerebral as well as spinal trauma were common reasons for severe injuries. Hence, it is important to use effective protective gear during riding activities. However, the protective effect of actual safety vests and helmets in case of accident is still unknown. In the present study reasons, mechanisms and patterns of equine-related spine injuries were analyzed. Based on these data the effectiveness of used protective gear during accident was assessed. MATERIAL AND METHODS: 30 equestrians took part in a questionnaire survey. Based on these answered questionnaires reasons, mechanisms and patterns of equine-related injuries as well as used protective gear during accident were evaluated and analyzed. RESULTS: 24 patients (80 %) were female and 6 (20 %) were male. The median age at the time of injury was 36 years (range 14 - 72 years). The causalities suffered from 18 fractures (60 %) and 11 discoligamentous injuries (37 %), in one case a bone-bruise-injury (3 %) was found. 7 equestrians (23 %) wore a safety vest at time of injury. DISCUSSION: Despite wearing a safety vest, the spine can get damaged when accident occurred. It is not possible to create vests for equestrians capable of protecting against all spine injuries in all accidents. If the energy impact is too high, serious injuries can result, even though protective body gear is worn. But the development of improved safety vests is necessary to reduce the number of severe spine injury in the future.

[Functional and radiological outcome after ACDF in 67 cases]. / Funktionelles und radiologisches Outcome nach ACDF bei 67 Patienten.

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) is an accepted technique for the treatment of symptomatic disc disease at the cervical spine. In this study the clinical outcome of 67 patients who underwent ACDF due to cervical disc herniation are presented. Based on the results of this study and those of other working groups the pros and cons of ACDF were analysed and discussed. METHODS: 67 patients with cervical disc herniation underwent ACDF of a single level. Clinical and/or radiological examination was performed immediately preoperatively, one day after surgery and 7 months postoperatively to assess the course of the examined parameters. RESULTS: The mean age of the patients was 53 years (range: 19-81). Seven months after surgery we observed pain reduction in 91% of the cases, range of motion in the neck improvement in 79%, motor function improvement in 78% and a function improvement in sensitivity in 78% of the cases. Analysis of the CT scans 7 months after surgery showed a fusion rate of 85% on the cervical spine segment that was treated. DISCUSSION: The results of this study demonstrate that ACDF is an effective surgical treatment for patients suffering from disc degeneration at the cervical spine. Over 80% of the patients showed an improved neurological status and had less pain than prior to surgery. It is a safe surgical technique with a low rate of complications and a high rate of bony consolidation on the treated level.

Non-conventional treatments sought by patients after surgery for intramedullary spinal cord tumors.

OBJECTIVE: Despite modern microsurgical techniques and interdisciplinary treatment options, intramedullary spinal cord tumors often lead to profound neurological deficits. Some patients may search for non-scientific or unconventional therapeutic options to treat the symptoms induced by the tumor itself or arising from treatment. The extent of non-scientific therapy use, the rationale behind it, and costs of these forms of therapy are unknown. METHODS: A questionnaire consisting of 20 questions was sent to 60 patients of a single neurosurgical center who had undergone surgery for an intramedullary spinal cord tumor. A retrospective study was carried out based on this data. Histological findings ranged from ependymoma (52.9%), hemangioblastoma (17.6%), cavernoma (14.7%), astrocytoma (8.8%), oligodendroglioma (2.9%) to ganglioglioma (2.9%). Non-scientific therapy was defined as a method not used in routine clinical practice for the treatment of symptoms induced by intramedullary spinal cord tumors. RESULTS: A total of 38 questionnaires was returned. About 55.3% of the patients claimed to use non-scientific therapies. No significant difference between histological types and the percentage of alternative therapy use was detected. There was a gender difference. One third (non user group) to one fourth (user group) did not feel adequately informed about their disease. The monthly costs for non-scientific therapies ranged from 50 to 500 Euros. The main motive for the use of non-scientific therapies was the wish to try everything possible. CONCLUSION: In the daily clinical routine, patients' use of non-scientific therapies may be largely overlooked and underestimated. Neurooncologists should be aware of this phenomenon and encourage an open but critical dialogue with their patients.

Therapeutic clues in spinal dural arteriovenous fistulas - a 30 year experience of 156 cases.

BACKGROUND: Spinal dural arteriovenous fistulae (SDAVF) are rare but remain the most common type of spinal vascular malformations. Treatment options for SDAVF include endovascular embolization, microsurgical dissection or a combination of both. But the optimal treatment paradigm has yet to be defined and may well be an individualized interdisciplinary combinatorial approach. MATERIAL AND METHODS: From 1980 to 2008, 156 patients with the diagnosis of SDAVF were treated by neuroradiological and neurosurgical means. Based on the procedure-related complications we retrospectively analyzed our data to elucidate the reasons for endovascular failure and the evolution of the surgical technique. RESULTS: 156 patients were included in this study. There were 31 (19.9%) female and 125 (80.1%) male patients. Average age at the time of diagnosis was 60.8 years. 102 out of 156 (65.4%) underwent endovascular obliteration, 54 (34.6%) patients were treated primarily by surgery. 134 (85.9%) underwent follow-up examination. A total of 29 (18.6%) out of 156 patients could not be treated successfully by endovascular (9.4%) or surgical (4.1%) means. CONCLUSION: Microsurgery can be recommended as the first choice treatment when the fistula's point is unmistakably identified intradurally. Endovascular obliteration may be justifiable in cases with an easy access to a monoradicular feeding artery during diagnostic angiography. Surgery is a definitive treatment with stable long-term results in which procedure-related morbidity is low. During evolution of the combined approach, endovascular coil placement for correct localization of the fistula and the use of intraoperative micro-Doppler was found to be very helpful in increasing the safety of the surgical procedure and minimizing surgical exposure.

[Prognosis after surgical treatment of spinal metastases due to lung cancer]. / Prognose nach operativem Wirbelsäuleneingriff bei Bronchialkarzinommetastasen.

BACKGROUND: Patients with spine metastases due to lung cancer suffer from a reduced lifespan. For a more precise prognosis, it is important to define parameters which influence the individual survival time. This study reviewed the mean survival time of patients who had undergone surgery because of spine metastases due to lung cancer. It should be evaluated whether the postsurgical survival time is dependent on the length of time between diagnosis and surgery and from the histological type of the tumor. MATERIAL AND METHODS: Between January 1999 and December 2003, 68 patients had undergone spine surgery because of spine metastases due to lung cancer at the department of traumatology of the St. Georg General Hospital in Hamburg, Germany. Retrospective data were collected from the hospital documentary system regarding the period between diagnosis of lung cancer and date of surgical treatment, and regarding the histological type of the tumor. The postsurgical survival times were evaluated using data from the Hamburger Cancer Index and from general practitioners. These times were analysed afterward according to the defined parameters. RESULTS: The average age was 62.6 years, and 24 female and 44 male patients were included. It was possible to evaluate the survival time of 65 patients. The average survival time of those with preoperative unknown primary manifestation (20 patients) was 88 days, in the group of patients with lung cancer histories of less than 12 months (35 patients) 141 days, and with patients with lung cancer histories of lung cancer longer than 12 months (13 patients) it was 171 days. The mean survival times after surgical treatment were 122 days for patients suffering from non-small-cell lung cancer (45 patients), 128 days for those with small-cell lung cancer (20 patients), and 247 days for patients with other histological types (three patients). DISCUSSION: The prognosis of patients after spine surgery for lung cancer metastases is poor. The indication for surgical treatment of spinal metastases due to lung cancer should be critically discussed. Especially patients with unknown primary manifestation might benefit from a conservative approach. With respect to the patients' reduced lifespan, they, their relatives, and the nursing staff should be carefully informed.

[Surgical complications after metastatic infiltration of the spine]. / Komplikationen bei operativer Dekompression an der tumorinfiltrierten Wirbelsäule.

INTRODUCTION: This study evaluated the intra- and post-surgical complications on tumor affected spines. Complications were analyzed according to selected patient groups so that risk factors could be determined. MATERIAL AND METHODS: Between January 1999 and December 2004, 401 patients underwent surgery because of spinal metastases in the Department of Traumatology, General Hospital St. Georg in Hamburg. Data were obtained from the hospital's documentary system. The results of this study were compared to other published studies. RESULTS: The average age of patients was 63 years (24-88) and there were 172 (42.9%) females and 229 (57.1%) males. A total of 118 (29.4%) patients suffered from 235 complications and 22 (5.5%) died. DISCUSSION: Patient's age >70 years, patients with a preoperative neurological deficit, and patients with heavily bleeding metastases are at high risk for complications. The dorsoventral/dorsolateral approach had the highest complication rate.

[Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate]. / Ergebnisse nach Versorgung instabiler proximaler Humerusfrakturen mittels winkelstabiler Platte.

BACKGROUND: Fixed-angle implants are being increasingly used in surgery of fractures of the proximal humerus. The aim of this retrospective investigation was to evaluate the outcome after fracture reduction utilizing a fixed-angle plate (Königsee). MATERIALS AND METHODS: Between January 2003 and April 2004, 58 patients were operated, 52 of whom received a fixed-angle implant; 46 cases were harvested for a follow-up examination. Each patient was re examined clinically and radiologically at least 6 and 18 months after surgery. The functional outcome was evaluated using the Constant Score and the Simple Shoulder Test. The results were compared to results of other investigations. RESULTS: The mean patient age was 68.8 years (34-94 years). Fractures were classified using the Neer Classification: 12 were classified as two-part, 25 as three-part, and 9 as four-part fractures. Three of the three-part and four of the four-part fractures were rated as luxation fractures. The overall functional outcome of all cases was good. More than 18 months after surgery the mean general "Constant Score" was 57; the mean side-related "Constant Score" was 89%. The Simple Shoulder Test revealed a pain-free range of motion in 41 (89.1%) of the individuals. The majority of the patients were satisfied with the results regarding remaining range of activity of the injured limb. In five cases significant complications occurred. In two cases the head of the humerus collapsed, and in one case a necrosis of the head occurred. In one individual the implant broke after an additional trauma. In this case a re-osteosynthesis utilizing a tibia plate was performed and the patient was excluded from further follow-up investigations. One soft tissue infection occurred after initial surgery. CONCLUSION: It has been shown that results after fixation of proximal humerus fractures with fixed-angle implants are good. The functional outcome is good and complications are rare. Our results correlate with other investigations regarding fracture reduction using fixed-angle plates and nails.

[Life-threatening complications after plastic tracheostomy closure. Which length of hospital stay according to clinical and forensic viewpoints is necessary?]. / Lebensbedrohende Komplikationen nach plastischem Tracheostomaverschluss. Welche stationäre Aufenthaltsdauer ist aus klinischer und forensischer Sicht erforderlich?

BACKGROUND: Plastic tracheostomy closure represents a safe surgical method with rare but potentially life-threatening complications such as dyspnea. Because of the general tendency to reduce hospital stay, the medically necessary time of hospitalization should be evaluated. METHODS: Ninety-eight patients operated in succession were examined retrospectively for extent, time, and therapeutic procedures in cases of life-threatening dyspnea. Moreover, disorders of wound healing which had to be treated surgically were analyzed. RESULTS: Of 98 patients 17% (17/98) developed dyspneas, 10% (10/98) up to the 3rd postoperative day, 2% (2/98) on the 6th postoperative day, and 5% (5/98) between the 17th and 92nd postoperative days; 13% (13/98) had to be treated because of extensive disorders of wound healing, 85% (11/13) up to the 3rd day. CONCLUSION: From the clinical and forensic viewpoint, a hospital stay for at least 3 postoperative days is necessary to record the majority of life-threatening complications after plastic tracheostomy closure.

Generation of GW radiation pulses from a VUV free-electron laser operating in the femtosecond regime.

Experimental results are presented from vacuum-ultraviolet free-electron laser (FEL) operating in the self-amplified spontaneous emission (SASE) mode. The generation of ultrashort radiation pulses became possible due to specific tailoring of the bunch charge distribution. A complete characterization of the linear and nonlinear modes of the SASE FEL operation was performed. At saturation the FEL produces ultrashort pulses (30-100 fs FWHM) with a peak radiation power in the GW level and with full transverse coherence. The wavelength was tuned in the range of 95-105 nm.

Experimental design optimization of filamentous phage transfection into mammalian cells by cationic lipids.

A previous study showed that filamentous phage could be efficiently transfected into mammalian cells in the presence of the cationic lipid Transfectam. In the present study, we used an experimental plan based on a uniform network (Doehlert) matrix to estimate optimal transfection conditions in two different cell lines, CHO and Cos-7. Using the cationic lipid RPR120535b as a model, we show that optimal conditions can be determined much more readily than with standard response curves. Under optimal conditions as analyzed by FACS, up to 60% of Cos-7 and 50% of CHO cells can be transfected. Furthermore, a comparison of different lipids (Transfectam, RPR120535b, TC1-12 and GAP-DLRIE/DOPE) suggests that lipids with multiple amine groups are more efficient for the transfection of filamentous phage.

Estimation of the noisy component of anatomical backgrounds.

The knowledge of the relationship that links radiation dose and image quality is a prerequisite to any optimization of medical diagnostic radiology. Image quality depends, on the one hand, on the physical parameters such as contrast, resolution, and noise, and on the other hand, on characteristics of the observer that assesses the image. While the role of contrast and resolution is precisely defined and recognized, the influence of image noise is not yet fully understood. Its measurement is often based on imaging uniform test objects, even though real images contain anatomical backgrounds whose statistical nature is much different from test objects used to assess system noise. The goal of this study was to demonstrate the importance of variations in background anatomy by quantifying its effect on a series of detection tasks. Several types of mammographic backgrounds and signals were examined by psychophysical experiments in a two-alternative forced-choice detection task. According to hypotheses concerning the strategy used by the human observers, their signal to noise ratio was determined. This variable was also computed for a mathematical model based on the statistical decision theory. By comparing theoretical model and experimental results, the way that anatomical structure is perceived has been analyzed. Experiments showed that the observer's behavior was highly dependent upon both system noise and the anatomical background. The anatomy partly acts as a signal recognizable as such and partly as a pure noise that disturbs the detection process. This dual nature of the anatomy is quantified. It is shown that its effect varies according to its amplitude and the profile of the object being detected. The importance of the noisy part of the anatomy is, in some situations, much greater than the system noise. Hence, reducing the system noise by increasing the dose will not improve task performance. This observation indicates that the tradeoff between dose and image quality might be optimized by accepting a higher system noise. This could lead to a better resolution, more contrast, or less dose.

Comparison between targeted and untargeted systemic immunizations with adjuvanted urease to cure Helicobacter pylori infection in mice.

Outbred OF1 mice infected in a first step with a mouse-adapted Helicobacter pylori strain were immunized in a second step by systemic or mucosal routes: systemic immunizations were performed subcutaneously with adjuvanted urease either in the infra or supra-diaphragmatic region of the body, while mucosal immunization was done with urease in the presence of E. coli heat Labile toxin. Mucosal and subcutaneous immunizations induced in infected mice a significant reduction in bacterial density whatever the site of injection but complete eradication was preferentially observed in mice immunized subcutaneously in the back. Systemic immunization with appropriate schedules and formulations could constitute a valuable approach to cure Helicobacter pylori infection.