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Sample records for beim polytrauma interdisziplinaeres

  1. Diagnostic radiology on multiple injured patients: interdisciplinary management; Radiologische Diagnostik beim Polytrauma: interdisziplinaeres Management

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    Linsenmaier, U.; Pfeifer, K.J. [Inst. fuer Radiologische Diagnostik, Klinikum der Univ. Muenchen (Germany); Kanz, K.G.; Mutschler, W. [Chirurgische Klinik Innenstadt, Klinikum der Univ. Muenchen, (Germany)

    2001-06-01

    The presence of a radiologist within the admitting area of an emergency department and his capability as a member of the trauma team have a major impact on the role of diagnostic radiology in trauma care. The knowledge of clinical decision criteria, algorithms, and standards of patient care are essential for the acceptance within a trauma team. We present an interdisciplinary management concept of diagnostic radiology for trauma patients, which comprises basic diagnosis, organ diagnosis, radiological ABC, and algorithms of early clinical care. It is the result of a prospective study comprising over 2000 documented multiple injured patients. The radiologist on a trauma team should support trauma surgery and anesthesia in diagnostic and clinical work-up. The radiological ABC provides a structured approach for diagnostic imaging in all steps of the early clinical care of the multiple injured patient. Radiological ABC requires a reevaluation in cases of equivocal findings or difficulties in the clinical course. Direct communication of radiological findings with the trauma team enables quick clinical decisions. In addition, the radiologist can priority-oriented influence the therapy by using interventional procedures. The clinical radiologist is an active member of the interdisciplinary trauma team, not only providing diagnostic imaging but also participating in clinical decisions. (orig.) [German] Die Anwesenheit des Radiologen im Schockraum und dessen Teamfaehigkeit bestimmen den Status der diagnostischen Radiologie in der Traumaversorgung. Voraussetzung zur Mitarbeit im interdisziplinaeren Traumateam ist die detaillierte Kenntnis der wesentlichen Entscheidungskriterien, Algorithmen und Behandlungsablaeufe. Das hier vorgestellte interdisziplinaere Managementkonzept der radiologischen Diagnostik beim Polytrauma mit Basisdiagnostik, Organdiagnostik, radiologischer ABC-Regel und Algorithmen zur fruehklinischen Behandlung beruht auf einer prospektiven Polytraumastudie mit

  2. Endovascular interventions for multiple trauma; Endovaskulaere Interventionen beim Polytrauma

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    Kinstner, C.; Funovics, M. [Klinik fuer Radiologie und Nuklearmedizin, Medizinische Universitaet Wien, Klinische Abteilung fuer Kardiovaskulaere und Interventionelle Radiologie, Wien (Austria)

    2014-09-15

    oder mittels Stent zu schienen. Speziell beim Polytrauma wird die Planung dieser Eingriffe wann immer moeglich nach einem praeinterventionellen Multidetektor-CT durchgefuehrt. Der Einsatz der endovaskulaeren Intervention ermoeglicht neben einer Verringerung des operativen Traumas auch eine wesentliche Verkuerzung der Behandlungszeit. Beim vaskulaeren Trauma am Stamm oder an den Extremitaeten, wo ein operativer Zugang nur unter erhoehtem Risiko durchfuehrbar erscheint, aber auch beim pelvinen Trauma und bei arteriellen Verletzungen parenchymatoeser Organe, die nicht gaenzlich geopfert werden sollen, sowie in anderen schwer zugaenglichen Regionen wie der oberen Thoraxapertur, ist die interventionelle Versorgung mittlerweile Standardmethode geworden. Heute kann die interventionelle Radiologie in praktisch allen vaskulaeren Territorien in einem interdisziplinaeren Zugang neben der offenen chirurgischen Versorgung dazu beitragen, eine schnellere Stabilisierung der Situation herbeizufuehren. (orig.)

  3. Cross-disciplinary management of polytrauma patients: radiological screening and comparison; Interdisziplinaeres Management von polytraumatisierten Patienten: Beitrag der Radiologie

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    Messmer, P. [Universitaetskliniken Basel, Dept. Chirurgie, Allgemeinchirurgische Klinik, Abt. Traumatologie (Switzerland); Loew, R.; Jacob, A.L. [Universitaetskliniken Basel, Dept. Medizinische Radiologie, Abt. Diagnostische Radiologie (Switzerland)

    2001-09-01

    The comprehensive survey addresses the various modalities available today for trauma screening and presents a comparative assessment of their value in respect of type of trauma and evidence provided. (orig./CB) [German] Die Versorgung polytraumatischer Patienten stellt hoechste Anforderungen an das Koennen des Radiologen. Neben einer schnellen und schonenden Durchfuehrung der notwendigen Diagnostik darf keine potenziell lebensbedrohende Verletzung uebersehen werden. Die Kriterien fuer eine rationelle Diagnostik wurden im ATLS-Kurs (Advanced Trauma Life Support) zusammengefasst. Es gilt, die sog. 'golden hour' moeglichst effektiv fuer die Primaerdiagnostik und -therapie zu nutzen. Haeufige Verletzungsformen beim Polytrauma sind das Schaedel-Hirn-Trauma, Thoraxverletzungen, Milzverletzungen, Leberverletzungen und Frakturen von Becken, Wirbelsaeule und Extremitaeten. Die Primaere und Sekundaere Radiologische Diagnostik ist abhaengig von der Ausstattung der Klinik und besteht aus einer abdominellen Sonographie, Thorax ap, Beckenuebersicht ap, Halswirbelsaeule seitlich sowie falls vorhanden aus CT und Angiographie. Ein definitiver Schritt zur Verkuerzung der Zeit bis zur Behandlung waeren sterile OP-Einheiten mit integrierter Roentgendiagnostik (moeglichst nativ und CT), die ein staendiges Umlagern und Transportieren des Patienten verhindern koennten. (orig.)

  4. Whole-body MSCT of patients after polytrauma: abdominal injuries; Ganzkoerper-MSCT beim Polytrauma: Abdominelle Verletzungen

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    Roehrl, B.; Sadick, M.; Diehl, S.; Dueber, C. [Universitaetsklinikum Mannheim, Inst. fuer Klinische Radiologie (Germany); Obertacke, U. [Universitaetsklinikum Mannheim, Zentrum fuer Orthopaedie und Traumatologie (Germany)

    2005-12-15

    Purpose: The goal of this retrospective study was to evaluate the spectrum of abdominal injuries and the reliability of computed tomography-based diagnosis in patients after polytrauma. Material and methods: CT findings and clinical reports for 177 patients after polytrauma were evaluated with regard to abdominal injuries. Clinical patient reports at the time of discharge from the hospital were utilized as the standard of reference. Abdominal injuries resulting from an accident, frequent additional traumas and following therapeutic procedures were recorded. In the case of discrepancies in the reports, the CT scans were viewed retrospectively. Results: In 30 out of 177 patients, 42 abdominal injuries were detected. 69% of the injuries were caused by traffic accidents while 31% resulted from falls. Liver and spleen injuries were the most common. 50% of the cases were treated surgically, and the other half of the cases underwent non-surgical conservative therapy. Massive chest traumas, pelvic injuries, cerebral traumas and injuries to extremities were commonly associated with abdominal injuries. Evaluation of the discrepancies in the clinical reports showed that injury to the pancreas and the small intestine were not successfully detected on CT, thus resulting in a false negative diagnosis. Early stages of organ parenchyma laceration were also initially misdiagnosed on CT. (orig.)

  5. Structured diagnostic imaging in patients with multiple trauma; Strukturierte radiologische Diagnostik beim Polytrauma

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    Linsenmaier, U.; Rieger, J.; Rock, C.; Pfeifer, K.J.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum der Universitaet Muenchen, Innenstadt (Germany); Kanz, K.G. [Chirurgische Klinik, Klinikum der Universitaet Muenchen, Innenstadt (Germany)

    2002-07-01

    Purpose. Development of a concept for structured diagnostic imaging in patients with multiple trauma.Material and methods. Evaluation of data from a prospective trial with over 2400 documented patients with multiple trauma. All diagnostic and therapeutic steps, primary and secondary death and the 90 days lethality were documented.Structured diagnostic imaging of multiple injured patients requires the integration of an experienced radiologist in an interdisciplinary trauma team consisting of anesthesia, radiology and trauma surgery. Radiology itself deserves standardized concepts for equipment, personnel and logistics to perform diagnostic imaging for a 24-h-coverage with constant quality.Results. This paper describes criteria for initiation of a shock room or emergency room treatment, strategies for documentation and interdisciplinary algorithms for the early clinical care coordinating diagnostic imaging and therapeutic procedures following standardized guidelines. Diagnostic imaging consists of basic diagnosis, radiological ABC-rule, radiological follow-up and structured organ diagnosis using CT. Radiological trauma scoring allows improved quality control of diagnosis and therapy of multiple injured patients.Conclusion. Structured diagnostic imaging of multiple injured patients leads to a standardization of diagnosis and therapy and ensures constant process quality. (orig.) [German] Fragestellung. Entwicklung eines strukturierten Konzeptes zur radiologischen Diagnostik polytraumatisierter Patienten.Methodik. Die Datenevaluation erfolgte auf Basis einer prospektiven interdisziplinaere Polytraumastudie mit ueber 2400 Patienten. Alle diagnostischen und therapeutischen Schritte werden jeweils unter Angabe von Zeitpunkt und auftretenden Komplikationen erfasst, ein primaeres oder sekundaeres Versterben und die 90-Tage-Letalitaet werden dokumentiert.Die strukturierte radiologische Diagnostik von Mehrfachverletzen verlangt die Integration eines erfahrenen Radiologen in

  6. Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT; Radiologische Bildgebung beim Polytrauma: Dosisvergleich von Ganzkoerper-MSCT und konventionellem Roentgen mit organspezifischer CT

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    Wedegaertner, U.; Lorenzen, M.; Weber, C.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Nagel, H.D. [Philips Medizin Systeme GmbH, Hamburg (Germany)

    2004-07-01

    Purpose: To compare the radiation dose of whole-body multislice CT (MSCT) and conventional radiography with organ-specific CT in polytrauma. Materials and Methods: The whole-body MSCT encompassing brain, neck and midface, chest, abdomen and pelvis was performed on a Somatom Volume Zoom (Siemens). Conventional radiography consisted of chest and cervical, thoracic and lumbar spine in two views as well as pelvis. Polymat, Siemens. Three combinations of organ specific CT were chosen: CT examination of (1) head and cervical spine, (2) head, cervical spine and chest, (3) head, cervical spine and abdomen. The effective doses of whole-body MSCT and conventional radiography with organ-specific CT were calculated. Results: Effective doses were 20 mSv for whole-body MSCT, 2 mSv for conventional x-ray, and 5 mSv for combination (1), 8 mSv for combination (2) and (3) 16 mSv for combination (3) of the organ-specific CT. The ratio of radiation dose between whole-body MSCT and radiography was 10: 1. This ratio was reduced to 3: 1, 2: 1 and 1: 1 when a combination of radiography and CT was performed. Conclusions: Whole-body MSCT in polytrauma compared to conventional radiography with organ-specific CT induces a threefold increased dose in unfavorable situations and no increased dose in favorable situations. Nevertheless, routine use of whole-body MSCT should be critically evaluated and should be adapted to the clinical benefit. (orig.) [German] Ziel: Dosisvergleich von Ganzkoerper-MSCT und konventioneller Basisdiagnostik mit organspezifischen Ct-Untersuchungen beim Polytrauma. Material und Methoden: Die Ganzkoerper-MSCT-Untersuchung von Schaedel, Mittelgesicht, HWS sowie Thorax, Abdomen und Becken erfolgte an einem Somatom-Volume-Zoom (Siemens). Die konventionelle Bildgebung, bestehend aus Thorax, Becken, HWS, BWS und LWs, wurde an einem Siemens-Polymat durchgefuehrt. Fuer die organspezifischen CT-Untersuchungen wurden 3 Kombinationen ausgewaehlt: (1) CCT + HWS, (2) CCT + HWS

  7. Interdisciplinary consensus on diagnosis and treatment of testicular germ cell tumors. Results of an update conference based on evidence-based medicine (EBM); Interdisziplinaerer Konsensus zur Diagnostik und Therapie von Hodentumoren. Ergebnisse einer Update-Konferenz auf Grundlage evidenzbasierter Medizin (EBM)

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    Souchon, R. [Deutsche Gesellschaft fuer Radioonkologie (DEGRO) (Germany); Arbeitsgemeinschaft Radiologische Onkologie (ARO), Strahlenklinik AKH Hagen (Germany); Krege, S. [Deutsche Gesellschaft fuer Urologie (DGU) (Germany); Essen Univ. (Gesamthochschule) (Germany). Klinik und Poliklinik fuer Urologie; Schmoll, H.J. [Arbeitsgemeinschaft Internistische Onkologie (AIO), Zentrum fuer innere Medizin IV der Martin-Luther-Univ. Halle-Wittenberg (Germany); Albers, P. [Bonn Univ. (Germany). Urologische Klinik; Beyer, J. [Marburg Univ. (Germany). Medizinisches Zentrum fuer Innere Medizin; Bokemeyer, C. [Tuebingen Univ. (Germany). Abt. fuer Innere Medizin 2; Classen, J. [Tuebingen Univ. (Germany). Medizinisches Strahleninstitut und Roentgenabteilung; Dieckmann, K.P. [Albertinen-Krankenhaus, Hamburg (Germany). Urologische Abt.; Hartmann, M. [Bundeswehrkrankenhaus, Hamburg (Germany). Urologische Abt.; Heidenreich, A. [Marburg Univ. (Germany). Urologische Klinik; Hoeltl, W. [Kaiser-Franz-Josef-Spital Wien (Austria). Urologische Klinik; Kliesch, S. [Muenster Univ. (Germany). Klinik fuer Urologie; Koehrmann, K.U. [Urologische Klinik des Klinikums der Stadt Mannheim (Germany); Kuczyk, M. [Medizinische Hochschule Hannover (Germany). Klinik fuer Urologie; Schmidberger, H. [Goettingen Univ. (Germany). Klinik fuer Strahlentherapie und Radioonkologie; Weinknecht, S. [Krankenhaus am Urban Berlin (Germany). Urologische Abt.; Winter, E. [Klinikum Schwerin (Germany). Urologische Klinik; Wittekind, C. [Leipzig Univ. (Germany). Inst. fuer Pathologie; Bamberg, M. [Tuebingen Univ. (Germany). Abt. fuer Strahlentherapie

    2000-09-01

    An 'Interdisciplinary Update Consensus Statement' summarizes and defines the diagnostic and therapeutic standards according to the current scientific practices in testicular cancer. For 21 separate areas scientifically based decision criteria are suggested. For treatment areas where more than one option exist without a consensus being reached for a preferred strategy, such as in seminoma in clinical Stage I or in non-seminoma Stages CS I or CS IIA/B, all acceptable alternative strategies with their respecitve advantages and disadvantages are presented. This 'Interdisciplinary Update Consensus' was presented at the 24th National Congress of the German Cancer Society on March 21st and subsequently evaluated and approved by the various German scientific medical societies. (orig.) [German] Der zu 21 Themenkomplexen anhand wissenschaftlich begruendeter Entscheidungskriterien erarbeitete 'Interdisziplinaere Update-Konsensus' praezisiert und definiert diagnostische und therapeutische Standards entsprechend dem aktuellen Wissensstand ueber die Tumorentitaet. Fuer Therapiesituationen, bei denen mehrere Optionen bestehen und kein Konsens ueber die favorisierte Strategie erzielt wurde wie beim Seminom im klinischen Stadium I oder beim Nichtseminom in den Stadien CS I bzw. CS IIA/B, wurden jeweilige Alternativen mit deren Vor- und Nachteilen dargestellt. Der 'Interdisziplinaere Update-Konsensus' wurde beim 24. Deutschen Krebskongress am 21.3.2000 vorgestellt, nachfolgend von den daran beteiligten wissenschaftlichen Fachgesellschaften geprueft und gebilligt. (orig.)

  8. Abdominal polytrauma and parenchymal organs; Abdominelles Polytrauma und Parenchymorgane

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    Krestan, C.R. [Medizinische Universitaet Wien AKH, Abteilung fuer Allgemeine Radiologie und Kinderradiologie, Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

    2014-09-15

    The acute radiological diagnostics of polytrauma patients has become an essential part of the interdisciplinary treatment in the emergency room. The incidence of polytrauma patients with an injury severity score (ISS) > 16 is approximately 450 cases/million inhabitants/year in Europe. Injuries of the parenchymal organs are of utmost importance for the prognosis and treatment of these patients. The injury patterns are complex and a great deal of experience is necessary to be able to obtain the correct diagnosis within minutes. This review article deals with the radiological diagnostics and grading of the severity of injuries to the spleen, liver, pancreas and kidneys. The use of ultrasound for the evaluation of polytraumatized patients will be discussed. The most important trauma-associated findings for the above mentioned organs using multidetector computed tomography (MDCT) will be described and illustrated by dedicated case findings. Ultrasound contrast agents can supply valuable, additional diagnostic information in the evaluation of polytraumatized patients. Computed tomography has become established as the most relevant imaging modality in severe trauma. Innovative organ-adapted and contrast application protocols improve the diagnostic performance of MDCT. The use of focused assessment sonography for trauma (FAST) scanning as a screening tool is in agreement with the other clinical disciplines of the trauma team. The use of MDCT is trauma-dependent and the classification of the severity of the different parenchymal organ injuries is ultimately decisive for further treatment and prognosis of trauma victims. (orig.) [German] Die akute radiologische Diagnostik bei Polytraumapatienten ist in den letzten Jahren unerlaesslicher Bestandteil der interdisziplinaeren Versorgung im Schockraum geworden. Die Inzidenz von Polytraumata mit einem Injury Severity Score (ISS) > 16 betraegt in Europa ca. 450/Mio. Einwohner/Jahr. Verletzungen abdomineller Parenchymorgane sind von

  9. Interdisciplinary shock-room care: tasks for the radiologist from the viewpoint of the trauma surgeon; Interdisziplinaere Schockraumversorgung: Die Aufgaben der Radiologie aus unfallchirurgischer Sicht

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    Mutschler, W.; Kanz, K.G. [Chirurgische Klinik und Poliklinik, Klinikum Innenstadt der Universitaet Muenchen (Germany)

    2002-07-01

    Efficient resuscitation of major trauma requests an interdisciplinary communication between trauma surgeons, anaesthesiologists and radiologists. Trauma outcome is significantly influenced by horizontal trauma team organisation and coherence to clinical algorithms, which allow fast diagnosis and intervention. A radiologist present on patients arrival in the trauma room provides a major impact on trauma care. Nevertheless optimal integration in the trauma team implies profound knowledge of the priorities of advanced trauma life support and trauma algorithms. His or her involvement is not limited to patient care only, also active participation in trauma room design, interdisciplinary algorithm development and trauma research are essential tasks for radiologists devoted to emergency radiology. Based on the pathophysiology of polytrauma and the structure of German trauma system, current concepts and proven clinical algorithms with special regard to the radiologist and his duties and tasks will are presented. (orig.) [German] Modernes Schockraummanagement mit dem Auftrag der zeitoptimierten Vernetzung diagnostischer und therapeutischer Handlungsablaeufe erfordert eine direkte Einbindung der Radiologie in das Schockraumteam im Sinne einer horizontalen Kommunikation zwischen Unfallchirurgie, Radiologie und Anaesthesie. Direkte Einbindung bedeutet dabei Einflussnahme auf Struktur- und Prozessqualitaet, Qualitaetsmanagement und interdisziplinaere Weiterentwicklung von Schockraumalgorithmen. Ausgehend von der Pathophysiologie des Polytraumas und der an Zeitgewinn orientierten Versorgungskette werden aktuelle diagnostische und therapeutische Algorithmen dargestellt und daraus die Aufgaben und Bedeutung der Radiologie im Schockraum abgeleitet. (orig.)

  10. The Management of Pediatric Polytrauma: Review

    NARCIS (Netherlands)

    H. Mevius; M. van Dijk (Monique); A. Numanoglu (Alp); A.B. van As (Àrjan Bastiaan)

    2014-01-01

    textabstractPolytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was con- ducted

  11. PAIN RELIEF IN POLYTRAUMA PATIENTS

    Directory of Open Access Journals (Sweden)

    M. C. Rajesh

    2016-09-01

    Full Text Available BACKGROUND Pain management in Polytrauma is a poorly-addressed concern at the time of active resuscitation. But, very often, pain assessment is also a challenge! Opioids belong to conventional analgesics of choice in any acute pain conditions. But, recently application of regional anaesthesia techniques and subanaesthetic doses of ketamine are satisfactorily employed. A clear understanding of neuropathic element of pain must be made as they require specific therapy. It must be emphasised that effective pain therapy is a multidisciplinary team work with active involvement of pain psychologist.

  12. Abdominal polytrauma and parenchymal organs

    International Nuclear Information System (INIS)

    Krestan, C.R.

    2014-01-01

    The acute radiological diagnostics of polytrauma patients has become an essential part of the interdisciplinary treatment in the emergency room. The incidence of polytrauma patients with an injury severity score (ISS) > 16 is approximately 450 cases/million inhabitants/year in Europe. Injuries of the parenchymal organs are of utmost importance for the prognosis and treatment of these patients. The injury patterns are complex and a great deal of experience is necessary to be able to obtain the correct diagnosis within minutes. This review article deals with the radiological diagnostics and grading of the severity of injuries to the spleen, liver, pancreas and kidneys. The use of ultrasound for the evaluation of polytraumatized patients will be discussed. The most important trauma-associated findings for the above mentioned organs using multidetector computed tomography (MDCT) will be described and illustrated by dedicated case findings. Ultrasound contrast agents can supply valuable, additional diagnostic information in the evaluation of polytraumatized patients. Computed tomography has become established as the most relevant imaging modality in severe trauma. Innovative organ-adapted and contrast application protocols improve the diagnostic performance of MDCT. The use of focused assessment sonography for trauma (FAST) scanning as a screening tool is in agreement with the other clinical disciplines of the trauma team. The use of MDCT is trauma-dependent and the classification of the severity of the different parenchymal organ injuries is ultimately decisive for further treatment and prognosis of trauma victims. (orig.) [de

  13. Gait Disorders In Patients After Polytrauma

    Directory of Open Access Journals (Sweden)

    Jakušonoka Ruta

    2015-04-01

    Full Text Available Evaluation of the gait of patients after polytrauma is important, as it indicates the ability of patients to the previous activities and work. The aim of our study was to evaluate the gait of patients with lower limb injuries in the medium-term after polytrauma. Three-dimensional instrumental gait analysis was performed in 26 polytrauma patients (16 women and 10 men; mean age 38.6 years, 14 to 41 months after the trauma. Spatio-temporal parameters, motions in pelvis and lower extremities joints in sagittal plane and vertical load ground reaction force were analysed. Gait parameters in polytrauma patients were compared with a healthy control group. Polytrauma patients in the injured side had decreased step length, cadence, hip extension, maximum knee flexion, vertical load ground reaction force, and increased stance time and pelvic anterior tilt; in the uninjured side they had decreased step length, cadence, maximum knee flexion, vertical load ground reaction force and increased stance time (p < 0.05. The use of the three-dimensional instrumental gait analysis in the evaluation of polytrauma patients with lower limb injuries consequences makes it possible to identify the gait disorders not only in the injured, but also in the uninjured side.

  14. Assessment of validity with polytrauma Veteran populations.

    Science.gov (United States)

    Bush, Shane S; Bass, Carmela

    2015-01-01

    Veterans with polytrauma have suffered injuries to multiple body parts and organs systems, including the brain. The injuries can generate a triad of physical, neurologic/cognitive, and emotional symptoms. Accurate diagnosis is essential for the treatment of these conditions and for fair allocation of benefits. To accurately diagnose polytrauma disorders and their related problems, clinicians take into account the validity of reported history and symptoms, as well as clinical presentations. The purpose of this article is to describe the assessment of validity with polytrauma Veteran populations. Review of scholarly and other relevant literature and clinical experience are utilized. A multimethod approach to validity assessment that includes objective, standardized measures increases the confidence that can be placed in the accuracy of self-reported symptoms and physical, cognitive, and emotional test results. Due to the multivariate nature of polytrauma and the multiple disciplines that play a role in diagnosis and treatment, an ideal model of validity assessment with polytrauma Veteran populations utilizes neurocognitive, neurological, neuropsychiatric, and behavioral measures of validity. An overview of these validity assessment approaches as applied to polytrauma Veteran populations is presented. Veterans, the VA, and society are best served when accurate diagnoses are made.

  15. Clinical treatment strategies and experimental studies in polytrauma

    NARCIS (Netherlands)

    van Wessem, K.J.P.

    2013-01-01

    This thesis describes the clinical treatment of polytrauma patients and the underlying pathophysiological mechanisms causing injury-induced inflammatory response. Even though the treatment of polytrauma patients has improved over the years, trauma is still the leading cause of death

  16. [Clinico-roentgenological semiotics of the chest damage in polytrauma].

    Science.gov (United States)

    Zamiatin, P N; Panchenko, E V; Grigor'ian, G O; Goloshchapova, E V

    2006-10-01

    There are presented the main clinico-roentgenological signs of the chest damage in the injured persons, suffering polytrauma, according to the data from the specialized department of traumatic shock and polytrauma.

  17. Rheumatische Erkrankungen beim älteren Patienten

    Directory of Open Access Journals (Sweden)

    Köller M

    2008-01-01

    Full Text Available Muskuloskeletale Erkrankungen stellen beim älteren Menschen die häufigste Ursache für Aktivitätseinschränkungen dar. Die Prävalenz der Osteoarthrose (OA steigt mit dem Lebensalter sprunghaft an. Nach den Allgemeinmaßnahmen ist bei der medikamentösen Therapie der OA Paracetamol der Vorzug zu geben. Die rheumatoide Arthritis (RA als häufigste entzündliche Gelenkerkrankung des Erwachsenenalters zeigt im Alter oft atypische Verlaufsformen und ist unter Umständen von der Polymyalgia rheumatica schwer abzugrenzen. Jedenfalls erscheint die RA beim älteren Patienten oft nicht adäquat behandelt. Auch hier sind konventionelle Therapien wie Methotrexat Mittel der Wahl und Biologika erscheinen ebenso sicher bei älteren Patienten. Das Infektrisiko wird vorwiegend durch die begleitende Kortikosteroid-Dosis bestimmt. Die Polymyalgia rheumatica betrifft in 90 % der Fälle Patienten älter als 60 Jahre. Kortikosteroide sind hier nach wie vor die wichtigste Therapie, welche meist über ein bis zwei Jahre erforderlich ist. Eine Riesenzellarteriitis muss bei Patienten mit PMR immer ausgeschlossen werden. Bei Vorliegen dieser Vaskulitis muss im Falle einer Mitbeteiligung der Augengefäße möglichst rasch eine hoch dosierte Steroidgabe erfolgen. Die Biopsie der Schläfenarterie kann auch einige Zeit nach Therapiebeginn erfolgen, ohne dass die diagnostische Aussagekraft darunter leidet.

  18. Variable Saline Concentrations for Initial Resuscitation Following Polytrauma

    Science.gov (United States)

    2017-02-22

    AFRL-SA-WP-TR-2017-0008 Variable Saline Concentrations for Initial Resuscitation Following Polytrauma Dr. Michael Goodman...Following Polytrauma 5a. CONTRACT NUMBER FA8650-10-2-6140 5b. GRANT NUMBER FA8650-14-2-6B29 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Dr. Michael...established. We investigated the utility of standard variable saline concentrations (0.9%, 3%, 23.4%) in a murine polytrauma model of traumatic brain injury

  19. Color coded duplex sonography. Interdisciplinary vascular ultrasonography; Farbkodierte Duplexsonographie. Interdisziplinaerer vaskulaerer Ultraschall

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    Kubale, R. [Institut fuer Radiologie, Sonographie und Nuklearmedizin, Pirmasens (Germany); Stiegler, H. [Staedtisches Krankenhaus Schwabing, Muenchen (Germany). 7. Medizinische Abt.

    2002-07-01

    An interdisciplinary team of experts impart the state of the art in color coded duplex sonography applied for examination of all anatomic areas. Detailed information is given for every vascular area, describing the examination procedure, possible origins of mistakes or faults, and means to avoid them. In addition to the classical applications, eg. for examination of the extra- and intracranial vessels, vessels of the limbs, visceral vessels and the vessels of liver and kidney, there are chapters devoted to: haemodialysis shunts, arteriovenous malformations, duplex sonography of the penis, tumor vascularisation. (orig./CB) [German] Ein interdisziplinaeres Autorenteam vermittelt Ihnen den State of the Art der FKDS fuer alle anatomischen Regionen. Fuer jede der Gefaessregionen werden detaillierte Angaben zum Untersuchungsablauf, zu moeglichen Fehlerquellen und zu deren Vermeidung geboten. Neben den klassischen Anwendungen bei der Untersuchung - der extra- und intrakraniellen Gefaesse, - der Extremitaetengefaesse, - der viszeralen Gefaesse sowie der Gefaesse von Niere und Leber finden Sie Kapitel zu den Themen: Haemodialyseshunt, arteriovenoese Malformationen, Duplexsonographie des Penis und Tumorvaskularisation. (orig./AJ)

  20. Pediatric polytrauma : Short-term and long-term outcomes

    NARCIS (Netherlands)

    vanderSluis, CK; Kingma, J; Eisma, WH; tenDuis, HJ

    Objective: To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. Materials and Methods: Ail pediatric polytrauma patients (Injury Severity Score of greater than or equal to 16, less than

  1. Tertiary survey in polytrauma patients should be an ongoing process

    NARCIS (Netherlands)

    Ferree, Steven; Houwert, Roderick M.; van Laarhoven, Jacqueline J E M; Smeeing, Diederik; Leenen, Luke P H; Hietbrink, Falco

    INTRODUCTION: Due to prioritisation in the initial trauma care, non-life threatening injuries can be overlooked or temporally neglected. Polytrauma patients in particular might be at risk for delayed diagnosed injuries (DDI). Studies that solely focus on DDI in polytrauma patients are not available.

  2. Oxidative Distress in Patients with Polytrauma

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    M. Sh. Khubutia

    2014-01-01

    Full Text Available Polytrauma is a serious threat to human life not only due to its direct damage to vital organs, but also to the development of significant oxidative distress that gives rise to multiple organ dysfunction. At the same time, the risk of lifethreatening infectious complications increases.Objective: to study oxidative distress over time and its association with early pulmonary infectious complications in patients with polytrauma.Subjects and methods. The authors examined 35 patients with polytrauma in the first 6—12 and 12—24 hours and 3, 5—7, and 10 days after injury and 25 healthy volunteers. Having regard to the development of pulmonary infectious complications, they formed two comparison groups of patients: 1 15 patients without pneumonia and 2 20 patients with pneumonia. The investigation used the antioxidant  index  (AOI  considering  the  activity  of  erythrocyte  enzymes  (superoxide  dismutase,  catalase,  glutathione peroxidase, and glutathione reductase and the degree of lipid peroxidation in the plasma (dienic conjugates and malonic dialdehyde to estimate the balance between oxidative lesions and the performance of the body's antioxidant systems.Results. In both groups, the AOI reflects the oxidative stress state, as substantiated by negative values for the AOI with its normal value equal to zero. However, with the virtually parallel nature of AOI changes after injury in the patients with pneumonia, the values of the index were significantly lower than in those without complications within the first 6—12 and 12—24 hours and 5—7 days (p<0.05.Conclusion. This investigation has indicated that the AOI is an early candidate biomarker for the risk of infectious complications and its values are of prognostic value just within the first hours after injury.

  3. The structure and feature of polytrauma in children of Barnaul

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    V. V. Timofeev

    2013-01-01

    Full Text Available Analysis of fatal polytrauma in children in Barnaul over the period of 11 years, study of medical records of polytrauma patients brought in to hospital and medicolegal autopsy data from the cases of fatal polytrauma in children. 685 cases of child polytrauma were registered from the year 2001 to 2011 including 88 cases of fatal polytrauma. 68 children died before admission, 20 patients hospitalized resulted in death. Most fatal cases resulted from motor vehicle incidents (61 / 69,3%, falling from a height (20 / 22,7%, criminal injuries (3 / 3,4%, home accidents (2 / 2,3%, and street injuries (2 / 2,3%. The highest lethality rate related to cases of falling from a height (18,2%, motor vehicle incidents (13,6%, criminal and street injuries (10%. The lethality rate of child polytrauma in urban area amounted to 12,8%, death rate - 7,1 per 100 000 population per year. The highest lethality rate was noted among infants (27,7% and adolescents (16,7%. Most fatal cases resulted from motor vehicle incidents (61 / 69,3%. The highest increase of mortality rate in polytrauma is observed during summer season. Major causes of death are shock and substantial blood loss.

  4. Outcomes of polytrauma patients with diabetes mellitus

    Science.gov (United States)

    2014-01-01

    Background The impact of diabetes mellitus in patients with multiple system injuries remains obscure. This study was designed to increase knowledge of outcomes of polytrauma in patients who have diabetes mellitus. Methods Data from the Trauma Audit and Research Network was used to identify patients who had suffered polytrauma during 2003 to 2011. These patients were filtered to those with known outcomes, then separated into those with diabetes, those known to have other co-morbidities but not diabetes and those known not to have any co-morbidities or diabetes. The data were analyzed to establish if patients with diabetes had differing outcomes associated with their diabetes versus the other groups. Results In total, 222 patients had diabetes, 2,558 had no past medical co-morbidities (PMC), 2,709 had PMC but no diabetes. The diabetic group of patients was found to be older than the other groups (P <0.05). A higher mortality rate was found in the diabetic group compared to the non-PMC group (32.4% versus 12.9%), P <0.05). Rates of many complications including renal failure, myocardial infarction, acute respiratory distress syndrome, pulmonary embolism and deep vein thrombosis were all found to be higher in the diabetic group. Conclusions Close monitoring of diabetic patients may result in improved outcomes. Tighter glycemic control and earlier intervention for complications may reduce mortality and morbidity. PMID:25026864

  5. Tertiary survey in polytrauma patients should be an ongoing process.

    Science.gov (United States)

    Ferree, Steven; Houwert, Roderick M; van Laarhoven, Jacqueline J E M; Smeeing, Diederik P J; Leenen, Luke P H; Hietbrink, Falco

    2016-04-01

    Due to prioritisation in the initial trauma care, non-life threatening injuries can be overlooked or temporally neglected. Polytrauma patients in particular might be at risk for delayed diagnosed injuries (DDI). Studies that solely focus on DDI in polytrauma patients are not available. Therefore the aim of this study was to analyze DDI and determine risk factors associated with DDI in polytrauma patients. In this single centre retrospective cohort study, patients were considered polytrauma when the Injury Severity Score was ≥ 16 as a result of injury in at least 2 body regions. Adult polytrauma patients admitted from 2007 until 2012 were identified. Hospital charts were reviewed to identify DDI. 1416 polytrauma patients were analyzed of which 12% had DDI. Most DDI were found during initial hospital admission after tertiary survey (63%). Extremities were the most affected regions for all types of DDI (78%) with the highest intervention rate (35%). Most prevalent DDI were fractures of the hand (54%) and foot (38%). In 2% of all patients a DDI was found after discharge, consisting mainly of injuries other than a fracture. High energy trauma mechanism (OR 1.8, 95% CI 1.2-2.7), abdominal injury (OR 1.5, 95% CI 1.1-2.1) and extremity injuries found during initial assessment (OR 2.3, 95% CI 1.6-3.3) were independent risk factors for DDI. In polytrauma patients, most DDI were found during hospital admission but after tertiary survey. This demonstrates that the tertiary survey should be an ongoing process and thus repeated daily in polytrauma patients. Most frequent DDI were extremity injuries, especially injuries of the hand and foot. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. The geriatric polytrauma: Risk profile and prognostic factors.

    Science.gov (United States)

    Rupprecht, Holger; Heppner, Hans Jürgen; Wohlfart, Kristina; Türkoglu, Alp

    2017-03-01

    In the German population, the percentage of elderly patients is increasing, and consequently there are more elderly patients among trauma cases, and particularly cases of polytrauma. The aim of this study was to present clinical results and a risk profile for geriatric polytrauma patients. Review of 140 geriatric (over 65 years of age) polytrauma patients who received prehospital treatment was performed. Severity of trauma was retrospectively assessed with Hannover Polytrauma Score (HPTS). Age, hemoglobin (Hb) level, systolic blood pressure (BP), Glasgow Coma Scale (GCS) score, timing of and necessity for intubation were analyzed in relation to mortality and in comparison with younger patients. Geriatric polytrauma patients (n=140) had overall mortality rate of 65%, whereas younger patients (n=1468) had mortality rate of 15.9%. Despite equivalent severity of injury (HPTS less age points) in geriatric and non-geriatric groups, mortality rate was 4 times higher in geriatric group. Major blood loss with Hb polytrauma patients. Additional risk factors include very low GCS score and systolic BP <80 mm Hg, for instance, as potential clinical indicators of massive bleeding and traumatic brain injury. Such parameters demand early and rapid treatment at prehospital stage and on admission.

  7. Bladder injuries frequently missed in polytrauma patients

    Directory of Open Access Journals (Sweden)

    Tanweer Karim

    2010-05-01

    Full Text Available Tanweer Karim, Margaret Topno, Vinod Sharma, Raymond Picardo, Ankur HastirSurgery, MGM Medical College, Kamothe, Navi Mumbai, IndiaAbstract: Bladder injuries are very common in patients who have had road traffic accidents. The method of diagnosis and management of such injuries is well established and accepted. However, trauma to the bladder can be associated with other life-threatening injuries which are frequently missed, and often diagnosed during laparotomy for other reasons. The aim of this study was to diagnose bladder injury in polytrauma patients as early as possible, taking into consideration the fact that these patients are hemodynamically unstable and require rapid evaluation and management. In order to achieve our objective, we used bedside sonography with retrograde instillation of normal saline to diagnose bladder injury in addition to use of the conventional retrograde cystogram.Keywords: bladder injury, bladder rupture, retrograde cystogram

  8. Interdisciplinary stratification of patients with myoma-related symptoms; Interdisziplinaere Stratifizierung von Patientinnen mit myombedingten Beschwerden

    Energy Technology Data Exchange (ETDEWEB)

    David, M. [Campus Virchow-Klinikum, Charite - Universitaetsmedizin Berlin, Klinik fuer Frauenheilkunde und Geburtshilfe, Berlin (Germany)

    2008-07-15

    With the establishment of uterine artery embolization (UAE), the individualization of treatment of the symptomatic myomatous uterus showed a general progression. The concrete therapy decision is made in an interactive process between doctor and patient. A series of factors influence the choice of a suitable, operative or non-operative, therapeutic procedure. In the weighting of therapeutic options between surgery or UAE, in addition to current results of studies which compare both techniques,recommendations made by expert committees and guidelines are helpful for a competent counseling of patients and additionally supportive in decision processes such as interdisciplinary stratification. (orig.) [German] Mit der Etablierung der Uterusarterienembolisation (UAE) wurde die Individualisierung der Behandlung beim symptomatischen Uterus myomatosus insgesamt weiter vorangetrieben. Die Therapieentscheidung wird individuell in einem interaktiven Prozess zwischen Arzt und Patientin getroffen. Eine Reihe von Faktoren beeinflusst die Auswahl eines geeigneten - operativen oder nichtoperativen - Therapieverfahrens. Bei der Abwaegung der Therapieoptionen Operation vs. UAE sind neben aktuellen Ergebnisse von Studien, die beide Verfahren vergleichen, fuer eine kompetente Beratung der Patientinnen Empfehlungen von Expertengremien bzw. Leitlinien hilfreich und in Entscheidungsprozessen wie der interdisziplinaeren Stratifizierung zusaetzlich unterstuetzend. (orig.)

  9. A rat model of concurrent combined injuries (polytrauma)

    Science.gov (United States)

    Akscyn, Robert M; Franklin, J Lee; Gavrikova, Tatyana A; Schwacha, Martin G; Messina, Joseph L

    2015-01-01

    Polytrauma, a combination of injuries to more than one body part or organ system, is common in modern warfare and in automobile and industrial accidents. The combination of injuries can include burn injury, fracture, hemorrhage, trauma to the extremities, and trauma to specific organ systems. To investigate the effects of combined injuries, we have developed a new and highly reproducible model of polytrauma. This model combines burn injury with soft tissue and gastrointestinal (GI) tract trauma. Male Sprague Dawley rats were subjected to a 15-20% total body surface area scald burn, or a single puncture of the cecum with a G30 needle, or the combination of both injuries (polytrauma). Unlike many ‘double hit’ models, the injuries in our model were performed simultaneously. We asked whether multiple minor injuries, when combined, would result in a distinct phenotype, different from single minor injuries or a more severe single injury. There were differences between the single injuries and polytrauma in the maintenance of blood glucose, body temperature, body weight, hepatic mRNA and circulating levels of TNF-α, IL-1β and IL-6, and hepatic ER-stress. It has been suggested that models utilizing combinatorial injuries may be needed to more accurately model the human condition. We believe our model is ideal for studying the complex sequelae of polytrauma, which differs from single injuries. Insights gained from this model may suggest better treatment options to improve patient outcomes. PMID:26884923

  10. Clinical diagnosis versus autopsy findings in polytrauma fatalities

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    Fakler Johannes K

    2010-10-01

    Full Text Available Abstract Objectives The aim of the study was to determine if differences in clinical diagnosis versus autopsy findings concerning the cause of death in polytrauma fatalities would be detected in 19 cases of fatal polytrauma from a Level 1 trauma centre. Methods Clinical diagnoses determining the cause of death in 19 cases of fatal polytrauma (2007 - 2008 from a Level 1 trauma centre were correlated with autopsy findings. Results In 13 cases (68%, the clinical cause of death and the cause of death as determined by autopsy were congruent. Marginal differences occurred in three (16% patients while obvious differences in interpreting the cause of death were found in another three (16% cases. Five fatalities (three with obvious differences and two with marginal differences were remarked as early death (1-4 h after trauma and one fatality with marginal differences as late death (>1 week after trauma. Obvious and marginal discrepancies mostly occurred in the early phase of treatment, especially when severely injured patients were admitted to the emergency room undergoing continued cardiopulmonary resuscitation, i. e. limiting diagnostic procedures, and thus the clinical cause of death was essentially determined by basic emergency diagnostics. Conclusions Autopsy as golden standard to define the cause of death in fatal polytrauma varies from the clinical point of view, depending on the patient's pre-existing condition, mechanism of polytrauma, necessity of traumatic cardiopulmonary resuscitation, survival time, and thus the possibility to perform emergency diagnostics. An autopsy should be performed at least in cases of early fatal polytrauma to help establishing the definite cause of death. Moreover, autopsy data should be included in trauma registries as a quality assessment tool.

  11. Catecholamine dependency in a polytrauma patient : relative adrenal insufficiency?

    NARCIS (Netherlands)

    Nieboer, P.; van der Werf, T.S.; Beentjes, J.A.M.; Tulleken, J.E.; Zijlstra, J.G.; Ligtenberg, J.J.M.

    A 65-year-old polytrauma patient was admitted post-operatively to the intensive care unit. His situation deteriorated with hemodynamic instability and continuous high fever. An infectious focus could not be found and repeated cultures remained negative. Empirical administration of antibiotics and

  12. Avoiding Errors in the Management of Pediatric Polytrauma Patients.

    Science.gov (United States)

    Chin, Kenneth; Abzug, Joshua; Bae, Donald S; Horn, Bernard D; Herman, Martin; Eberson, Craig P

    2016-01-01

    Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment. Diagnoses may be missed most frequently because of a surgeon's inability to reliably assess patients who have traumatic brain injuries and painful distracting injuries. Cervical spine injuries are particularly difficult to identify in a child with polytrauma and may have devastating consequences. In children who have multiple injuries, the stabilization of long bone fractures with pediatric fixation techniques, such as elastic nails and other implants, allows for easier care and more rapid mobilization compared with cast treatments. Adolescent polytrauma patients who are approaching skeletal maturity, however, are ideally treated as adults to avoid complications, such as loss of fixation, and to speed rehabilitation.

  13. Ellbogen- und Handgelenksendoprothetik beim Rheumatiker - Richtlinien und Rehabilitation

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    Chochole M

    2008-01-01

    Full Text Available Die Endoprothetik an Ellbogen und Handgelenk ist seit etwa drei Jahrzehnten etabliert. An beiden Gelenken haben sich einzelne Implantate oder Designs durchgesetzt. Operationstechniken und Nachuntersuchungsergebnisse sind publiziert. Wenig ist jedoch zum Thema Nachbehandlung und Nachsorge veröffentlicht. Diese Arbeit beschäftigt sich detailliert mit der ärztlichen und therapeutischen Betreuung nach Implantation einer Ellbogen- oder Handgelenksendoprothese beim Patienten mit rheumatischer Arthritis unter Aufgliederung in Krankenhausaufenthalt, ambulanter Nachsorge sowie stationärer Rehabilitation. Dabei werden Zeitrahmen, Therapieziele und Behandlungen gesondert angeführt.

  14. Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer.

    Science.gov (United States)

    Ferree, Steven; van der Vliet, Quirine M J; Nawijn, Femke; Bhashyam, Abhiram R; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    2018-03-01

    For several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. A total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients. Higher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. Advances in Biomarkers in Critical Ill Polytrauma Patients.

    Science.gov (United States)

    Papurica, Marius; Rogobete, Alexandru F; Sandesc, Dorel; Dumache, Raluca; Cradigati, Carmen A; Sarandan, Mirela; Nartita, Radu; Popovici, Sonia E; Bedreag, Ovidiu H

    2016-01-01

    The complexity of the cases of critically ill polytrauma patients is given by both the primary, as well as the secondary, post-traumatic injuries. The severe injuries of organ systems, the major biochemical and physiological disequilibrium, and the molecular chaos lead to a high rate of morbidity and mortality in this type of patient. The 'gold goal' in the intensive therapy of such patients resides in the continuous evaluation and monitoring of their clinical status. Moreover, optimizing the therapy based on the expression of certain biomarkers with high specificity and sensitivity is extremely important because of the clinical course of the critically ill polytrauma patient. In this paper we wish to summarize the recent studies of biomarkers useful for the intensive care unit (ICU) physician. For this study the available literature on specific databases such as PubMed and Scopus was thoroughly analyzed. Each article was carefully reviewed and useful information for this study extracted. The keywords used to select the relevant articles were "sepsis biomarker", "traumatic brain injury biomarker" "spinal cord injury biomarker", "inflammation biomarker", "microRNAs biomarker", "trauma biomarker", and "critically ill patients". For this study to be carried out 556 original type articles were analyzed, as well as case reports and reviews. For this review, 89 articles with relevant topics for the present paper were selected. The critically ill polytrauma patient, because of the clinical complexity the case presents with, needs a series of evaluations and specific monitoring. Recent studies show a series of either tissue-specific or circulating biomarkers that are useful in the clinical status evaluation of these patients. The biomarkers existing today, with regard to the critically ill polytrauma patient, can bring a significant contribution to increasing the survival rate, by adapting the therapy according to their expressions. Nevertheless, the necessity remains to

  16. Neuronale Korrelate sozialer Interaktion beim Menschen und deren genetische Modulation unter besonderer Berücksichtigung des Spiegelneuronensystems

    OpenAIRE

    Cordes, Andrea

    2013-01-01

    Die in vielen Lebenssituationen über Erfolg und Misserfolg, Sympathie und Antipathie entscheidende, unterschiedlich ausgeprägte Fähigkeit zur sozialen Interaktion ist Gegenstand neurowissenschaftlicher Untersuchungen. Die Versuche einer kortikalen Lokalisierung führten zur Beschreibung des Spiegelneuronensystems (SNS) in Hirnregionen, die sowohl beim Ausführen einer Aktion Aktivität zeigten als auch beim Beobachten derselben beim Gegenüber. Die stärkste Aktivierung dieser Areale wurde bei sch...

  17. Injury mechanisms, patterns and outcomes of older polytrauma patients : An analysis of the Dutch Trauma Registry

    NARCIS (Netherlands)

    de Vries, Rob; Reininga, Inge H. F.; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus

    2018-01-01

    Background Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Methods Data from

  18. Characteristics of polytrauma patients with posttraumatic stress disorder in a level 1 trauma center

    NARCIS (Netherlands)

    B.E. Kreis; N.J.Y. Castano; W.E. Tuinebreijer (Wim); L.C.A. Hoogenboom; S.A.G. Meylaerts (Sven); S. Rhemrev (Steven)

    2011-01-01

    textabstractAims: The aims of this study were to determine if the severity of injury is related to the prevalence of posttraumatic stress disorder (PTSD) in polytrauma patients and to review the personality traits of patients with PTSD. Methods: During 2006 and 2007, 252 polytrauma patients were

  19. Mitochondrial and Nuclear DNA in Patients with Severe Polytrauma

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    M. Sh Khubutia

    2013-01-01

    Full Text Available The components of mitochondria from the cells damaged by injury are a key component for the development of systemic inflammatory response syndrome (SIRS under aseptic conditions. At the same time, there is a significant increase in the plasma level of mitochondrial DNA (mtDNA, which may be a prognostic marker for infectious complications in patients with severe polytrauma. Objective: to study the time course of changes in the serum levels of mtDNA and nuclear DNA (nDNA in healthy individuals and patients with polytrauma and to reveal its possible association with the development of infectious pulmonary complications and with mortality. Subjects and methods. Seven healthy volunteers and 25 polytrauma with polytrauma of a mean injury severity score (ISS of 40.2±9.2. Sixteen (64% patients developed purulent tracheobronchitis and pneumonia; 5 (20% patients died. The amount of mtDNA and nDNA was determined within the first at 12 and 24 hours, then on days 3 and 5—7 after injury by the authors’ modified procedure using as the exogenous control of a circular DNA molecule. The content of mtDNA and nDNA was expressed as absolute values, by taking the arithmetic mean values as 100% for the volunteers. Results. There was a more than 2.5-fold increase in mtDNA levels in dead patients as compared to survivors (p<0.05; the differences in nDMA levels were insignificant (p=0.1. Within the first 12 hours, the mean mtDNA level in patients with pneumonia was 34 times greater than the reference values and continued to rise in the following 12 hours whereas in those without pneumonia, it was only 17 times higher with its further decrease in the comparable time periods. In the first 12 hours, nDNA was increased in both groups, but 24 hours after injury it was 2555 times more than the reference value only in patients with pneumonia whereas it was decreased 3-fold in those without this condition. Conclusion. This paper is the first to describe the time course of

  20. The utilization of dual source CT in imaging of polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Nicolaou, S. [University of British Columbia, Vancouver General Hospital, Department of Radiology, 899 West 12th Avenue, Vancouver, British Columbia, V5Z1M9 (Canada)], E-mail: savvas.nicolaou@vch.ca; Eftekhari, A.; Sedlic, T.; Hou, D.J.; Mudri, M.J.; Aldrich, John; Louis, L. [University of British Columbia, Vancouver General Hospital, Department of Radiology, 899 West 12th Avenue, Vancouver, British Columbia, V5Z1M9 (Canada)

    2008-12-15

    Despite the growing role of imaging, trauma remains the leading cause of death in people below the age of 45 years in the western industrialized countries. Trauma has been touted as the largest epidemic in the 20th century. The advent of MDCT has been the greatest advance in trauma care in the last 25 years. However, there are still challenges in CT imaging of the polytrauma individual including time restraints, diagnostic errors, radiation dose effects and bridging the gap between anatomy and physiology. This article will analyze these challenges and provide possible solutions offered by the unique design of the dual source CT scanner.

  1. The utilization of dual source CT in imaging of polytrauma

    International Nuclear Information System (INIS)

    Nicolaou, S.; Eftekhari, A.; Sedlic, T.; Hou, D.J.; Mudri, M.J.; Aldrich, John; Louis, L.

    2008-01-01

    Despite the growing role of imaging, trauma remains the leading cause of death in people below the age of 45 years in the western industrialized countries. Trauma has been touted as the largest epidemic in the 20th century. The advent of MDCT has been the greatest advance in trauma care in the last 25 years. However, there are still challenges in CT imaging of the polytrauma individual including time restraints, diagnostic errors, radiation dose effects and bridging the gap between anatomy and physiology. This article will analyze these challenges and provide possible solutions offered by the unique design of the dual source CT scanner

  2. Nitric oxide as an indicator for severity of injury in polytrauma.

    Science.gov (United States)

    Beitl, E; Banasova, A; Vlcek, M; Mikova, D; Hampl, V

    2016-01-01

    Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide the prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated in tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide could serve as an indicator for severity of injury in polytrauma. We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers. On admission, serum NOx was higher in patients with moderate polytrauma than both in controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In the groups, where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on admission were elevated in proportion to the severity of subsequent clinical course. Elevated serum NOx and blood lactate in patients with polytrauma are markers of serious clinical course, while normal NOx combined with a very high lactate may signal a fatal prognosis (Fig. 4, Ref. 8).

  3. Injury mechanisms, patterns and outcomes of older polytrauma patients—An analysis of the Dutch Trauma Registry

    Science.gov (United States)

    Reininga, Inge H. F.; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus

    2018-01-01

    Background Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Methods Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18–59) and older (Group B: ages ≥60) polytrauma patients were compared. Differences in injury severity, trauma mechanism (only data for the year 2014), vital signs, injury patterns, ICU characteristics and hospital mortality were analyzed. Results Data of 25,304 polytrauma patients were analyzed. The older patients represented 47.8% of the polytrauma population. Trauma mechanism in the older patients was more likely to be a bicycle accident (A: 17%; B: 21%) or a low-energy fall (A: 13%; B: 43%). Younger polytrauma patients were more likely to have the worst scores on the Glasgow coma scale (EMV = 3, A: 20%, B: 13%). However, serious head injuries were seen more often in the older patients (A: 53%; B: 69%). The hospital mortality was doubled for the older polytrauma patients (19.8% vs. 9.6%). Conclusion Elderly are involved more often in polytrauma. Although injury severity did not differ between groups, the older polytrauma patients were at a higher risk of dying than their younger counterparts despite sustaining less high-energy accidents. PMID:29304054

  4. Injury mechanisms, patterns and outcomes of older polytrauma patients-An analysis of the Dutch Trauma Registry.

    Science.gov (United States)

    de Vries, Rob; Reininga, Inge H F; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus

    2018-01-01

    Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18-59) and older (Group B: ages ≥60) polytrauma patients were compared. Differences in injury severity, trauma mechanism (only data for the year 2014), vital signs, injury patterns, ICU characteristics and hospital mortality were analyzed. Data of 25,304 polytrauma patients were analyzed. The older patients represented 47.8% of the polytrauma population. Trauma mechanism in the older patients was more likely to be a bicycle accident (A: 17%; B: 21%) or a low-energy fall (A: 13%; B: 43%). Younger polytrauma patients were more likely to have the worst scores on the Glasgow coma scale (EMV = 3, A: 20%, B: 13%). However, serious head injuries were seen more often in the older patients (A: 53%; B: 69%). The hospital mortality was doubled for the older polytrauma patients (19.8% vs. 9.6%). Elderly are involved more often in polytrauma. Although injury severity did not differ between groups, the older polytrauma patients were at a higher risk of dying than their younger counterparts despite sustaining less high-energy accidents.

  5. Patterns and Outcome of Missed Injuries in Egyptians Polytrauma Patients

    Directory of Open Access Journals (Sweden)

    Adel Hamed Elbaih

    2018-01-01

    Full Text Available Introduction: “polytrauma” patients are higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, missed injuries still significant affect modern trauma services and its outcome. Aim: to improve outcome and determine the incidence and nature of missed injuries in polytrauma patients. Methods: the study is a cross-sectional, prospective study included 600 polytraumatized patients admitted in Suez Canal University Hospital. Firstly assessed and treated accordingly to Advanced Trauma Life Support (ATLS guidelines and treat the life threading conditions if present with follow-up short outcome for 28 days. Results: The most common precipitate factor for missed injuries in my study was clinical evaluation error due to Inadequate diagnostic workup in 42.9%. And the second risk factor was Deficiency in Physical Examination in 35.7%. Lastly Incomplete assessment due to patient instability in 10.7% and incorrect interpretation of imaging10.7%.low rates of missed injuries (40.8% in patients arriving during the day compared with (59.2% of night arrivals. Conclusion: the incidence of missed injuries in the study is 9.0 % which is still high compared to many trauma centers. And mostly increase the period of stay in the hospital and affect the outcome of polytrauma patients.

  6. Cambridge Polytrauma Pathway: Are we making appropriately guided decisions?

    Science.gov (United States)

    Wynell-Mayow, William; Guevel, Borna; Quansah, Benjamin; O'Leary, Ronan; Carrothers, Andrew D

    2016-10-01

    Addenbrooke's Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion. It facilitates provision of best practice Early Appropriate Care, encompassing - multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries. Re-audit was conducted of 15 patients meeting selection criteria, admitted between 1st October 2014 and 31st March 2015. Significant improvements in recording of lactate and fibrinogen were demonstrated, both on admission (lactate - ppolytrauma patients and it is recommended that either the GOS-E, or the EQ-5D scoring systems be introduced to assess this. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  7. Whole-body MSCT of patients after polytrauma: abdominal injuries

    International Nuclear Information System (INIS)

    Roehrl, B.; Sadick, M.; Diehl, S.; Dueber, C.; Obertacke, U.

    2005-01-01

    Purpose: The goal of this retrospective study was to evaluate the spectrum of abdominal injuries and the reliability of computed tomography-based diagnosis in patients after polytrauma. Material and methods: CT findings and clinical reports for 177 patients after polytrauma were evaluated with regard to abdominal injuries. Clinical patient reports at the time of discharge from the hospital were utilized as the standard of reference. Abdominal injuries resulting from an accident, frequent additional traumas and following therapeutic procedures were recorded. In the case of discrepancies in the reports, the CT scans were viewed retrospectively. Results: In 30 out of 177 patients, 42 abdominal injuries were detected. 69% of the injuries were caused by traffic accidents while 31% resulted from falls. Liver and spleen injuries were the most common. 50% of the cases were treated surgically, and the other half of the cases underwent non-surgical conservative therapy. Massive chest traumas, pelvic injuries, cerebral traumas and injuries to extremities were commonly associated with abdominal injuries. Evaluation of the discrepancies in the clinical reports showed that injury to the pancreas and the small intestine were not successfully detected on CT, thus resulting in a false negative diagnosis. Early stages of organ parenchyma laceration were also initially misdiagnosed on CT. (orig.)

  8. Evaluation of multiple trauma victims with 16-row multidetector CT (MDCT): a time analysis; Anwendung der 16-Zeilen-Mehrdetektor-CT in der Initialdiagnostik beim Polytrauma: Eine Zeitanalyse

    Energy Technology Data Exchange (ETDEWEB)

    Heyer, C.M.; Nicolas, V. [Bochum Univ. (Germany). Inst. fuer Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin; Rduch, G.J. [Bochum Univ. (Germany). Klinik fuer Chirurgie; Wick, M.; Muhr, G. [Bochum Univ. (Germany). Medizinische Klinik III, Pneumologie, Allergologie und Schlafmedizin; Bauer, T.T. [Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Univ. Bochum (Germany)

    2005-12-15

    Purpose: Description and time analysis of a 16-row MDCT protocol in the evaluation of multiple trauma patients considering transport, time of scanning, patient positioning, image reconstruction, and image interpretation. Materials and methods: Between May and December 2004, 60 multiple trauma patients underwent 16-row MDCT (Sensation, Siemens, Erlangen, Germany). The protocol included serial scanning of the head, spiral scanning of the cervical spine and contrast-enhanced spiral scanning of the thorax/abdomen with multiplanar reformations (MPR) of the thoracic/lumbar spine and the pelvis. All time intervals including transport, patient positioning, scanning, duration of MPR, total time in the examination room, and time to first and final image interpretation were prospectively evaluated. Furthermore, patient characteristics, trauma profiles, and mortality rates were recorded. Results: 46 male and 14 female patients (mean age 43.6 years) were enrolled in the study. Time analysis of 16-row MDCT revealed the following results (mean time standard deviation): Emergency room treatment and transport 19.2{+-}6.7 min, patient positioning 16.5{+-}6.5 min, scan duration 8.0{+-}3.3 min, total time in examination room 24.5{+-}7.2 min, image reconstruction including MPR 32.0{+-}16.4 min, and time of first (16.4{+-}4.7 min) and final image interpretation (82.5{+-}30.4 min). Trauma profiles revealed thoracic injuries in 35/60 patients (58.3%), head injuries in 23/60 patients (38.3%), abdominal injuries in 15/60 patients (25.0%), injuries of the cervical (9/60 patients, 15.0%), thoracic (12/60 patients, 20.0%), and lumbar spine (19/60 patients, 31.7%), pelvic injuries in 13/60 patients (21.7%), and injuries of extremities in 39/60 patients (65.0%). The mortality rate was 21.7%. (orig.)

  9. Interleukin-6 and interleukin-10 plasma levels and mRNA expression in polytrauma patients

    Directory of Open Access Journals (Sweden)

    Heber B. Sapan

    2017-12-01

    Conclusion: The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient's outcome.

  10. Induced Hypothermia Does Not Harm Hemodynamics after Polytrauma: A Porcine Model

    Science.gov (United States)

    Mommsen, Philipp; Pfeifer, Roman; Mohr, Juliane; Ruchholtz, Steffen; Flohé, Sascha; Fröhlich, Matthias; Keibl, Claudia; Seekamp, Andreas; Witte, Ingo

    2015-01-01

    Background. The deterioration of hemodynamics instantly endangers the patients' life after polytrauma. As accidental hypothermia frequently occurs in polytrauma, therapeutic hypothermia still displays an ambivalent role as the impact on the cardiopulmonary function is not yet fully understood. Methods. We have previously established a porcine polytrauma model including blunt chest trauma, penetrating abdominal trauma, and hemorrhagic shock. Therapeutic hypothermia (34°C) was induced for 3 hours. We documented cardiovascular parameters and basic respiratory parameters. Pigs were euthanized after 15.5 hours. Results. Our polytrauma porcine model displayed sufficient trauma impact. Resuscitation showed adequate restoration of hemodynamics. Induced hypothermia had neither harmful nor major positive effects on the animals' hemodynamics. Though heart rate significantly decreased and mixed venous oxygen saturation significantly increased during therapeutic hypothermia. Mean arterial blood pressure, central venous pressure, pulmonary arterial pressure, and wedge pressure showed no significant differences comparing normothermic trauma and hypothermic trauma pigs during hypothermia. Conclusions. Induced hypothermia after polytrauma is feasible. No major harmful effects on hemodynamics were observed. Therapeutic hypothermia revealed hints for tissue protective impact. But the chosen length for therapeutic hypothermia was too short. Nevertheless, therapeutic hypothermia might be a useful tool for intensive care after polytrauma. Future studies should extend therapeutic hypothermia. PMID:26170533

  11. Induced Hypothermia Does Not Harm Hemodynamics after Polytrauma: A Porcine Model

    Directory of Open Access Journals (Sweden)

    Matthias Weuster

    2015-01-01

    Full Text Available Background. The deterioration of hemodynamics instantly endangers the patients’ life after polytrauma. As accidental hypothermia frequently occurs in polytrauma, therapeutic hypothermia still displays an ambivalent role as the impact on the cardiopulmonary function is not yet fully understood. Methods. We have previously established a porcine polytrauma model including blunt chest trauma, penetrating abdominal trauma, and hemorrhagic shock. Therapeutic hypothermia (34°C was induced for 3 hours. We documented cardiovascular parameters and basic respiratory parameters. Pigs were euthanized after 15.5 hours. Results. Our polytrauma porcine model displayed sufficient trauma impact. Resuscitation showed adequate restoration of hemodynamics. Induced hypothermia had neither harmful nor major positive effects on the animals’ hemodynamics. Though heart rate significantly decreased and mixed venous oxygen saturation significantly increased during therapeutic hypothermia. Mean arterial blood pressure, central venous pressure, pulmonary arterial pressure, and wedge pressure showed no significant differences comparing normothermic trauma and hypothermic trauma pigs during hypothermia. Conclusions. Induced hypothermia after polytrauma is feasible. No major harmful effects on hemodynamics were observed. Therapeutic hypothermia revealed hints for tissue protective impact. But the chosen length for therapeutic hypothermia was too short. Nevertheless, therapeutic hypothermia might be a useful tool for intensive care after polytrauma. Future studies should extend therapeutic hypothermia.

  12. Interdisciplinary interventional therapy for tracheobronchial stenosis with modern metal net stents; Interdisziplinaere interventionelle Therapie tracheobronchialer Stenosen mit modernen Metallmaschenstents

    Energy Technology Data Exchange (ETDEWEB)

    Rieger, J.; Linsenmaier, U.; Fedorowski, A.; Pfeifer, K.J. [Ludwig-Maximilians-Universitaet Muenchen (Germany). Inst. fuer Klinische Radiologie; Hautmann, H.; Huber, R.M. [Klinikum Innenstadt der Ludwig-Maximilians-Universitaet Muenchen (Germany). Abteilung Pulmonologie, Medizinische Klinik

    2002-08-01

    , ein Rueschstent und ein Palmazstent) wurde in einer unifizierten Datenbank erfasst. Die Patienten wurden hinsichtlich der klinischen Wirkung der Endoprothesen einschliesslich Lungenfunktionsparameter, relevanter Komplikationen, Implantationsmethodik und radiologischer Verlaufsparameter untersucht. Die Verweil-, Dislokations- und Kompressionswahrscheinlichkeit wurde nach Kaplan-Meier berechnet und dargestellt. Ergebnisse: Bei 86% der Patienten stellte die Stentimplantation eine effektive Behandlungsmethode dar. Der Atemwegswiderstand normalisierte sich bei 9/9 Patienten. Die Analyse nach Kaplan-Meier ergab fuer den Wall- und den Nitinolstent eine deutlich hoehere Wahrscheinlichkeit, im Tracheobronchialsystem zu verweilen und nicht komprimiert zu werden. Eine Dislokation war ebenfalls seltener. Die Explantation eines Wallstents ist jedoch im Vergleich zum Streckerstent erheblich schwieriger. Auch kam es beim Wallstent gelegentlich zur interventionspflichtigen Bildung von Granulationsgewebe am proximalen Stentende. (orig.)

  13. Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

    Science.gov (United States)

    Halbgebauer, Rebecca; Eisele, Philipp; Messerer, David A. C.; Weckbach, Sebastian; Schultze, Anke; Braumüller, Sonja; Gebhard, Florian

    2017-01-01

    Evidence is emerging that systemic inflammation after trauma drives structural and functional impairment of cardiomyocytes and leads to cardiac dysfunction, thus worsening the outcome of polytrauma patients. This study investigates the structural and molecular changes in heart tissue 4 h after multiple injuries with additional hemorrhagic shock using a clinically relevant rodent model of polytrauma. We determined mediators of systemic inflammation (keratinocyte chemoattractant, macrophage chemotactic protein 1), activated complement component C3a and cardiac troponin I in plasma and assessed histological specimen of the mouse heart via standard histomorphology and immunohistochemistry for cellular and subcellular damage and ongoing apoptosis. Further we investigated spatial and quantitative changes of connexin 43 by immunohistochemistry and western blotting. Our results show significantly increased plasma levels of both keratinocyte chemoattractant and cardiac troponin I 4 h after polytrauma and 2 h after induction of hypovolemia. Although we could not detect any morphological changes, immunohistochemical evaluation showed increased level of tissue high-mobility group box 1, which is both a damage-associated molecule and actively released as a danger response signal. Additionally, there was marked lateralization of the cardiac gap-junction protein connexin 43 following combined polytrauma and hemorrhagic shock. These results demonstrate a molecular manifestation of remote injury of cardiac muscle cells in the early phase after polytrauma and hemorrhagic shock with marked disruption of the cardiac gap junction. This disruption of an important component of the electrical conduction system of the heart may lead to arrhythmia and consequently to cardiac dysfunction. PMID:29084268

  14. A New Experimental Polytrauma Model in Rats: Molecular Characterization of the Early Inflammatory Response

    Directory of Open Access Journals (Sweden)

    Sebastian Weckbach

    2012-01-01

    Full Text Available Background. The molecular mechanisms of the immune response after polytrauma are highly complex and far from fully understood. In this paper, we characterize a new standardized polytrauma model in rats based on the early molecular inflammatory and apoptotic response. Methods. Male Wistar rats (250 g, 6–10/group were anesthetized and exposed to chest trauma (ChT, closed head injury (CHI, or Tib/Fib fracture including a soft tissue trauma (Fx + STT or to the following combination of injuries: (1 ChT; (2 ChT + Fx + STT; (3 ChT + CHI; (4 CHI; (5 polytrauma (PT = ChT + CHI + Fx + STT. Sham-operated rats served as negative controls. The inflammatory response was quantified at 2 hours and 4 hours after trauma by analysis of “key” inflammatory mediators, including selected cytokines and complement components, in serum and bronchoalveolar (BAL fluid samples. Results. Polytraumatized (PT rats showed a significant systemic and intrapulmonary release of cytokines, chemokines, and complement anaphylatoxins, compared to rats with isolated injuries or selected combinations of injuries. Conclusion. This new rat model appears to closely mimic the early immunological response of polytrauma observed in humans and may provide a valid basis for evaluation of the complex pathophysiology and future therapeutic immune modulatory approaches in experimental polytrauma.

  15. A New Experimental Polytrauma Model in Rats: Molecular Characterization of the Early Inflammatory Response

    Science.gov (United States)

    Weckbach, Sebastian; Perl, Mario; Heiland, Tim; Braumüller, Sonja; Stahel, Philip F.; Flierl, Michael A.; Ignatius, Anita; Gebhard, Florian; Huber-Lang, Markus

    2012-01-01

    Background. The molecular mechanisms of the immune response after polytrauma are highly complex and far from fully understood. In this paper, we characterize a new standardized polytrauma model in rats based on the early molecular inflammatory and apoptotic response. Methods. Male Wistar rats (250 g, 6–10/group) were anesthetized and exposed to chest trauma (ChT), closed head injury (CHI), or Tib/Fib fracture including a soft tissue trauma (Fx + STT) or to the following combination of injuries: (1) ChT; (2) ChT + Fx + STT; (3) ChT + CHI; (4) CHI; (5) polytrauma (PT = ChT + CHI + Fx + STT). Sham-operated rats served as negative controls. The inflammatory response was quantified at 2 hours and 4 hours after trauma by analysis of “key” inflammatory mediators, including selected cytokines and complement components, in serum and bronchoalveolar (BAL) fluid samples. Results. Polytraumatized (PT) rats showed a significant systemic and intrapulmonary release of cytokines, chemokines, and complement anaphylatoxins, compared to rats with isolated injuries or selected combinations of injuries. Conclusion. This new rat model appears to closely mimic the early immunological response of polytrauma observed in humans and may provide a valid basis for evaluation of the complex pathophysiology and future therapeutic immune modulatory approaches in experimental polytrauma. PMID:22481866

  16. Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach.

    Science.gov (United States)

    Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2017-09-11

    Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ -6.0], coagulopathy [partial thromboplastin time ≥ 40 s or international normalized ratio ≥ 1.4], and age [≥70 years]). Methods: We retrieved detailed data on 369 polytrauma patients and 1260 non-polytrauma patients with an overall Injury Severity Score (ISS) ≥ 18 who were hospitalized between 1 January 2009 and 31 December 2015 for the treatment of all traumatic injuries, from the Trauma Registry System at a level I trauma center. Patients with burn injury or incomplete registered data were excluded. Categorical data were compared with two-sided Fisher exact or Pearson chi-square tests. The unpaired Student t -test and the Mann-Whitney U -test was used to analyze normally distributed continuous data and non-normally distributed data, respectively. Propensity-score matched cohort in a 1:1 ratio was allocated using the NCSS software with logistic regression to evaluate the effect of polytrauma on patient outcomes. Results: The polytrauma patients had a significantly higher ISS than non-polytrauma patients (median (interquartile range Q1-Q3), 29 (22-36) vs. 24 (20-25), respectively; p Polytrauma patients had a 1.9-fold higher odds of mortality than non-polytrauma patients (95% CI 1.38-2.49; p polytrauma patients, polytrauma patients had a substantially longer hospital length of stay (LOS). In addition, a higher proportion of polytrauma patients were admitted to the intensive

  17. Untersuchungen ausgewählter Nierenkrankheiten beim Frettchen (Mustela putorius f. furo L. 1758)

    OpenAIRE

    Riechert, Maren

    2005-01-01

    Um Häufigkeit, Bedeutung und diätetische Ursachen veränderter Nieren beim Frettchen zu erarbeiten, wurden die Nieren von 63 Heimtieren und 120 Labortieren sonographisch untersucht und Fütterungsanalysen durchgeführt. Anatomische Studien an gesunden Nieren wurden für den Vergleich mit den veränderten Nieren angefertigt. Die Untersuchungen zur Anatomie ergaben für das Frettchen Nieren vom einfachen glatten und einwarzigen Typ. Des Weiteren konnten mithilfe von anatomischen ...

  18. Fractures and dislocations of the hand in polytrauma patients: Incidence, injury pattern and functional outcome.

    Science.gov (United States)

    Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    2017-04-01

    Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients. A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS). Copyright © 2017 Elsevier Ltd. All

  19. Evaluation of standardized and applied variables in predicting treatment outcomes of polytrauma patients.

    Science.gov (United States)

    Aksamija, Goran; Mulabdic, Adi; Rasic, Ismar; Muhovic, Samir; Gavric, Igor

    2011-01-01

    Polytrauma is defined as an injury where they are affected by at least two different organ systems or body, with at least one life-threatening injuries. Given the multilevel model care of polytrauma patients within KCUS are inevitable weaknesses in the management of this category of patients. To determine the dynamics of existing procedures in treatment of polytrauma patients on admission to KCUS, and based on statistical analysis of variables applied to determine and define the factors that influence the final outcome of treatment, and determine their mutual relationship, which may result in eliminating the flaws in the approach to the problem. The study was based on 263 polytrauma patients. Parametric and non-parametric statistical methods were used. Basic statistics were calculated, based on the calculated parameters for the final achievement of research objectives, multicoleration analysis, image analysis, discriminant analysis and multifactorial analysis were used. From the universe of variables for this study we selected sample of n = 25 variables, of which the first two modular, others belong to the common measurement space (n = 23) and in this paper defined as a system variable methods, procedures and assessments of polytrauma patients. After the multicoleration analysis, since the image analysis gave a reliable measurement results, we started the analysis of eigenvalues, that is defining the factors upon which they obtain information about the system solve the problem of the existing model and its correlation with treatment outcome. The study singled out the essential factors that determine the current organizational model of care, which may affect the treatment and better outcome of polytrauma patients. This analysis has shown the maximum correlative relationships between these practices and contributed to development guidelines that are defined by isolated factors.

  20. [Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience].

    Science.gov (United States)

    Vodička, J; Doležal, J; Vejvodová, Š; Šafránek, J; Špidlen, V; Třeška, V

    2016-01-01

    PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma

  1. The use of the Statscan digital X-ray unit in paediatric polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Pitcher, Richard D. [University of Cape Town, Division of Paediatric Radiology, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); Wilde, Jim C.H. [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); University of Amsterdam, Paediatric Surgical Centre of Amsterdam, Emma Children' s Hospital, Academic Medical Centre, Amsterdam (Netherlands); Douglas, Tania S. [University of Cape Town, MRC/UCT Medical Imaging Research Unit, Department of Human Biology, Cape Town (South Africa); As, Arjan Bastiaan van [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa)

    2009-05-15

    We present a 3-year review of clinical paediatric experience with the statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided. (orig.)

  2. Family Care Map: Sustaining family-centered care in Polytrauma Rehabilitation Centers

    Science.gov (United States)

    Ford, James H.; Wise, Meg; Krahn, Dean; Oliver, Karen Anderson; Hall, Carmen; Sayer, Nina

    2015-01-01

    The study assessed sustainability of the Family Care Map, a family-centered approach to providing care for Veterans with polytrauma-related injuries, in four Department of Veterans Affairs Polytrauma Rehabilitation Centers. We applied a mixed-methods approach. Staff surveys used standardized measures of sustainability, commitment to change, information, and participation during implementation. Qualitative inquiry assessed Family Care Map implementation and facilitators and barriers to sustainability. Staff sustainability perceptions had a significant positive correlation with affective commitment to change, participation, and information received about the change process. Family Care Map integration into standard practices and use of its concepts with patients and families related to staff perceptions about sustainability. The degree of use and integration of the Family Care Map in traumatic brain injury/polytrauma care varied among the Polytrauma Rehabilitation Centers. Some successful sustainability strategies included integration into daily workflow and organizational culture. Examples of sustainability barriers included staff awareness and use and outdated information. Some practices, such as measuring and documenting the use of the Family Care Map in treatment plans, may not routinely occur. The focus on family-centered care will require further evaluation of organization-, staff-, and innovation-level attributes that influence sustainability of changes designed to improve family-centered care. PMID:25671632

  3. The use of the Statscan digital X-ray unit in paediatric polytrauma

    International Nuclear Information System (INIS)

    Pitcher, Richard D.; Wilde, Jim C.H.; Douglas, Tania S.; As, Arjan Bastiaan van

    2009-01-01

    We present a 3-year review of clinical paediatric experience with the statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided. (orig.)

  4. Is the golden hour optimally used in South Africa for children presenting with polytrauma?

    NARCIS (Netherlands)

    J. Zuidgeest (J.); A. Jonkheijm (Annabel); M. van Dijk (Monique); A.B. van As (Àrjan Bastiaan)

    2013-01-01

    textabstractBackground. The major paediatric public health problem worldwide is injury or trauma. In 2004, 950 000 children died as a result of injury. Objective. The aim of this study was to evaluate the logistics of medical care after paediatric polytrauma within the first hours after arrival into

  5. Fractures and dislocations of the hand in polytrauma patients : Incidence, injury pattern and functional outcome

    NARCIS (Netherlands)

    Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence,

  6. Effects of exogenous ubiquitin in a polytrauma model with blunt chest trauma

    Science.gov (United States)

    Baker, Todd A.; Romero, Jacqueline; Bach, Harold H.; Strom, Joel A.; Gamelli, Richard L.; Majetschak, Matthias

    2013-01-01

    Objective To determine whether treatment with the CXC chemokine receptor (CXCR) 4 agonist ubiquitin results in beneficial effects in a polytrauma model consisting of bilateral femur fractures plus blunt chest trauma (Injury Severity Score 18-25). Design Treatment study. Setting Research Laboratory. Subjects Seventeen Yorkshire pigs. Interventions Intravenous (i.v.) injection of 1.5 mg/kg ubiquitin or albumin (=control) at 60 min after polytrauma. Measurements and Main Results Anesthetized, mechanically ventilated pigs underwent polytrauma, followed by a simulated 60 min shock phase. At the end of the shock phase ubiquitin or albumin were administered and animals were resuscitated to a mean arterial blood pressure of 70 mmHg until t = 420 min. After i.v. ubiquitin, ubiquitin plasma concentrations increased sixteen-fold to 2870 ± 1015 ng/mL at t = 90 min and decreased with t1/2 = 60 min. Endogenous plasma ubiquitin increased two-fold in the albumin group with peak levels of 359 ± 210 ng/mL. Plasma levels of the cognate CXCR4 ligand stromal cell-derived factor (SDF)-1α were unchanged in both groups. Ubiquitin treatment reduced arterial lactate levels and prevented a continuous decrease in arterial oxygenation, which occurred in the albumin group during resuscitation. Wet weight to dry weight ratios of the lung contralateral from the injury, heart, spleen and jejunum were lower with ubiquitin. With ubiquitin treatment, tissue levels of IL-8, IL-10, TNFα and SDF-1α were reduced in the injured lung and of IL-8 in the contralateral lung, respectively. Conclusions Administration of exogenous ubiquitin modulates the local inflammatory response, improves resuscitation, reduces fluid shifts into tissues and preserves arterial oxygenation after blunt polytrauma with lung injury. This study further supports the notion that ubiquitin is a promising protein therapeutic and implies CXCR4 as a drug target after polytrauma. PMID:22622399

  7. [Definition of polytrauma in the German DRG system 2006. Up to 30% "incorrect classifications"].

    Science.gov (United States)

    Flohé, S; Buschmann, C; Nabring, J; Merguet, P; Luetkes, P; Lefering, R; Nast-Kolb, D; Ruchholtz, S

    2007-07-01

    Severely injured patients represent a relevant financial cost factor in the health system especially for high level trauma centres. The introduction of a"diagnosis-related group" (DRG) system in Germany further revealed the potential negative economic impact of severely injured patients for trauma centres. In recent years several changes of the specific DRG for severely injured patients occurred with the aim of a convenient reimbursement for the trauma patient. The present study analysed 38 multiply injured patients admitted in the first half of the year 2004. These patients were analysed in terms of the respective DRG that was attributed to the patient on the basis of the definition criteria for 2004 and 2005. In addition for the same patient group the total inpatient treatment costs were calculated according to the algorithm developed by the Working Group on Polytrauma of the German Trauma Society. The analysis revealed three major problems in the reimbursement for severely injured patients according to the German DRG system: (1) In spite of the additional payment for blood compounds on top of the DRG reimbursement in 2005 a mean economic deficit of more than 4000 euro remains for each severely injured patient. (2) In 30% of the analysed trauma patients the combination of the diagnosis and operations did not lead to a specific polytrauma DRG or to an intensive care medicine DRG. (3) In the patients that could not be attributed to a polytrauma DRG, the economic deficit was with an average of more than 9000 euro even higher. This attribution aspect is also currently relevant, since the definition criteria for a polytrauma DRG were not changed in 2006 or 2007. We conclude that besides the recent changes in the reimbursement for polytrauma DRGs, which have been at least partly adapted to the real financial burden of these patients, the definition of a severely injured patient in the German DRG system may also need to be revised.

  8. Qualität beim E-Learning: Der Lernende als Grundkategorie bei der Qualitätssicherung

    Directory of Open Access Journals (Sweden)

    Ulf Ehlers

    2002-03-01

    Full Text Available Qualität wird über die zukünftigen Erfolgschancen des E-Learning entscheiden. Das ist das Ergebnis vieler Analysen und Entwicklungen der letzten Zeit. So stellte etwa die KPMG-Studie heraus, dass es beim E-Learning nicht nur auf gute Technologie ankommt, sondern die betriebliche Lernkultur und der Lerner wesentlich mehr als bisher einzubeziehen sind. Dieser Beitrag beschäftigt sich damit, was Qualität beim E-Learning eigentlich ist und welche Konzepte zur Beschreibung und Sicherung von Qualität bestehen.

  9. Hopp, hopp, hopp im Schweinsgalopp? Klauen- und Gliedmaßengesundheit beim Schwein

    OpenAIRE

    Leeb, Christine; Bernardi, Florian; Winckler, Christoph

    2009-01-01

    Immer wieder kommen aus der Praxis Anfragen, über Lahmheitbeim Schwein zu berichten, auch ein Klauenpflegekurs wurde bereits durchgeführt, um akute Probleme lösen zu können. Doch was sind die Ursachen für Lahmheiten beim Schwein? Dieser Beitrag soll nicht nur die klinischen Symptome aufzählen und rasche Lösungen vermitteln (die es selten gibt), sondern Fragen stellen und zum selbst Beobachten und Nachdenken anregen. Dazu wird vom Wildschwein ausgehend das Normalverhalten betrac...

  10. Zu einigen entwicklungstendenzen beim ausdruck der gewissheits modalität

    Directory of Open Access Journals (Sweden)

    Stojan Bračič

    1981-12-01

    Full Text Available Das verfolgte Ziel in diesem Artikel - einem für den Druck bear­ beiteten Kapitel aus der Magisterarbeit des Verfassers - ist es, möglichst viele Ausdrucksmittel zum Ausdruck der Gewissheits­ modälitat (im weiteren GMO zu finden und sie sys.tematisch zu behandeln. Ausserdem soll durch statistische Bearbeitung der im Korpus gefundenen Belege festgestellt werden, ob man in der Zeit­ spanne derletzten siebzig Jahre beim Ausdruck der GMO in der deutschen Sprache mit Entwicklungstendenzen /ET/ rechnen kann.

  11. Randzonenveränderung beim Bohren und ihre Auswirkung auf Folgebearbeitungsverfahren

    OpenAIRE

    Schmier, Marcus

    2004-01-01

    In der Praxis kommt es bei der spanenden Bearbeitung immer wieder zu großen Standwegunterschieden identischer Werkzeuge bei vordergründig identischen Bearbeitungsrandbedingungen. Insbesondere bei Fertigungsschritten, die das Bohren als Vorbearbeitung erfordern, kommt es gelegentlich zu atypischen Verschleißerscheinungen, die auf das Entstehen einer Neuhärtezone an der Werkstückoberfläche beim Bohren zurückgeführt werden. Grundsätzlich sind Randzonenveränderungen eine Folge der mechanischen un...

  12. Zum Erleben von Thrills und anderen starken emotionalen Reaktionen beim Musikhören

    OpenAIRE

    Schönberger, Jörg

    2003-01-01

    Obwohl unbestritten ist, dass Musik in der Lage ist, starke emotionale Reaktionen auszulösen, hat sich die Musikpsychologie wenig mit den Emotionen beschäftigt, die Menschen beim Musikhören erleben. Zwei mögliche Zugänge zum Erfassen solch starker emotionaler Reaktionen sind die Ansätze von John A. Sloboda und Alf Gabrielsson. Sloboda nutzt für seinen Ansatz das Phänomen der "Thrills" — physiologische Begleiterscheinungen starker emotionaler Reaktionen wie z.B. Gänsehaut, Schauer, die ü...

  13. C-Reactive Protein and Cytokines in Polytrauma

    Directory of Open Access Journals (Sweden)

    E. K Gumanenko

    2007-01-01

    Full Text Available Objective: to study the association of C-reactive protein (CRP with cytokines in polytrauma.Subjects and methods. Eighty-four victims with severe concomitant injury were examined. Twenty-five (29.7% patients developed sepsis, death being observed in 83.3%. CRP was daily determined in the sera of the victims, by using CRP latex test kits (HUMATEX, Germany. On days 1, 3, 7, 10, and 15 after injury, serum and lymphocytic culture IL-2, IL-4, TNF-a, IFN-y, and HLA-DR were studied on an automatic Elx 800 Universal Microplate Reader enzyme immunoassay analyzer (BIO-TEK INSTRUMENTS, Inc., USA, by applying enzyme immunoassay systems (OOO «Cytokine», Saint Petersburg, Russia.Results. No complications were observed with a CRP level of 40 mg/l on day 1 and its further reduction. The CRP level of 40 mg/l on day 1 (without use of glucocorticoids and its prolonged increase were determined in visceral inflammatory and infectious complications. The CRP level of 120 mg/l within the first 7 days was noted in subsequently developed sepsis. Glucocorticoids and specific immune drugs resulted in a reduction or complete disappearance of CRP. When the latter were discontinued, CRP appeared in the quantity reflecting the effect of treatment. In the absence of multiple organ dysfunctions, the level of CRP decreased as the infectious process diminished. The low level of CRP and the activation of an infectious process suggest the areactivity of an organism. With the CRP level of 40 mg/l, the spontaneous production and level of blood IL-4 increased less significantly, whereas those of IFN-y rose more substantially; the induced activity of TNF-a also more drastically decreased (by 10 times versus 2.2 with a CRP level of 40 mg/l. Irrespective of the level of CRP, the induced activity of IL-4 decreased by 59%, suggesting immunosuppression. There was no association of CRP with IL-2 and HLA-DR.Conclusion. Daily blood CRP analysis in injury makes it possible to predict visceral

  14. Comparative Analysis of the Regulatory T Cells Dynamics in Peripheral Blood in Human and Porcine Polytrauma

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    Rafael Serve

    2018-03-01

    Full Text Available BackgroundSeverely injured patients experience substantial immunological stress in the aftermath of traumatic insult, which often results in systemic immune dysregulation. Regulatory T cells (Treg play a key role in the suppression of the immune response and in the maintenance of immunological homeostasis. Little is known about their presence and dynamics in blood after trauma, and nothing is known about Treg in the porcine polytrauma model. Here, we assessed different subsets of Treg in trauma patients (TP and compared those to either healthy volunteers (HV or data from porcine polytrauma.MethodsPeripheral blood was withdrawn from 20 TP with injury severity score (ISS ≥16 at the admittance to the emergency department (ED, and subsequently on day 1 and at day 3. Ten HV were included as controls (ctrl. The porcine polytrauma model consisted of a femur fracture, liver laceration, lung contusion, and hemorrhagic shock resulting in an ISS of 27. After polytrauma, the animals underwent resuscitation and surgical fracture fixation. Blood samples were withdrawn before and immediately after trauma, 24 and 72 h later. Different subsets of Treg, CD4+CD25+, CD4+CD25+FoxP3+, CD4+CD25+CD127−, and CD4+CD25+CD127−FoxP3+ were characterized by flow cytometry.ResultsAbsolute cell counts of leukocytes were significantly increasing after trauma, and again decreasing in the follow-up in human and porcine samples. The proportion of human Treg in the peripheral blood of TP admitted to the ED was lower when compared to HV. Their numbers did not recover until 72 h after trauma. Comparable data were found for all subsets. The situation in the porcine trauma model was comparable with the clinical data. In porcine peripheral blood before trauma, we could identify Treg with the typical immunophenotype (CD4+CD25+CD127−, which were virtually absent immediately after trauma. Similar to the human situation, most of these cells expressed FoxP3, as assessed by

  15. Handlungsmuster von Lehrerinnen und Lehrern beim Einsatz neuer Medien. Grundlagen eines Projekts zur empirischen Unterrichtsforschung

    Directory of Open Access Journals (Sweden)

    Sigrid Blömeke

    2017-08-01

    Full Text Available Ziel des vorzustellenden Projekts ist es in einem ersten Schritt, Handlungsmuster von Lehrpersonen beim Einsatz von neuen Medien im Unterricht der Fächer Deutsch, Mathematik und Informatik der Sekundarstufe II zu identifizieren. Zu diesem Zweck werden Videoaufnahmen von 30 Unterrichtsstunden im Hinblick auf zugrunde liegende ‚Unterrichtsscripts’ (i.e. didaktische Routinen analysiert und die subjektiven Theorien der Lehrkräfte zum Lehren und Lernen erhoben. Bei der Zusammensetzung der Stichprobe findet neben der Variation der Fachzugehörigkeit der Expertisegrad der Lehrpersonen bezogen auf den Einsatz neuer Medien Berücksichtigung, und zwar in zwei Abstufungen (hoch – niedrig. Auf diese Weise wird ermöglicht, in einem zweiten Schritt begründet Hypothesen zu Zusammenhängen zwischen Handlungsmustern sowie Fach und Expertise als Kontextfaktoren zu generieren und mögliche Geltungsbereiche zu beschreiben. Über diese Grundlagenforschung hinausgehend sollen in einem dritten Schritt anhand der gewonnenen Erkenntnisse Interventionen entwickelt werden, die eine Weiterentwicklung von Lehrerhandeln beim Einsatz neuer Medien im Unterricht ermöglichen. Hier stellt sich allerdings die Frage, wie sich Handeln grundsätzlich verändern lässt.

  16. Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients.

    Science.gov (United States)

    Aveta, Achille; Casati, Paolo

    2008-01-01

    Facial injuries are often accompanied by soft tissue injuries. The complexity of these injuries is represented by the potential for loss of relationships between the functional and the aesthetic subunits of the head. Most reviews of craniofacial trauma have concentrated on fractures. With this article, we want to emphasize the importance of early aesthetic reconstruction of the face in polytrauma patients. We present 13 patients with soft tissue injuries of the face, treated in our emergency department in the 'day one surgery", without "second look"procedures. The final result always restored a sense of normalcy to the face. The face is the first most visible part of the human anatomy, so, in emergency, surgeons must pay special attention also to the reconstruction of the face, in polytrauma patients.

  17. Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

    Directory of Open Access Journals (Sweden)

    Andrew M. Mason

    2009-01-01

    Full Text Available A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

  18. The value of precontrast thoraco-abdominopelvic CT in polytrauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Esposito, A.A., E-mail: rxandreaesposito@yahoo.it [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy); Zilocchi, M., E-mail: massimo.zilocchi@gmail.com [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy); Fasani, P., E-mail: fasapier65@gmail.com [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy); Giannitto, C., E-mail: caterina.giannitto@gmail.com [School of Radiology, University of Milan, Via A. di Rudinì 8, Milan (Italy); Maccagnoni, S., E-mail: maccagnnisara@libero.it [School of Radiology, University of Milan, Via A. di Rudinì 8, Milan (Italy); Maniglio, M., E-mail: marinamaniglio@gmail.com [School of Radiology, University of Milan, Via A. di Rudinì 8, Milan (Italy); Campoleoni, M., E-mail: campoleoni@policlinico.mi.it [Medical Phisic Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20121 Milan (Italy); Brambilla, R., E-mail: roberto.brambilla@policlinico.mi.it [Medical Phisic Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20121 Milan (Italy); Casiraghi, E., E-mail: casiraghi@di.unimi.it [Computer Science Department, University of Milan, Via Comelico 39, Milan (Italy); Biondetti, P.R., E-mail: pibionde@tin.it [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy)

    2015-06-15

    Highlights: • We evaluated the additional value of precontrast CT in polytrauma patient. • We evaluated the radiation dose CT in polytrauma patient. • Precontrast CT scan does not have an additional value in polytrauma patient. • Precontrast CT expose patient to an unjustified radiation dose. - Abstract: Purpose: To evaluate the utility and radiation dose of thoraco-abdominopelvic precontrast CT in polytrauma patients. Materials and methods: We examined retrospectively 125 patients who underwent a thoraco-abdominopelvic CT for trauma. Two radiologists, independently, evaluated precontrast CT acquisition and two other radiologists examined the contrast-enhanced scans. A further two radiologists assessed both the acquisitions. Mean value of sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated by each group of radiologists. For 104 patients, CTDIvol, DLP data and individual mean size were collected to calculate effective dose. Results: Mean values of SE, SP, PPV and NPV of findings of radiologists who assessed contrast-enhanced acquisitions were respectively: SE = 85%, SP = 98%, PPV = 86%, NPV = 88% versus: SE = 43%, SP = 95%, PPV = 69%, NPV = 88% of radiologists who examined non-contrast-enhanced scans. Mean values of radiologists who analyzed both acquisitions were: SE = 80%, SP = 97%, PPV = 80%, NPV = 88%. Neither the precontrast scans nor the precontrast and postcontrast scans together provided additional useful information compared to the single contrast-enhanced acquisition. Patients received a mean dose of 12 mSv for the precontrast CT. Conclusions: Precontrast CT acquisition did not provide significant information in trauma patients, exposing them to an unjustified radiation dose.

  19. The value of precontrast thoraco-abdominopelvic CT in polytrauma patients

    International Nuclear Information System (INIS)

    Esposito, A.A.; Zilocchi, M.; Fasani, P.; Giannitto, C.; Maccagnoni, S.; Maniglio, M.; Campoleoni, M.; Brambilla, R.; Casiraghi, E.; Biondetti, P.R.

    2015-01-01

    Highlights: • We evaluated the additional value of precontrast CT in polytrauma patient. • We evaluated the radiation dose CT in polytrauma patient. • Precontrast CT scan does not have an additional value in polytrauma patient. • Precontrast CT expose patient to an unjustified radiation dose. - Abstract: Purpose: To evaluate the utility and radiation dose of thoraco-abdominopelvic precontrast CT in polytrauma patients. Materials and methods: We examined retrospectively 125 patients who underwent a thoraco-abdominopelvic CT for trauma. Two radiologists, independently, evaluated precontrast CT acquisition and two other radiologists examined the contrast-enhanced scans. A further two radiologists assessed both the acquisitions. Mean value of sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated by each group of radiologists. For 104 patients, CTDIvol, DLP data and individual mean size were collected to calculate effective dose. Results: Mean values of SE, SP, PPV and NPV of findings of radiologists who assessed contrast-enhanced acquisitions were respectively: SE = 85%, SP = 98%, PPV = 86%, NPV = 88% versus: SE = 43%, SP = 95%, PPV = 69%, NPV = 88% of radiologists who examined non-contrast-enhanced scans. Mean values of radiologists who analyzed both acquisitions were: SE = 80%, SP = 97%, PPV = 80%, NPV = 88%. Neither the precontrast scans nor the precontrast and postcontrast scans together provided additional useful information compared to the single contrast-enhanced acquisition. Patients received a mean dose of 12 mSv for the precontrast CT. Conclusions: Precontrast CT acquisition did not provide significant information in trauma patients, exposing them to an unjustified radiation dose

  20. Outcome differences in adolescent blunt severe polytrauma patients managed at pediatric versus adult trauma centers.

    Science.gov (United States)

    Rogers, Amelia T; Gross, Brian W; Cook, Alan D; Rinehart, Cole D; Lynch, Caitlin A; Bradburn, Eric H; Heinle, Colin C; Jammula, Shreya; Rogers, Frederick B

    2017-12-01

    Previous research suggests adolescent trauma patients can be managed equally effectively at pediatric and adult trauma centers. We sought to determine whether this association would be upheld for adolescent severe polytrauma patients. We hypothesized that no difference in adjusted outcomes would be observed between pediatric trauma centers (PTCs) and adult trauma centers (ATCs) for this population. All severely injured adolescent (aged 12-17 years) polytrauma patients were extracted from the Pennsylvania Trauma Outcomes Study database from 2003 to 2015. Polytrauma was defined as an Abbreviated Injury Scale (AIS) score ≥3 for two or more AIS-defined body regions. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. ATC were defined as adult-only centers, whereas standalone pediatric hospitals and adult centers with pediatric affiliation were considered PTC. Multilevel mixed-effects logistic regression models assessed the adjusted impact of center type on mortality and total complications while controlling for age, shock index, Injury Severity Score, Glasgow Coma Scale motor score, trauma center level, case volume, and injury year. A generalized linear mixed model characterized functional status at discharge (FSD) while controlling for the same variables. A total of 1,606 patients met inclusion criteria (PTC: 868 [54.1%]; ATC: 738 [45.9%]), 139 (8.66%) of which died in-hospital. No significant difference in mortality (adjusted odds ratio [AOR]: 1.10, 95% CI 0.54-2.24; p = 0.794; area under the receiver operating characteristic: 0.89) was observed between designations in adjusted analysis; however, FSD (AOR: 0.38, 95% CI 0.15-0.97; p = 0.043) was found to be lower and total complication trends higher (AOR: 1.78, 95% CI 0.98-3.32; p = 0.058) at PTC for adolescent polytrauma patients. Contrary to existing literature on adolescent trauma patients, our results suggest patients aged 12-17 presenting with polytrauma may experience

  1. Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center.

    Science.gov (United States)

    El Mestoui, Zainab; Jalalzadeh, Hamid; Giannakopoulos, Georgios F; Zuidema, Wietse P

    2017-02-01

    Earlier studies assessing mortality in polytrauma patients have focused on improving trauma care and reducing complications during hospital stay. The same studies have shown that the complication rate in these patients is high, often resulting in death. The aim of this study was to assess the incidence and causes of mortality in polytrauma patients in our institute. Secondarily, we assessed the donation and autopsy rates and outcome in these patients. All polytrauma patients (injury severity score≥16) transported to and treated in our institute during a period of 6 years were retrospectively analyzed. We included all patients who died during hospital stay. Prehospital and in-hospital data were collected on patients' condition, diagnostics, and treatment. The chance of survival was calculated according to the TRISS methodology. Patients were categorized according to the complications during treatment and causes of death. Logistic regression analysis was used to design a prediction model for mortality in major trauma. A statistical analysis was carried out. Of the 1073 polytrauma patients who were treated in our institute during the study period, 205 (19.1%) died during hospital stay. The median age of the deceased patients was 58.8 years and 125 patients were men. Their mean injury severity score was 30.4. The most common mechanism of injury involved fall from height, followed by bicycle accidents. Almost 50% of the patients underwent an emergency intervention. Almost 92% of the total population died because of the effects of the accident (primary trauma). Of these, 24% died during primary assessment in the emergency department. Most patients died because of the effects of severe head injury (63.4%), followed by exsanguination (17.6%). The most common type of complications causing death during treatment was respiratory failure (6.3%), followed by multiple organ failure (1.5%). Autopsy was performed in 10.4%. Organ donation procedure was performed in 14

  2. Does the applied polytrauma definition notably influence outcome and patient population? - a retrospective analysis.

    Science.gov (United States)

    Frenzel, Stephan; Krenn, Philipp; Heinz, Thomas; Negrin, Lukas Leopold

    2017-08-31

    Although the term "polytrauma" has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient population result in diverse subgroups of individuals, who in turn present a varying outcome. All patients (≥18 years) treated at our level I trauma center within a time period of three years were classified according to 11 selected polytrauma definitions and included in our study, if they were rated "polytraumatized" by at least one of these definitions. All patients, who met the criteria of a certain definition, were combined to the relevant definition-positive group, thus resulting in 11 patient subgroups. Their demographic data (number of patients, mean patient age, mean Injury Severity Score value, median number of ventilator days, median length of stay at the intensive care unit and at the hospital, mortality rate and odds ratio) were statistically compared. Three hundred seventy-five patients (73% male) with a mean age of 47 years met the inclusion criteria and were allocated to the relevant subgroups; their patient number varied from 55 to 346 and their mean Injury Severity Score value ranged from 4 to 75. Not surprisingly, all examined parameters were subject to variations. Whereas most definition-positive groups showed a mortality rate of about 21% to 30%, 18% of the individuals, who met the criteria according to Blacker, and 40% of the polytrauma victims according to Schalamon died. The Pape 1-, Schalamon-, and Berlin-positive groups presented a significant odds ratio with regard to mortality that considerably exceeded 1. A polytrauma definition can only be a reliable tool in classifying trauma victims if it provides a significant odds ratio with regard to mortality that considerably exceeds 1 and if it succeeds in capturing patients with multiple severe injuries and a higher mortality rate without reducing the number of polytraumatized

  3. Radiotherapeutic concepts in cancer of unknown primary site; Strahlentherapeutische Konzepte beim CUP-Syndrom

    Energy Technology Data Exchange (ETDEWEB)

    Krug, D.; Debus, J.; Sterzing, F. [Universitaetsklinikum Heidelberg, Klinik fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany)

    2014-02-15

    The term cancer of unknown primary (CUP) encompasses a group of entities which differ to a great extent regarding etiology, prognosis and therapeutic management. The aim of the study was an elaboration of the role of radiotherapy in CUP syndrome. Systematic literature search and specification of the available treatment options. Radiotherapy is an integral part of interdisciplinary management approaches for patients with CUP in both curative and palliative situations. Radio-oncological techniques, such as intensity-modulated radiotherapy and stereotactic body radiotherapy increase the therapeutic window. Modern diagnostic modalities from radiology and nuclear medicine are the cornerstone of radiotherapeutic interventions, especially in terms of target volume definition and pretherapeutic staging. In the interdisciplinary setting radiation oncology offers the possibility of curative and often organ preserving approaches in patients with axillary and cervical CUP. In addition, improvement and preservation of quality of life can be achieved in patients with metastatic disease. Radiation oncology is a crucial component of the interdisciplinary management of patients with CUP. Therapeutic decisions in patients with CUP should be made in an interdisciplinary setting. (orig.) [German] Das Cancer-of-unknown-primary(CUP)-Syndrom fasst eine Gruppe von Erkrankungen zusammen, die durch eine ausgepraegte Heterogenitaet hinsichtlich Aetiologie, Therapie und Prognose gepraegt sind. Darstellung der Rolle der Strahlentherapie beim CUP-Syndrom. Systematische Literaturrecherche und Erlaeuterung der Behandlungsoptionen. Die Strahlentherapie ist beim CUP-Syndrom sowohl in adjuvanten und definitiven Therapiekonzepten wie auch in palliativer Intention etabliert. Technisch innovative Verfahren wie die intensitaetsmodulierte Radiotherapie und die stereotaktische Bestrahlung im Koerperstammbereich ermoeglichen eine Vergroesserung der therapeutischen Breite. Eine leistungsfaehige und moderne

  4. Crucial role of IL1beta and C3a in the in vitro-response of multipotent mesenchymal stromal cells to inflammatory mediators of polytrauma.

    Directory of Open Access Journals (Sweden)

    Nina-Emily Hengartner

    Full Text Available Multipotent mesenchymal stromal cells (MSC exert immune-modulatory effects and support tissue regeneration in various local trauma models. In case of a polytrauma, high amounts of danger-associated molecular patterns are released, leading to a systemic increase of inflammatory mediators. The influence of such a complex inflammatory microenvironment on human MSC is mainly unknown so far. Therefore, we investigated the effects of a defined serum-free polytrauma "cocktail" containing IL beta, IL6, IL8 and the anaphylatoxins C3a and C5a, in concentrations corresponding to those measured in the blood of polytrauma patients, on human MSC in vitro. The polytrauma cocktail induced directed migration of MSC with C3a representing its major soluble chemoattractive agent. Furthermore, the polytrauma cocktail and IL1beta upregulated the expression of MMP1 indicating a potential role of IL1beta to enhance MSC migration in the tissue context. COX2, PTGES and TSG6 were also found to be upregulated upon stimulation with the polytrauma cocktail or IL1beta, but not through other single factors of the polytrauma cocktail in pathophysiologically relevant concentrations. An RNA expression array of 84 inflammation-related genes revealed that both the polytrauma cocktail and IL1beta induced C3, CSF1, TLR3 and various chemokines without major qualitative or quantitative differences. These results indicate that IL1beta is a crucial mediator of the polytrauma cocktail in terms of immune-modulation and MMP1 expression. Thus, upon encountering the primary sterile, inflammatory milieu of a polytrauma, endogenous or systemically transfused MSC might be able to migrate to sites of injury, secrete TSG6 and PGE2 and to influence macrophage biology as observed in local trauma models.

  5. Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients.

    Science.gov (United States)

    Elbaih, Adel Hamed; Housseini, Ahmed Mohamed; Khalifa, Mohamed E M

    2018-03-26

    "Polytrauma" patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography (pan-CT) were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support (ATLS) guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock (64%), followed by obstructive shock (14%), distributive shock (12%) and cardiogenic shock (10%) respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT. Copyright © 2018 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  6. Untersuchungen zur Involution der Vagina and Zervix beim Rind post partum unter Berücksichtigung der Zervix als Geburtshindernis

    OpenAIRE

    Wehrend, Axel

    2002-01-01

    Ziel der vorliegenden Arbeit war es die physiologische Involution der Zervix im Vergleich zur Vagina beim Rind während der ersten zehn Tage post partum zu charakterisieren. Weiterhin sollte durch klinische Untersuchungen an Kühen nach Dystokie und einer retrospektiven Datenauswertung von Schwergeburten unterschiedlicher Tierarten der Anteil zervikal bedingter Geburtsstockungen im Interspeziesvergleich analysiert und Einflussfaktoren auf das Auftreten dieser Dystokieform sowie Störungen in der...

  7. The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.

    Science.gov (United States)

    Licht, Heather; Murray, Mark; Vassaur, John; Jupiter, Daniel C; Regner, Justin L; Chaput, Christopher D

    2015-11-18

    With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  8. Systemic release of cytokines and heat shock proteins in porcine models of polytrauma and hemorrhage

    Science.gov (United States)

    Baker, Todd A.; Romero, Jacqueline; Bach, Harold H.; Strom, Joel A.; Gamelli, Richard L.; Majetschak, Matthias

    2011-01-01

    Objective To define systemic release kinetics of a panel of cytokines and heat shock proteins (HSP) in porcine polytrauma/hemorrhage models and to evaluate whether they could be useful as early trauma biomarkers. Design and Setting Prospective study in a research laboratory. Subjects Twenty-one Yorkshire pigs. Measurements and Main Results Pigs underwent polytrauma (femur fractures/lung contusion, P), hemorrhage (mean arterial pressure 25-30mmHg, H), polytrauma plus hemorrhage (P/H) or sham procedure (S). Plasma was obtained at baseline, in 5-15min intervals during a 60min shock period without intervention and in 60-120min intervals during fluid resuscitation for up to 300min. Plasma was assayed for IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12/IL-23p40, IL-13, IL-17, IL-18, IFNγ, TGFβ, TNFα, HSP40, HSP70 and HSP90 by ELISA. All animals after S, P and H survived (n=5/group). Three of six animals after P/H died. IL-10 increased during shock after P and this increase was attenuated after H. TNFα increased during the shock period after P, H and also after S. P/H abolished the systemic IL-10 and TNFα release and resulted in 20-30% increased levels of IL-6 during shock. As fluid resuscitation was initiated TNFα and IL-10 levels decreased after P, H and P/H, HSP 70 increased after P, IL-6 levels remained elevated after P/H and also increased after P and S. Conclusions Differential regulation of the systemic cytokine release after polytrauma and/or hemorrhage, in combination with the effects of resuscitation, can explain the variability and inconsistent association of systemic cytokine/HSP levels with clinical variables in trauma patients. Insults of major severity (P/H) partially suppress the systemic inflammatory response. The plasma concentrations of the measured cytokines/HSPs do not reflect injury severity or physiological changes in porcine trauma models and are unlikely to be able to serve as useful trauma biomarkers in patients. PMID:21983369

  9. Kinked and retained nasogastric tube in polytrauma patient; a case report

    Directory of Open Access Journals (Sweden)

    Kumar Ashok

    2017-06-01

    Full Text Available Enteral feeding is an important and preferred technique of feeding in head injury patient to provide nutrition. As inadequate nutrition causes decrease in physical ability, neurological impairment and takes a long time for improvement or delayed deterioratation. With our best knowledge kinked and retained nasogastric tube in stomach is a very rare complication of feeding in head injuries patients. Predisposing factors that can cause kinking is excess tube length, tube in situ for long time and small bore tube. We are reporting one such case of kinked and retained nasogastric tube in the stomach of a polytrauma patient which was retrieved by upper GI endoscope.

  10. Juvenile Stroke: Cervical Artery Dissection in a Patient after a Polytrauma

    Directory of Open Access Journals (Sweden)

    Nicole Marschner-Preuth

    2013-01-01

    Full Text Available Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (polytrauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms.We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm.To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.

  11. Penetrating Cardiac and Hepatic Injury; Polytrauma of a Child After Bombing

    Directory of Open Access Journals (Sweden)

    Baris Akca

    2013-10-01

    Full Text Available After a bombing attack, patients were brought into hospital suffering from a combination of injuries caused by the blast, penetrating injuries and burns which as a case of polytrauma. In penetrating thoracoabdominal injuries due to bombing possibility of cardiac injury should be kept in mind. Penetrating cardiac injuries in children are rare but has a high mortality and morbidity. In some cases there may be difficulty in diagnosis of penetrating cardiac injury. In this case we want to share the diagnosis, treatment and follow-up processes of penetrating cardiac and hepatic injury with burns of a politrauma child due to bombing.

  12. Modern imaging technology for childhood urinary tract infection; Moderne Bildgebung beim Harnweginfekt im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, M.; Fotter, R. [Radiologische Universitaetsklinik Graz (Germany). Abteilung Kinderradiologie

    2005-12-01

    Imaging in childhood urinary tract infection (UTI) is still a matter of debate. There are established guidelines, however new knowledge and the changed medical environment have enhanced this ongoing discussion. These new insights have impacted therapy and consequently the imaging algorithm. Modern imaging methods - particularly MRI and modern ultrasound (US) - are less invasive with a lower radiation burden. Additionally, it has been shown that VUR is a poor predictor for renal scarring out, which affects long-term results. Furthermore, the majority of UT malformations is depicted by prenatal US. The most crucial aspect of improving long-term outcome appears to be the early and reliable depiction of UTI and effective treatment to prevent renal scarring. This review tries to present this new knowledge and to discuss the potential of modern imaging. Recent changes in imaging algorithms are highlighted and an outcome-oriented algorithm that addresses these recent developments is proposed, without lightly abandoning established standards. It consists of an orienting US and - for depiction of renal involvement - amplitude coded color Doppler sonography or renal static scintigraphy (considered the gold standard, particularly for evaluating scars); in future MRI may play a role. Based on this concept, only patients with renal damage as well as patients with complex urinary tract malformations or intractable recurrent UTI may have to undergo VCUG. (orig.) [German] Die bildgebende Diagnostik beim kindlichen Harnweginfekt (HWI) wird weiterhin heftig diskutiert. Zwar existieren etablierte Bildgebungsalgorithmen, insbesondere fuer das Kleinkindesalter; neue Erkenntnisse bzw. Aufgabenstellungen haben aber zu einer Aenderung des Therapiekonzepts mit Auswirkungen auf die Bildgebung gefuehrt. Zusaetzlich haben technische (Weiter)Entwicklungen das Potenzial der Bildgebung erweitert; v. a. MRT und moderne Ultraschallverfahren versprechen eine weniger invasive und strahlenfreie

  13. Neodadjuvante und adjuvante Kurzzeit-Hormontherapie in Kombination mit konformaler HDR-Brachytherapie beim Prostatakarzinom

    Directory of Open Access Journals (Sweden)

    Martin T

    2004-01-01

    Full Text Available Zielsetzung: Auswertung der Behandlungsergebnisse der neoadjuvanten und adjuvanten Kurzzeit-Hormontherapie kombiniert mit konformaler HDR-Brachytherapie und externer Radiotherapie beim Prostatakarzinom. Patienten und Methoden: Von 01/97 bis 09/99 behandelten wir 102 Patienten mit Prostatakarzinomen im Stadium T1–3 N0 M0. Im Stadium T1–2 befanden sich 71, im Stadium T3 31 Patienten. Der mediane prätherapeutische PSA-Wert betrug 15,3 ng/ml. Nach ultraschallgesteuerter transrektaler Implantation von vier Afterloadingnadeln erfolgte die CT-gestützte 3D-Brachytherapie- Planung. Alle Patienten erhielten vier HDR-Implantate mit einer Referenzdosis von 5 Gy oder 7 Gy pro Implantat. Die Zeit zwischen jedem Implantat betrug jeweils 14 Tage. Nach der Brachytherapie folgte die externe Radiotherapie bis 39,6 Gy oder 45,0 Gy. Alle Patienten erhielten eine neoadjuvante und adjuvante Kurzzeit-Hormontherapie, die 2–19 Monate vor der Brachytherapie eingeleitet und 3 Monate nach Abschluß der externen Radiotherapie abgesetzt wurde (mediane Dauer: 9 Monate. Ergebnisse: Die mediane Nachbeobachtungszeit war 2,6 Jahre (range: 2,0–4,1 Jahre. Die biochemische Kontrollrate betrug 82 % nach 3 Jahren. Bei 14/102 Patienten registrierten wir ein biochemisches Rezidiv, bei 5/102 Patienten ein klinisches Rezidiv. Das Gesamtüberleben betrug 90 %, das krankheitsspezifische Überleben 98,0 % nach 3 Jahren. Ein Patient entwickelte eine prostato-urethro-rektale Fistel als späte Grad 4-Toxizität. Akute Grad-3 Toxizitäten traten bei 4 %, späte Grad-3 Toxizitäten bei 5 % der Patienten auf. Schlußfolgerung: Die neoadjuvante und adjuvante Kurzzeit-Hormontherapie kombiniert mit konformaler HDR-Brachytherapie und externer Radiotherapie erweist sich als sichere und wirksame Behandlungsmodalität beim Prostatakarzinom mit minimalen behandlungsbedingten Toxizitäten und einer vielversprechenden biochemischen Kontrollrate nach medianer Nachbeobachtungszeit von 2,6 Jahren.

  14. Clinical information seeking in traumatic brain injury: a survey of Veterans Health Administration polytrauma care team members.

    Science.gov (United States)

    Hogan, Timothy; Martinez, Rachael; Evans, Charlesnika; Saban, Karen; Proescher, Eric; Steiner, Monica; Smith, Bridget

    2018-03-01

    The polytraumatic nature of traumatic brain injury (TBI) makes diagnosis and treatment difficult. To (1) characterise information needs among Veterans Health Administration (VHA) polytrauma care team members engaged in the diagnosis and treatment of TBI; (2) identify sources used for TBI related information; and (3) identify barriers to accessing TBI related information. Cross-sectional online survey of 236 VHA polytrauma care team members. Most respondents (95.8%) keep at least somewhat current regarding TBI, but 31.5% need more knowledge on diagnosing TBI and 51.3% need more knowledge on treating TBI. Respondents use VHA affiliated sources for information, including local colleagues (81.7%), VHA offsite conferences/meetings (78.3%) and onsite VHA educational offerings (73.6%); however, limited time due to administrative responsibilities (50.9%), limited financial resources (50.4%) and patient care (50.4%) were prominent barriers. Medical librarians are in a unique position to develop information services, resources and other electronic tools that reflect the clinical context in which polytrauma care team members practice, and the different tasks they perform. Polytrauma care team members could benefit from additional information regarding the diagnosis and treatment of TBI. Addressing their information needs and supporting their information seeking requires a mulit-pronged approach to time and financial constraints. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  15. Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

    International Nuclear Information System (INIS)

    Schlorhaufer, C.; Behrends, M.; Diekhaus, G.; Keberle, M.; Weidemann, J.

    2012-01-01

    Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

  16. Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

    Energy Technology Data Exchange (ETDEWEB)

    Schlorhaufer, C., E-mail: Schlorhaufer.Celia@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Behrends, M., E-mail: behrends.marianne@mh-hannover.de [Peter L. Reichertz Department of Medical Informatics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Diekhaus, G., E-mail: Diekhaus.Gesche@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Keberle, M., E-mail: m.keberle@bk-paderborn.de [Department of Diagnostic and Interventional Radiology, Brüderkrankenhaus St. Josef Paderborn, Husener Str. 46, 33098 Paderborn (Germany); Weidemann, J., E-mail: Weidemann.Juergen@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany)

    2012-12-15

    Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

  17. IDENTIFICATION AND DESCRIPTION OF A NOVEL MURINE MODEL FOR POLYTRAUMA AND SHOCK

    Science.gov (United States)

    Gentile, Lori F; Nacionales, Dina C; Cuenca, Alex G; Armbruster, Michael; Ungaro, Ricardo F; Abouhamze, Amer S; Lopez, Cecelia; Baker, Henry V; Moore, Frederick A; Ang, Darwin N; Efron, Philip A

    2013-01-01

    Objective To develop a novel polytrauma model that better recapitulates the immunological response of the severely injured patient by combining long-bone fracture, muscle tissue damage and cecectomy with hemorrhagic shock, resulting in an equivalent Injury Severity Score of greater than 15. We compared this new polytrauma/shock model to historically-used murine trauma-hemorrhage models. Design Pre-clinical controlled in vivo laboratory study. Setting Laboratory of Inflammation Biology and Surgical Science. Subjects 6–10 wk old C57BL/6 (B6) mice Interventions Mice underwent 90 minutes of shock (MAP 30 mmHg) and resuscitation via femoral artery cannulation followed by either laparotomy (TH), laparotomy with femur fracture (H+FFx), or laparotomy with cecetomy and femur fracture with muscle tissue damage (PT). Mice were euthanized at two hours, one day and three days post injury. Measurements and Main Results The spleen, bone marrow, blood, and serum were collected from mice for analysis at the above time points. None of the models were lethal. Mice undergoing PT exhibited a more robust inflammatory response with significant elevations in cytokine/chemokine concentrations when compared to traditional models. PT was the only model to induce neutrophilia (Ly6G+CD11b+ cells) on days 1 and 3 (ppolytrauma model better replicates the human leukocyte, cytokine, and overall inflammatory response following injury and hemorrhagic shock. PMID:23399937

  18. Evaluation of the polytrauma victim by the nursing staff in an emergency service of Santa Catarina

    Directory of Open Access Journals (Sweden)

    Leandro Sanceverino Mattos

    2012-06-01

    Full Text Available Objective: To investigate the actions developed by the nursing staff of a private hospital emergency service in the southern Santa Catarina (SC, related to primary and secondary evaluation of polytrauma victims. Methods: Research of a qualitative approach, the type of case study, performed with twelve nurses. Sample has been characterized as non-probabilistic intentional. Data collection has been performed using the techniques of semi-structured interview and participant observation. Data analysis has been developed using the technique of content analysis. Results: Analysis of nurses’ testimonies and the results of observation have showed that most participants comprehend the importance of adopting the ABCDE rule in primary evaluation - A (Air Way - airway permeability with safe administration of cervical collar; B (Breathing; C (Circulation - search for bleeding and control; D (Disability - neurological evaluation; e E (Exposure - patient’s body exposition seeking missed injuries - and the need of meticulous secondary evaluation of polytrauma victim. However, due to demand of urgency and agility in emergencies of this nature, the rule is not followed in a systematic way. Conclusion: It has been demonstrated the nursing staff’s concern over the following aspects: agility of service; immediate performance of examinations; communication between emergency service professionals; adequate perception of the general condition of the victim; and the reception to victim and family.

  19. Radiological management of blunt polytrauma with computed tomography and angiography: an integrated approach

    Energy Technology Data Exchange (ETDEWEB)

    Kurdziel, J.C.; Dondelinger, R.F.; Hemmer, M.

    1987-01-01

    107 polytraumatized patients, who had experienced blunt trauma have been worked up at admission with computed tomography of the thorax, abdomen and pelvis following computed tomography study of the brain: significant lesions were revealed in 98 (90%) patients. 79 (74%) patients showed trauma to the thorax, in 69 (64%) patients abdominal or pelvic trauma was evidenced. No false positive diagnosis was established. 5 traumatic findings were missed. Emergency angiography was indicated in 3 (3%) patients, following computed tomography examination. 3 other trauma patients were submitted directly to angiography without computed tomography examination during the time period this study was completed. Embolization was carried out in 5/6 patients. No thoracotomy was needed. 13 (12%) patients underwent laparotomy following computed tomography. Overall mortality during hospital stay was 14% (15/107). No patient died from visceral bleeding. Conservative management of blunt polytrauma patients can be advocated in almost 90% of visceral lesions. Computed tomography coupled with angiography and embolization represent an adequate integrated approach to the management of blunt polytrauma patients.

  20. Provisional reporting of polytrauma CT by on-call radiology registrars. Is it Safe?

    Energy Technology Data Exchange (ETDEWEB)

    Briggs, R.H., E-mail: robbriggs@hotmail.co.u [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Rowbotham, E.; Johnstone, A.L.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2010-08-15

    Aim: To assess the accuracy of provisional reporting and the impact on patient management. Materials and methods: Over a 6 month period, 137 polytrauma computed tomography (CT) examinations were performed by on-call registrar radiologists at our institution. After exclusions, 130 cases were analysed. Discrepancies between registrar and consultant reports were reviewed and classified as either major or minor dependent on potential impact on patient safety. The relationship between seniority of reporting registrar and likelihood of a missed finding was analysed using the Chi-square test. Results: Of the 130 patients, 46 (35%) had a serious injury, 36 (28%) a minor injury, and 48 (38%) no identifiable injury on CT. There were 32 (25%) patients with discrepancies of which 24 (18%) had missed or significantly under-reported findings and eight (6%) overcalled findings. There were six misses classified as major; the remaining 18 were classified as minor. No association was found between the seniority of reporting registrar and the likelihood of a miss (p = 0.96). Conclusion: The incidence of major discrepancies between the provisional and final report was low and did not lead to any significant clinical deterioration. Our study provides a reference of the commonly missed injuries. We conclude that registrar provisional reporting of polytrauma is safe; however, note that a large proportion of examinations are normal and that further work is required to produce robust criteria given the radiation risk to a young population group scanned in trauma.

  1. Provisional reporting of polytrauma CT by on-call radiology registrars. Is it Safe?

    International Nuclear Information System (INIS)

    Briggs, R.H.; Rowbotham, E.; Johnstone, A.L.; Chalmers, A.G.

    2010-01-01

    Aim: To assess the accuracy of provisional reporting and the impact on patient management. Materials and methods: Over a 6 month period, 137 polytrauma computed tomography (CT) examinations were performed by on-call registrar radiologists at our institution. After exclusions, 130 cases were analysed. Discrepancies between registrar and consultant reports were reviewed and classified as either major or minor dependent on potential impact on patient safety. The relationship between seniority of reporting registrar and likelihood of a missed finding was analysed using the Chi-square test. Results: Of the 130 patients, 46 (35%) had a serious injury, 36 (28%) a minor injury, and 48 (38%) no identifiable injury on CT. There were 32 (25%) patients with discrepancies of which 24 (18%) had missed or significantly under-reported findings and eight (6%) overcalled findings. There were six misses classified as major; the remaining 18 were classified as minor. No association was found between the seniority of reporting registrar and the likelihood of a miss (p = 0.96). Conclusion: The incidence of major discrepancies between the provisional and final report was low and did not lead to any significant clinical deterioration. Our study provides a reference of the commonly missed injuries. We conclude that registrar provisional reporting of polytrauma is safe; however, note that a large proportion of examinations are normal and that further work is required to produce robust criteria given the radiation risk to a young population group scanned in trauma.

  2. [Polytrauma following a truck accident : How to save lives by guideline-oriented emergency care].

    Science.gov (United States)

    Kippnich, M; Jelting, Y; Markus, C; Kredel, M; Wurmb, T; Kranke, P

    2017-12-01

    Identification and immediate treatment of life-threatening conditions is fundamental in patients with multiple trauma. In this context, the S3 guidelines on polytrauma and the S1 guidelines on emergency anesthesia provide the scientific background on how to handle these situations. This case report deals with a seriously injured driver involved in a truck accident. The inaccessible patient showed a scalping injury of the facial skeleton with massive bleeding and partially blocked airway but with spontaneous breathing as well as centralized cardiovascular circulation conditions and an initial Glasgow coma scale (GCS) of 8. An attempt was made to stop the massive bleeding by using hemostyptic-coated dressings. In addition, the patient was intubated via video laryngoscopy and received a left and right thoracic drainage as well as two entry points for intraosseous infusion. In modern emergency medical services, treatment based on defined algorithms is recommended and also increasingly established in dealing with critical patients. The guideline-oriented emergency care of patients with polytrauma requires invasive measures, such as intubation and thoracic decompression in the preclinical setting. The foundation for this procedure includes training in theory and practice both of the non-medical and medical rescue service personnel.

  3. Radiological management of blunt polytrauma with computed tomography and angiography: an integrated approach

    International Nuclear Information System (INIS)

    Kurdziel, J.C.; Dondelinger, R.F.; Hemmer, M.

    1987-01-01

    107 polytraumatized patients, who had experienced blunt trauma have been worked up at admission with computed tomography of the thorax, abdomen and pelvis following computed tomography study of the brain: significant lesions were revealed in 98 (90%) patients. 79 (74%) patients showed trauma to the thorax, in 69 (64%) patients abdominal or pelvic trauma was evidenced. No false positive diagnosis was established. 5 traumatic findings were missed. Emergency angiography was indicated in 3 (3%) patients, following computed tomography examination. 3 other trauma patients were submitted directly to angiography without computed tomography examination during the time period this study was completed. Embolization was carried out in 5/6 patients. No thoracotomy was needed. 13 (12%) patients underwent laparotomy following computed tomography. Overall mortality during hospital stay was 14% (15/107). No patient died from visceral bleeding. Conservative management of blunt polytrauma patients can be advocated in almost 90% of visceral lesions. Computed tomography coupled with angiography and embolization represent an adequate integrated approach to the management of blunt polytrauma patients

  4. The Relationship between Training and Mental Health among Caregivers of Individuals with Polytrauma

    Directory of Open Access Journals (Sweden)

    Lillian Flores Stevens

    2015-01-01

    Full Text Available This was a hypothesis-generating exploration of relationships between caregiver training during TBI/polytrauma rehabilitation and caregiver mental health. In this cross-sectional study, 507 informal caregivers to US service members with TBI who received inpatient rehabilitation care in a Veterans Affairs’ Polytrauma Rehabilitation Center from 2001 to 2009 completed a retrospective, self-report survey. Embedded in the survey were measures of caregiver mental health, including the National Institutes of Health’s Patient Reported Outcome Measurement Information System (PROMIS Anxiety and Depression Short Forms, the Rosenberg Self-Esteem scale, and the Zarit Burden Short Form. Though no groups endorsed clinical levels, mental health symptoms varied by caregiver training category (Trained, Not Trained, and Did Not Need Training. Caregivers who did not receive training on how to navigate healthcare systems endorsed higher depression and burden and lower self-esteem than those who did. Caregivers who did not receive training in supporting their care recipients’ emotions endorsed higher anxiety, depression, and burden and lower self-esteem than those who did. Analyses also suggested a different association between training and mental health based on caregivers’ relationship to the care recipient and the intensity of care recipient needs. Potential hypotheses for testing in future studies raised by these findings are discussed.

  5. The Relationship between Training and Mental Health among Caregivers of Individuals with Polytrauma

    Science.gov (United States)

    Pickett, Treven C.; Wilder Schaaf, Kathryn P.; Taylor, Brent C.; Gravely, Amy; Van Houtven, Courtney Harold; Friedemann-Sánchez, Greta; Griffin, Joan M.

    2015-01-01

    This was a hypothesis-generating exploration of relationships between caregiver training during TBI/polytrauma rehabilitation and caregiver mental health. In this cross-sectional study, 507 informal caregivers to US service members with TBI who received inpatient rehabilitation care in a Veterans Affairs' Polytrauma Rehabilitation Center from 2001 to 2009 completed a retrospective, self-report survey. Embedded in the survey were measures of caregiver mental health, including the National Institutes of Health's Patient Reported Outcome Measurement Information System (PROMIS) Anxiety and Depression Short Forms, the Rosenberg Self-Esteem scale, and the Zarit Burden Short Form. Though no groups endorsed clinical levels, mental health symptoms varied by caregiver training category (Trained, Not Trained, and Did Not Need Training). Caregivers who did not receive training on how to navigate healthcare systems endorsed higher depression and burden and lower self-esteem than those who did. Caregivers who did not receive training in supporting their care recipients' emotions endorsed higher anxiety, depression, and burden and lower self-esteem than those who did. Analyses also suggested a different association between training and mental health based on caregivers' relationship to the care recipient and the intensity of care recipient needs. Potential hypotheses for testing in future studies raised by these findings are discussed. PMID:26770015

  6. Trauma and Injury Severity Score in Predicting Mortality of Polytrauma Patients

    Directory of Open Access Journals (Sweden)

    Bambang Gunawan

    2018-01-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Abstract TRISS (Trauma and Injury Severity Score is one of the most commonly used trauma score. Currently, there is no data about using TRISS in the care of polytrauma patients at emergency department of dr. Cipto Mangunkusumo Hospital (CMH. This research was intended to evaluate whether TRISS can predict the mortality of polytrauma patients at CMH. This was an analytic descriptive study with retrospective cohort design. Data was collected from medical records of polytrauma patients who were admitted to emergency department of CMH from 2011-201 4 then we analyzed the relationship between TRISS and patient’s prognosis. Furthermore, we conducted bivariate and multivariate analysis by SPSS 20 software. Seventy medical records were included in this study. The majority of patients were male (65% in young age. There were 69 patients who experienced blunt trauma, with the majority (94.3% were caused by motor vehicle accident. After receiving trauma care, there were 26 deaths, while other 44 patients survived. From bivariate and multivariate analysis, we found a significant difference between TRISS and patient’s prognosis. TRISS strongly predicts polytrauma patient’s mortality (AUC 0,899; IK95% 0,824-0,975. TRISS has 84,6% sensitivity and 81.8% specificity with optimal intersection point ≤ 90,5. TRISS is able to predict the mortality of polytrauma patients at CMH. TRISS untuk Memprediksi Mortalitas Pasien Politrauma Abstrak TRISS merupakan salah satu penilaian trauma yang paling sering digunakan. Namun, saat ini belum ada data penggunaan TRISS dalam penanganan pasien politrauma di Instalasi Gawat Darurat (IGD Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSUPNCM. Penelitian ini bertujuan untuk mengetahui kemampuan TRISS dalam memprediksi mortalitas pasien politrauma di IGD RSUPNCM. Penelitian ini adalah studi analitik deskriptif dengan menggunakan desain kohort retrospektif. Data diambil

  7. Magnetic resonance imaging of complex congenital heart disease in aduits; Magnetresonanztomographie komplexer kongenitaler Herzerkrankungen beim Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Bremerich, J. [San Francisco Univ, CA (United States). Dept. of Radiology]|[Universitaetsklinik Basel (Switzerland). Abt. fuer Medizinische Radiologie; Wyttenbach, R.; Higgins, C.B. [San Francisco Univ, CA (United States). Dept. of Radiology; Buser, P. [Universitaetsklinik Basel (Switzerland). Abt. fuer Kardiologie; Steinbrich, W. [Universitaetsklinik Basel (Switzerland). Abt. fuer Medizinische Radiologie

    1999-04-01

    An increasing number of patients with complex congenital heart disease reaches adulthood, because treatment and patient outcome have improved considerably in recent years. Monitoring of these patients requires both definition of cardiac anatomy and assessment of function with good reproducibility. Complications after surgical repair such as restenoses of pulmonary arteries after surgical repair of Tetralogy of Fallot, ventricular hypertrophy, stenoses or leakage of baffles, or stenosis and aneurysms of anastomoses have to be detected at an early stage. Magnetic Resonance Imaging (MRI) is an excellent tool to monitor these patients because of its noninvasive nature, its good interstudy and interobserver reproducibility, and because it allows assessment of both cardiac anatomy and function. This paper reviews the current applications of MRI in complex congenital heart disease in adults. (orig.) [Deutsch] Durch Verbesserungen in der Diagnose und Therapie komplexer kongenitaler Herzerkrankungen kann eine zunehmende Anzahl von betroffenen Patienten das Erwachsenenalter erreichen. Diese Patienten benoetigen regelmaessige postoperative Verlaufskontrollen, um Komplikationen wie z.B. Restenosen der grossen Arterien, Stenosen, Lecks und Aneurysmata von Anastomosen, Ventrikelhypertrophie und -dilatation oder Klappendysfunktionen fruehzeitig zu erkennen und zu behandeln. Fuer nichtinvasive regelmaessige Verlaufskontrollen bietet sich die Magnetresonanztomographie (MRT) des Herzens an, da sie eine umfassende Untersuchung sowohl der Morphologie als auch der Funktion des Herzens mit guter Reproduzierbarkeit erlaubt. Die gegenwaertigen klinischen Anwendungen der MRT bei komplexen kongenitalen Herzerkrankungen beim Erwachsenen werden in dieser Uebersicht beschrieben. (orig.)

  8. Hilfe oder Hindernis? Meinungen finnischer Sprachstudierender über Mehrsprachigkeit als Ressource beim Deutschlernen

    Directory of Open Access Journals (Sweden)

    Sabine Grasz

    2017-10-01

    Full Text Available Der Fremdsprachenunterricht in Finnland befindet sich gerade in einer Umbruchphase, denn mit der Einführung neuer Lehrpläne im Jahr 2016 werden Verfahren der Mehrsprachigkeitsdidaktik in Zukunft eine zentrale Rolle spielen. In diesem Beitrag wird untersucht, ob und wie finnische Universitätsstudierende, die selbst von einer eher monolingual ausgerichteten Lerntradition geprägt sind, ihr mehrsprachiges Repertoire als Ressource beim Lernen weiterer Fremdsprachen sehen. Zu diesem Zweck wurde eine Befragung unter Lehramtsstudierenden der Fächer Anglistik und Skandinavistik, die Germanistik als Nebenfach studieren möchten, durchgeführt. Die Analyse zeigt, dass die Studierenden zwar mehrheitlich positive Einstellungen gegenüber Mehrsprachigkeit aufweisen, dass es aber Entwicklungsbedarf im Hinblick auf Sprachbewusstheit, multilinguale Fähigkeiten und bei den Einstellungen gegenüber Sprachmischungen gibt. Foreign language education in Finland is currently undergoing a period of change, as the introduction of new curricula in 2016 will lead to a central role of multilingualism in teaching. This article examines whether and how Finnish university students, who themselves were influenced by a more monolingual learning tradition, consider their multilingual repertoire as a resource for learning other foreign languages. For this purpose, a survey was conducted among teacher students of English and Swedish, who would like to study German as a minor. The analysis shows that while the majority of students have positive attitudes towards multilingualism, there is a need for development in terms of language awareness, multilingual skills, and attitudes towards language mixes.

  9. Tranexamic Acid Attenuates The Loss of Lung Barrier Function in a Rat Model of Polytrauma And Hemorrhage With Resuscitation.

    Science.gov (United States)

    Wu, Xiaowu; Dubick, Michael A; Schwacha, Martin G; Cap, Andrew P; Darlington, Daniel N

    2017-04-01

    Severe trauma, hemorrhage, and resuscitation can lead to a trauma-related acute lung injury that involves rapid infiltration of immune cells and platelets. This infiltration involves exymatic degradation of matrix proteins, including plasmin, and causes loss of barrier function. Since tranexamic acid (TXA) inhibits plasminogen/ plasmin binding to target substrates, it may attenuate loss of barrier function after severe trauma, hemorrhage, and resuscitation. Sprague-Dawley rats were subjected to polytrauma (laparotomy, and trauma to intestines, liver, right leg skeletal muscle, and right femur fracture), then bled 40% of their blood volume. One hour after completion of polytrauma and hemorrhage, resuscitation was begun with fresh whole blood (FWB) or FWB with prior bolus administration of TXA (10 mg/kg in 0.2 mL). Polytrauma, hemorrhage, and resuscitation with FWB led to an elevation in lung water content that was significantly reduced with TXA administration. Polytrauma and hemorrhage led to rise in the number of neutrophils/monocytes and platelets in the lungs, and a rise in myeloperoxidase (MPO), neutrophil elastase and complement C5a content. While resuscitation with FWB significantly reduced the cellular infiltrate and MPO, FWB/TXA further reduced the levels of neutrophil/monocytes, neutrophil elastase, and complement C5a. Polytrauma and hemorrhage led to rise in lung plasmin activity that was significantly reduced with either FWB or FWB/TXA resuscitation. Severe trauma and hemorrhage leads to increases in lung water content, and immune cell, platelets, MPO, elastase, and C5a content in lung tissue, all markers of inflammation and acute lung injury. The addition of TXA to FWB resuscitation markedly attenuated the rise in these parameters suggesting its utility in treating acute lung injury.

  10. Damage Control Resuscitation Supplemented with Vasopressin in a Severe Polytrauma Model with Traumatic Brain Injury and Uncontrolled Internal Hemorrhage.

    Science.gov (United States)

    Dickson, J Michael; Wang, Xu; St John, Alexander E; Lim, Esther B; Stern, Susan A; White, Nathan J

    2018-03-14

    Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of traumatic death worldwide and particularly on the battlefield. They are especially challenging when present simultaneously (polytrauma), and clear blood pressure end points during fluid resuscitation are not well described for this situation. The goal of this study is to evaluate for any benefit of increasing blood pressure using a vasopressor on brain blood flow during initial fluid resuscitation in a swine polytrauma model. We used a swine polytrauma model with simultaneous TBI, femur fracture, and HS with uncontrolled noncompressible internal bleeding from an aortic tear injury. Five animals were assigned to each of three experimental groups (hydroxyethyl starch only [HES], HES + 0.4 U/kg vasopressin, and no fluid resuscitation [No Fluids]). Fluids were given as two 10 mL/kg boluses according to tactical field care guidelines. Primary outcomes were mean arterial blood pressure (MAP) and brain blood flow at 60 min. Secondary outcomes were blood flows in the heart, intestine, and kidney; arterial blood lactate level; and survival at 6 hr. Organ blood flow was measured using injection of colored microspheres. Five animals were tested in each of the three groups. There was a statistically significant increase in MAP with vasopressin compared with other experimental groups, but no significant increase in brain blood flow during the first 60 min of resuscitation. The vasopressin group also exhibited greater total internal hemorrhage volume and rate. There was no difference in survival at 6 hours. In this experimental swine polytrauma model, increasing blood pressure with vasopressin did not improve brain perfusion, likely due to increased internal hemorrhage. Effective hemostasis should remain the top priority for field treatment of the polytrauma casualty with TBI.

  11. Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study.

    Science.gov (United States)

    Briet, Jan Paul; Houwert, Roderick Marijn; Smeeing, Diederik P J; Dijkgraaf, Marcel G W; Verleisdonk, Egbert Jan; Leenen, Luke P H; Hietbrink, Falco

    Although fracture type and treatment options for ankle fractures are well defined, the differences between mono- and polytrauma patients and low- and high-energy trauma have not been addressed. The aim of the present study was to compare the fracture type and trauma mechanism between mono- and polytrauma and low- and high-energy trauma patients with an ankle fracture. We performed a single-center retrospective cohort study. Fractures were classified according to the Lauge-Hansen classification and a descriptive classification. High-energy trauma (HET) was defined using triage criteria. All other patients were classified as having experienced low-energy trauma (LET). The patients were divided into 2 groups according to the injury severity score (ISS). Monotrauma patients were defined as patients with an ISS of 4 to 11 with an isolated ankle fracture or an ankle fracture with a minor contusion or laceration. Polytrauma patients were defined as patients with an ISS of ≥16 with ≥2 body regions involved. Patients with an ISS from 12 to 15 were excluded. A total of 96 patients were eligible for analysis. Of the 96 patients, 62 had experienced monotrauma and 34 had experienced polytrauma. A significant difference was found between the mono- and polytrauma patients in the Lauge-Hansen classification (p polytrauma patients. The same pattern was observed for ankle fractures after HET compared with LET (p polytrauma patients sustain different types of ankle fractures than patients with an isolated ankle fracture. This difference likely results from the high-energy transfer associated with polytrauma, because pronation abduction and supination adduction injuries were only observed after HET. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture.

    Science.gov (United States)

    Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P H; Houwert, Roderick M

    2017-01-01

    Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality. A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered. Polytrauma patients, defined as an Injury Severity Score ≥16, and those with an isolated clavicle fracture were compared. Fracture healing disorders (nonunion and delayed union) and delayed fixation rates were determined. Functional outcome was assessed by the Quick Disability of the Arm, Shoulder, and Hand questionnaire. A total of 152 patients were analyzed, 71 polytrauma patients and 81 patients with an isolated DMCF. Questionnaire response of 121 patients (80%) was available (mean, 53 months; standard deviation, 22 months). No differences were found between polytrauma patients and those with an isolated DMCF with regard to nonunion (7% vs. 5%, respectively), delayed union (4% vs. 4%), and delayed fixation rate (13% vs. 13%). Polytrauma patients had an overall worse functional outcome, regardless of initial nonoperative treatment or delayed operative fixation. Polytrauma patients had a similar nonunion and delayed fixation rate but had an overall worse functional outcome compared with patients with an isolated DMCF. For polytrauma patients, a wait and see approach can be advocated without the risk of decreased upper extremity function after delayed fixation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  13. Cognitive functions in the acute period of polytrauma and correction of their disorders with thiocetam

    Directory of Open Access Journals (Sweden)

    Krishtafor A.A.

    2017-10-01

    Full Text Available Aim of the work – to evaluate the effectiveness of thiocetam as a medicine that prevents cognitive impairments in patients with polytrauma, as well as to compare the scales of cognitive function assessment - MoCA and MMSE. We examined 50 victims with polytrauma without severe intracranial lesions, randomly divided into a control group (26 patients and a main (24 patients group. Patients of the control group received conventional intensive therapy for traumatic illness, patients of the main group in addition to this therapy received thiocetam. The somatic status was assessed according to the generally accepted clinical and laboratory indicators. The level of cognitive functions before the injury was assessed by the CFQ questionnaire for 2-3 days after the injury; The MoCA and MMSE scales were used on the 2nd day, when patients were transferred from the intensive care unit and before the discharge. The severity of injury was assessed by the ISS scale. The severity of the response to traumatic stress was assessed by the IES-R scale. In both groups, the baseline level of cognitive function was within the age range. On the second day after the trauma, significant inhibition of cognitive functions in both groups was noted, but in the main group this decrease was un­reliably less. At subsequent stages a gradual increase in both groups was noted, however, in the main group recovery of cognitive functions occurred more rapidly. After 3 months, decrease in cognitive functions preserved at a level when patients were discharged from the hospital. In the main group there were significantly fewer pa­tients whose posttraumatic stress after 3 months increased from minimal to low. When using the MoCA scale, there was a more pronounced decrease in cognitive functions than with the MMSE scale, but it in the less degree consider pecu­liarities of thinking. Thiocetam prevents the decrease of cognitive functions in patients with polytrauma and, due to that, also

  14. The quest for a universal definition of polytrauma: a trauma registry-based validation study.

    Science.gov (United States)

    Butcher, Nerida E; D'Este, Catherine; Balogh, Zsolt J

    2014-10-01

    A pilot validation recommended defining polytrauma as patients with an Abbreviated Injury Scale (AIS) score greater than 2 in at least two Injury Severity Score (ISS) body regions (2 × AIS score > 2). This study aimed to validate this definition on larger data set. We hypothesized that patients defined by the 2 × AIS score > 2 cutoff have worse outcomes and use more resources than those without 2 × AIS score > 2 and that this would therefore be a better definition of polytrauma. Patients injured between 2009 and 2011, with complete documentation of AIS by New South Wales Trauma Registry and 16 years and older were selected. Age and sex were obtained in addition to outcomes of ISS, hospital length of stay (LOS), intensive care unit (ICU) admission, ICU LOS, and mortality. We compared demographic characteristics and outcomes between patients with ISS greater than 15 who did and did not meet the 2 × AIS score > 2 definition. We then undertook regression analyses (logistic regression for binary outcomes [ICU admission and death] and linear regression for hospital and ICU LOS) to compare outcomes for patients with and without 2 × AIS score > 2, adjusting for sex and age categories. In the adjusted analyses, patients with 2 × AIS score > 2 had twice the odds of being admitted to the ICU compared with those without 2 × AIS score > 2 (odds ratio, 2.5; 95% confidence interval [CI], 2.2-2.8) and 1.7 times the odds of dying (95% CI, 1.4-2.0; p 2 also had a mean difference of 1.5 days longer stay in the hospital compared with those without 2 × AIS score > 2 (95% CI, 1.4-1.7) and 1.6 days longer ICU stay (95% CI, 1.4-1.8; p 2 had higher mortality, more frequent ICU admissions, and longer hospital and ICU stay than those without 2 × AIS score > 2 and represents a superior definition to the definitions for polytrauma currently in use. Diagnostic test/ criteria, level III.

  15. ”DAMAGE CONTROL“ STRATEGY IN THE TREATMENT OF POLYTRAUMA PATIENTS WITH OPEN FEMORAL SHAFT FRACTURE COMBINED WITH SPLENIC RUPTURE - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ivan Golubović

    2011-09-01

    Full Text Available Polytrauma represents the most difficult form of trauma epidemic. Appropriate treatment of the femoral shaft fracture in polytrauma patients can significantly reduce mortality and morbidity. External skeletal fixation in patients with femoral shaft fracture presents a minor surgical trauma with minimal blood loss. In modern trauma centres, external skeletal fixation in polytrauma patients is a temporary method (as a part of „damage control“strategy where immediate extensive internal fixation could be risky. It is usually postponed until the patient status is stable with normal vital parameters.This paper presents a polytrauma patient with dominant abdominal injury and femoral shaft fracture. During the same operation, external skeletal fixation was applied after abdominal surgery was done. Conversion of external into internal fixation was carried out because of postoperative febrile state that lasted for 14 days. External skeletal fixation was a definitive method of treatment. Fracture of the femoral shaft healed after 7 months with good functional outcome.External skeletal fixation is a successful method of treatment for femoral shaft fracture in polytrauma patients. It is a temporary method as a part of „damage control“ strategy and is usually followed by internal fixation. Sometimes, it is a definitive treatment method in patients with open and comminuted fractures of the femoral shaft and in polytrauma patients when the above mentioned conversion is not safe.

  16. A state-of-the-art review of built environment information modelling (BeIM

    Directory of Open Access Journals (Sweden)

    Tah J.H.M.

    2017-12-01

    Full Text Available Elements that constitute the built environment are vast and so are the independent systems developed to model its various aspects. Many of these systems have been developed under various assumptions and approaches to execute functions that are distinct, complementary or sometimes similar. Furthermore, these systems are ever increasing in number and often assume similar nomenclatures and acronyms, thereby exacerbating the challenges of understanding their peculiar functions, definitions and differences. The current societal demand to improve sustainability per­formance through collaboration as well as whole-system and through-life thinking is driving the need to integrate independent systems associated with different aspects and scales of the built environment to deliver smart solutions and services that improve the well-being of citizens. The contemporary object-oriented digitization of real-world elements appears to provide a leeway for amalgamating the modelling systems of various domains in the built environment which we termed as built environment information modelling (BeIM. These domains include architecture, engineering, construction as well as urban planning and design. Applications such as building information modelling, geographic information systems and 3D city modelling systems are now being integrated for city modelling purposes. The various works directed at integrating these systems are examined, revealing that current research efforts on integration fall into three categories: (1 data/file conversion systems, (2 semantic mapping systems and (3 the hybrid of both. The review outcome suggests that good knowledge of these domains and how their respective systems operate is vital to pursuing holistic systems integration in the built environment.

  17. Costs and role of ultrasound follow-up of polytrauma patients after initial computed tomography

    International Nuclear Information System (INIS)

    Maurer, M.H.; Winkler, A.; Powerski, M.J.; Elgeti, F.; Huppertz, A.; Roettgen, R.; Marnitz, T.; Wichlas, F.

    2012-01-01

    Purpose: To assess the costs and diagnostic gain of abdominal ultrasound follow-up of polytrauma patients initially examined by whole-body computed tomography (CT). Materials and Methods: A total of 176 patients with suspected multiple trauma (126 men, 50 women; age 43.5 ± 17.4 years) were retrospectively analyzed with regard to supplementary and new findings obtained by ultrasound follow-up compared with the results of exploratory FAST (focused assessment with sonography for trauma) at admission and the findings of whole-body CT. A process model was used to document the staff, materials, and total costs of the ultrasound follow-up examinations. Results: FAST yielded 26 abdominal findings (organ injury and/or free intra-abdominal fluid) in 19 patients, while the abdominal scan of whole-body CT revealed 32 findings in 25 patients. FAST had 81 % sensitivity and 100 % specificity. Follow-up ultrasound examinations revealed new findings in 2 of the 25 patients with abdominal injuries detected with initial CT. In the 151 patients without abdominal injuries in the initial CT scan, ultrasound follow-up did not yield any supplementary or new findings. The total costs of an ultrasound follow-up examination were EUR 28.93. The total costs of all follow-up ultrasound examinations performed in the study population were EUR 5658.23. Conclusion: Follow-up abdominal ultrasound yields only a low overall diagnostic gain in polytrauma patients in whom initial CT fails to detect any abdominal injuries but incurs high personnel expenses for radiological departments. (orig.)

  18. The management of musculoskeletal pain and disfunction from traffic accidents polytrauma

    Directory of Open Access Journals (Sweden)

    Monica Adriana Farago

    2018-02-01

    Full Text Available After complex orthopaedic-surgical treatment of car crash polytrauma, we face multilevel patient problems, from algodisfunctional to psychological consequences, which are very difficult to manage. Aim of the study: identifying the optimal ways to approach cases of polytrauma with major functional and psychological implications. Material and Methods: We present the cases of two female patients, 19 and 18-year-old, victims of major road accidents that required car extrication. The accidents resulted in minor craniocerebral trauma, weight bearing bones and pelvis fractures, musculoskeletal and skin avulsion, and neurogenic bladder with catheterization. They underwent repeated orthopedic-surgical interventions and plastic surgery after which they were referred to functional rehabilitation. In the rehabilitation department we were confronted with anxious, uncooperative patients, with a very high level of somatic pain, incapable of actively mobilizing in the bed plan, one of them, within the limits of physical resources, presenting agitation and night aggressiveness. Results: After the complex clinical evaluation we initiated the rehabilitation treatment. The initial rehabilitation results were minimal because of the pain threshold, high levels of anxiety and fatigue due to insomnia. We asked for psychological evaluation and counseling and we organized 6 short daily exercise sessions, then four longer ones, so as not to exceed the patients' momentary resources. The level of difficulty of the kinetic training was progressively increased, being constantly adapted to the daily training gains of the patients. The aggressive outbursts in one of the patients were related to the dread of darkness and loneliness at night, as a consequence of incarceration from the night road accident. In 4 weeks we gained independence for eating, spontaneous urination, bedside independent mobilization, verticalisation and walking with a frame for short distances. Conclusions

  19. Association between gene expression biomarkers of immunosuppression and blood transfusion in severely injured polytrauma patients.

    Science.gov (United States)

    Torrance, Hew Dt; Brohi, Karim; Pearse, Rupert M; Mein, Charles A; Wozniak, Eva; Prowle, John R; Hinds, Charles J; OʼDwyer, Michael J

    2015-04-01

    To explore the hypothesis that blood transfusion contributes to an immunosuppressed phenotype in severely injured patients. Despite trauma patients using disproportionately large quantities of blood and blood products, the immunomodulatory effects of blood transfusion in this group are inadequately described. A total of 112 ventilated polytrauma patients were recruited. Messenger RNA (mRNA) was extracted from PAXGene tubes collected within 2 hours of the trauma, at 24 hours, and at 72 hours. T-helper cell subtype specific cytokines and transcription factors were quantified using real-time polymerase chain reaction. Median injury severity score was 29. Blood transfusion was administered to 27 (24%) patients before the 2-hour sampling point. Transfusion was associated with a greater immediate rise in IL-10 (P = 0.003) and IL-27 (P = 0.04) mRNA levels. Blood products were transfused in 72 (64%) patients within the first 24 hours. There was an association between transfusion at 24 hours and higher IL-10 (P < 0.0001), lower Foxp3 (P = 0.01), GATA3 (P = 0.006), and RORγt (P = 0.05) mRNA levels at 24 hours. There were greater reductions in T-bet (P = 0.03) mRNA levels and lesser increases in TNFα (P = 0.015) and IFNγ (P = 0.035) at 24 hours in those transfused. Multiple regression models confirmed that the transfusion of blood products was independently associated with altered patterns of gene expression. Blood stream infections occur in 15 (20.8%) of those transfused in the first 24 hours, compared with 1 patient (2.5%) not transfused (OR = 10.3 [1.3-81], P = 0.008). The primarily immunosuppressive inflammatory response to polytrauma may be exacerbated by the transfusion of blood products. Furthermore, transfusion was associated with an increased susceptibility to nosocomial infections.

  20. Treatment of air leak in polytrauma patients with blunt chest injury.

    Science.gov (United States)

    Halat, Gabriel; Negrin, Lukas L; Chrysou, Konstantina; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

    2017-09-01

    Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of air leak in polytrauma patients with blunt chest trauma. The aim of this study was to evaluate the incidence, characteristics, and management of air leak following this injury pattern. Data from 110 polytrauma patients was collected retrospectively. Fifty-four patients received initial treatment by chest tube placement for pneumothorax. These patients were classified into two groups, one with severe air leak and one with minor air leak. An evaluation of injury pattern, chest wall injuries in particular, duration of air leak, reason for drainage maintenance in place, hospital length of stay, ICU stay, ventilator duration, type of treatment, and the delay to surgical intervention was performed. Whereas 4 patients showed severe air leak and were subsequently scheduled for timely surgical intervention, the remaining 50 patients only showed minor air leak. Only 7 patients with minor air leak suffered from prolonged air leak (>5days), which spontaneously resolved in all of them after a mean duration of 7.7days (range 6-12days). Absence of a prolonged air leak resulted in a shorter length of stay and a shorter duration of mechanical ventilation, although no statistical significance was observed. Early spontaneous cessation of most minor air leaks as well as early surgical intervention for severe air leak lead to very satisfactory patient outcomes with a relatively short hospital stay in our patients. We therefore advocate early surgery for lacerations of the pulmonary parenchyma resulting in severe air leak, whereas minor air leaks can usually be treated conservatively. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Experimental investigations of tyre-road interactions during braking; Experimentelle Untersuchungen zur Interaktion zwischen Pkw-Reifen und Fahrbahn beim Bremsen

    Energy Technology Data Exchange (ETDEWEB)

    Chunyang Xie

    2002-07-01

    Tyre-road interactions during braking were investigated experimentally. The measurements were found to be highly accurate. In the first stage, the braking force is enhanced by elastic deformation of the profile elements at the onset of tyre contact. In case of high slip or a high sliding velocity, frictional vibration of the tyre section in contact with the road may occur, which is enhanced by the reduction of braking pressure in case of automatic brake control. The eigenfreequency of the frictional vibration also depends on the road texture and friction coefficient. The measured movements of the profile elements provide a good explanation of the causes of tyre noise. [German] In der Dissertation wurde die Interaktion Reifen/Fahrbahn beim Bremsen experimentell untersucht. Die Messungen zeigen, dass die mit dem neuen Reifensensor erfassten Profilelementverformungen den Reibungszustand zwischen Reifen und Fahrbahn gut widerspiegeln. Die Bremskraft wird zunaechst durch die elastischen Verformungen der Profilelemente am Anfang des Reifenlatsches wesentlich aufgebaut. Beim hohen Bremsschlupf bzw. der hohen Gleitgeschwindigkeit kann die Reibungsschwingung des Laufstreifens des Reifens auftreten. Der Bremsdruckabbau der ABS-Regelung beguenstigt die Entstehung dieser Reibungsschwingung. Die Eigenfrequenz der Reibungsschwingung ist auch abhaengig von der Fahrbahntextur und dem Reibwert. Die aus den Signalen des Profilrillensensors berechneten Beschleunigungen der Profilelemente zeigen deutlich den Aufschlag beim Einlauf des Reifens und das Ausschnappen beim Auslauf. Durch die gemessenen Bewegungen der Profilelemente laesst sich die Entstehung des Reifengeraeusches in einigen Frequenzbereichen gut erklaeren. (orig.)

  2. Early Detection of Junctional Adhesion Molecule-1 (JAM-1 in the Circulation after Experimental and Clinical Polytrauma

    Directory of Open Access Journals (Sweden)

    Stephanie Denk

    2015-01-01

    Full Text Available Severe tissue trauma-induced systemic inflammation is often accompanied by evident or occult blood-organ barrier dysfunctions, frequently leading to multiple organ dysfunction. However, it is unknown whether specific barrier molecules are shed into the circulation early after trauma as potential indicators of an initial barrier dysfunction. The release of the barrier molecule junctional adhesion molecule-1 (JAM-1 was investigated in plasma of C57BL/6 mice 2 h after experimental mono- and polytrauma as well as in polytrauma patients (ISS ≥ 18 during a 10-day period. Correlation analyses were performed to indicate a linkage between JAM-1 plasma concentrations and organ failure. JAM-1 was systemically detected after experimental trauma in mice with blunt chest trauma as a driving force. Accordingly, JAM-1 was reduced in lung tissue after pulmonary contusion and JAM-1 plasma levels significantly correlated with increased protein levels in the bronchoalveolar lavage as a sign for alveolocapillary barrier dysfunction. Furthermore, JAM-1 was markedly released into the plasma of polytrauma patients as early as 4 h after the trauma insult and significantly correlated with severity of disease and organ dysfunction (APACHE II and SOFA score. The data support an early injury- and time-dependent appearance of the barrier molecule JAM-1 in the circulation indicative of a commencing trauma-induced barrier dysfunction.

  3. Early Detection of Junctional Adhesion Molecule-1 (JAM-1) in the Circulation after Experimental and Clinical Polytrauma

    Science.gov (United States)

    Denk, Stephanie; Wiegner, Rebecca; Hönes, Felix M.; Messerer, David A. C.; Radermacher, Peter; Kalbitz, Miriam; Braumüller, Sonja; McCook, Oscar; Gebhard, Florian; Weckbach, Sebastian; Huber-Lang, Markus

    2015-01-01

    Severe tissue trauma-induced systemic inflammation is often accompanied by evident or occult blood-organ barrier dysfunctions, frequently leading to multiple organ dysfunction. However, it is unknown whether specific barrier molecules are shed into the circulation early after trauma as potential indicators of an initial barrier dysfunction. The release of the barrier molecule junctional adhesion molecule-1 (JAM-1) was investigated in plasma of C57BL/6 mice 2 h after experimental mono- and polytrauma as well as in polytrauma patients (ISS ≥ 18) during a 10-day period. Correlation analyses were performed to indicate a linkage between JAM-1 plasma concentrations and organ failure. JAM-1 was systemically detected after experimental trauma in mice with blunt chest trauma as a driving force. Accordingly, JAM-1 was reduced in lung tissue after pulmonary contusion and JAM-1 plasma levels significantly correlated with increased protein levels in the bronchoalveolar lavage as a sign for alveolocapillary barrier dysfunction. Furthermore, JAM-1 was markedly released into the plasma of polytrauma patients as early as 4 h after the trauma insult and significantly correlated with severity of disease and organ dysfunction (APACHE II and SOFA score). The data support an early injury- and time-dependent appearance of the barrier molecule JAM-1 in the circulation indicative of a commencing trauma-induced barrier dysfunction. PMID:26556956

  4. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem?

    Science.gov (United States)

    Chrysou, Konstantina; Halat, Gabriel; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

    2017-04-20

    Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients' mortality. In this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included. A total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AIS thorax 3), 19.1% a severe chest injury (AIS thorax 4) and 15.5% a moderate chest injury (AIS thorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AIS thorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AIS thorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality. Although 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AIS

  5. The Effect Of Supraphysiologic Blood Pressure on Traumatic Brain Injury and Proximal Tissue Beds During Resuscitative Balloon Occlusion of the Aorta and Variable Aortic Control in a Porcine Model (Sus scrofa) of Polytrauma.

    Science.gov (United States)

    2017-04-27

    Control In A Porcine Model (Sus Scrofa) Of Polytrauma . PRINCIPAL INVESTIGATOR (PI) / TRAINING COORDINATOR (TC): Lt Col Timothy Williams DEPARTMENT...Mandatory) The Effect of REBOA, Partial Aortic Occlusion and Aggressive Blood Transfusion on Traumatic Brain Injury in a Swine Polytrauma Model

  6. Cerebral MR imaging of malignant melanoma; Zerebrale MR-Bildgebung beim malignen Melanom

    Energy Technology Data Exchange (ETDEWEB)

    Breckwoldt, M.; Bendszus, M. [Universitaetsklinikum Heidelberg, Abteilung Neuroradiologie, Neurologische Klinik, Heidelberg (Germany)

    2015-01-16

    Suszeptibilitaetssignale (ITSS), was sie von anderen Metastasen unterscheidet (Spezifitaet ca. 81-96 %). Die Diffusionsbildgebung spielt beim MM nur eine untergeordnete Rolle. Die suszeptibilitaetsgewichtete Bildgebung verbessert die Sensitivitaet der Metastasendetektion bei eingeschraenkter Spezifitaet. Eine Unterscheidung von Mikroblutungen oder Verkalkungen kann im Einzelfall unmoeglich sein. Kontrovers ist zudem, wie SWI-Signalausloeschungen zu werten sind, fuer die sich kein Korrelat in den anderen Sequenzen findet (Differenzialdiagnose: Metastase, Mikroblutung, Verkalkung). Der beim MM haeufig vorkommende ZNS-Befall ist ab Stadium IIc auch bei neurologisch asymptomatischen Patienten auszuschliessen. Ebenso sind im Stadium IV alle 3 Monate kraniale MRT-Untersuchungen indiziert. Die Unterscheidung von Metastasen und intrazerebralen Einblutungen ist nicht immer moeglich und muss im Einzelfall durch eine Verlaufsuntersuchung geklaert werden. Zusaetzliche diagnostische Sensitivitaet bei eingeschraenkter Spezifitaet bringt die SWI. (orig.)

  7. Fresh Frozen Plasma Resuscitation Provides Neuroprotection Compared to Normal Saline in a Large Animal Model of Traumatic Brain Injury and Polytrauma

    DEFF Research Database (Denmark)

    Imam, Ayesha; Jin, Guang; Sillesen, Martin

    2015-01-01

    Abstract We have previously shown that early treatment with fresh frozen plasma (FFP) is neuroprotective in a swine model of hemorrhagic shock (HS) and traumatic brain injury (TBI). However, it remains unknown whether this strategy would be beneficial in a more clinical polytrauma model. Yorkshire...... as well as cerebral perfusion pressures. Levels of cerebral eNOS were higher in the FFP-treated group (852.9 vs. 816.4 ng/mL; p=0.03), but no differences in brain levels of ET-1 were observed. Early administration of FFP is neuroprotective in a complex, large animal model of polytrauma, hemorrhage...

  8. Fair in the face: modern diagnostics of midfacial trauma; Mitten ins Gesicht: Moderne bildgebende Diagnostik beim Gesichtsschaedeltrauma

    Energy Technology Data Exchange (ETDEWEB)

    Zajaczek, J.E.W. [Abt. Neuroradiologie (OE 8210), Zentrum Radiologie, Medizinische Hochschule Hannover (Germany); Abt. Diagnostische Radiologie, Medizinische Hochschule Hannover (Germany); Rodt, T.; Keberle, M. [Abt. Diagnostische Radiologie, Medizinische Hochschule Hannover (Germany)

    2007-07-15

    Modern diagnostics of midfacial trauma are embedded in a diagnostic concept that is oriented to the therapeutic relevance for the individual. Critical analysis of the indicated and efficient radiological method in the acute phase shows that MSCT is currently the method of choice in the diagnosis of midfacial trauma. Besides extensive acquisition of data in the shortest time the possibilities of modern post-processing provide a three-dimensional picture of the often complex injuries in real time. Other perilous injuries are often more important especially for the polytrauma patient. With modern scan protocols intracranial injuries as well as injuries of bone and soft tissue of the head and neck region can be diagnosed during a single examination. Radiology plays a key role for the economically oriented strategy of patient care. (orig.)

  9. The use of external fixators in the definitive stabilisation of the pelvis in polytrauma patients: Safety, efficacy and clinical outcomes.

    Science.gov (United States)

    Tosounidis, Theodoros H; Sheikh, Hassaan Qaiser; Kanakaris, Nikolaos K; Giannoudis, Peter V

    2017-06-01

    To analyse the complications and outcomes (functional/radiographic) of Pelvic External Fixators applied as part of the definitive fixation in polytrauma patients. A single center retrospective chart review. A level-1 trauma center. We reviewed all the polytrauma patients (ISS>16) between 2007 and 2012 that had a PEF applied more than 30days. Complications including infection, aseptic loosening, neurological injury, loss of reduction, non-union and mal-union were recorded. Pelvic asymmetry and Deformity Index (DI) were measured at the immediate postoperative radiographs and final follow-up. The functional outcome at final follow up was estimated using a scale previously reported by Chiou et al. 59 patients with mean age of 38.4 (16 - 81) years and mean ISS score 28 (16- 66) were included. The PEFs were applied for mean duration of 56 (30-104) days. The average follow-up was 403days. 22 injuries were type B and 37 type C (AO/OTA). The most common symptomatic complications were pin site infection in 11 (18.6%) and loosening in 5 (8.5%) cases. 44 (74.5%) patients had satisfactory functional outcome. The immediate post-operative and final asymmetry and DI were compared between the two pelvic injury groups (type B and C fractures). The difference in displacement progression was more for type C injuries (p=0.034) but no correlation to the functional outcome was evident. PEF can be used as definitive alternative stabilization method in specific situations at polytrauma setting. Radiological displacement occurred in both type B and C injuries but the clinical outcome was not correlated to this displacement. Complications related to PEF do not affect the final clinical outcome. Therapeutic Level III. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients.

    Science.gov (United States)

    Elbaih, Adel Hamed; Abu-Elela, Sameh T

    2017-12-01

    The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynamically unstable polytraumatized patients and to determine its role as an indication of laparotomy. This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS (advanced trauma life support) guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  11. Feinkartierung von Loss of Heterozygosity-Intervallen auf Chromosom 11p und Untersuchungen zum Expressions- und Methylierungsstatus von FANCF beim Ovarialkarzinom

    OpenAIRE

    Schulze, Kathrin

    2011-01-01

    Um Tumorsuppressorgene beim Ovarialkarzinom zu identifizieren wurde eine Kartierung von LOH-Intervallen der Region 11p15.5 - 11p11.2 mittels 11 Mikrosatellitenmarkern an 47 Ovarialtumorproben vorgenommen. Im Bereich des ST5- und AFM255/KAI1-Locus konnten potentielle Intervalle abgegrenzt werden. Das Fanconi Anämie Gen FANCF wurde für Untersuchungen zum Expressions- und Methylierungsstatus ausgewählt, da dessen Abschaltung mit einem besseren Ansprechen auf Cisplatin bei Ovarialkarzinompatienti...

  12. The definition of polytrauma: variable interrater versus intrarater agreement--a prospective international study among trauma surgeons.

    Science.gov (United States)

    Butcher, Nerida E; Enninghorst, Natalie; Sisak, Krisztian; Balogh, Zsolt J

    2013-03-01

    The international trauma community has recognized the lack of a validated consensus definition of "polytrauma." We hypothesized that using a subjective definition, trauma surgeons will not have substantial agreement; thus, an objective definition is needed. A prospective observational study was conducted between December 2010 and June 2011 (John Hunter Hospital, Level I trauma center). Inclusion criteria were all trauma call patients with subsequent intensive care unit admission. The study was composed of four stages as follows: (1) four trauma surgeons assessed patients until 24 hours, then coded as either "yes" or "no" for polytrauma, and results compared for agreement; (2) eight trauma surgeons representing the United States, Germany, and the Netherlands graded the same prospectively assessed patients and coded as either "yes" or "no" for polytrauma; (3) 12 months later, the original four trauma surgeons repeated assessment via data sheets to test intrarater variability; and (4) individual subjective definitions were compared with three anatomic scores, namely, (a) Injury Severity Score (ISS) of greater than 15, (b) ISS of greater 17, and (c) Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions. A total of 52 trauma patients were included. Results for each stage were as follows: (1) κ score of 0.50, moderate agreement; (2) κ score of 0.41, moderate agreement; (3) Rater 1 had moderate intrarater agreement (κ score, 0.59), while Raters 2, 3, 4 had substantial intrarater agreement (κ scores, 0.75, 0.66, and 0.71, respectively); and (4) none had most agreement with ISS of greater than 15 (κ score, 0.16), while both definitions ISS greater than 17 and Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions had on average fair agreement (κ scores, 0.27 and 0.39, respectively). Based on subjective assessments, trauma surgeons do not agree on the definition of polytrauma, with the subjective

  13. [Myocardial infarction as cause of an accident. The role of multislice CT in polytrauma management, differential diagnosis and insurance aspects].

    Science.gov (United States)

    Kleber, C; Oswald, B; Bail, H J; Haas, N P; Kandziora, F

    2008-12-01

    We present for the first time the use of contrast-enhanced multislice computed tomography in trauma care to detect acute myocardial infarction and verify it as the cause of a traffic accident. In addition to the case report, cardiac contusion, coronary dissection, and facets of insurance law are discussed. The determination of acute myocardial infarction, cardiac contusion, and coronary dissection can be challenging, but answers can be found in the medical history and accident details. The trauma surgeon in the emergency department must always be interested in clarifying the cause of trauma and keeping a secondary diagnosis in mind to strive for the goal of optimal and complete polytrauma care.

  14. Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

    Science.gov (United States)

    V, Dei Giudici; N, Giampaolini; A, Panfighi; M, Marinelli; R, Procaccini; A, Gigante

    2015-01-01

    The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards “where” and “when” to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient’s outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113

  15. Systemic Inflammatory Effects of Traumatic Brain Injury, Femur Fracture, and Shock: An Experimental Murine Polytrauma Model

    Directory of Open Access Journals (Sweden)

    C. Probst

    2012-01-01

    Full Text Available Objective. Despite broad research in neurotrauma and shock, little is known on systemic inflammatory effects of the clinically most relevant combined polytrauma. Experimental investigation in an animal model may provide relevant insight for therapeutic strategies. We describe the effects of a combined injury with respect to lymphocyte population and cytokine activation. Methods. 45 male C57BL/6J mice (mean weight 27 g were anesthetized with ketamine/xylazine. Animals were subjected to a weight drop closed traumatic brain injury (WD-TBI, a femoral fracture and hemorrhagic shock (FX-SH. Animals were subdivided into WD-TBI, FX-SH and combined trauma (CO-TX groups. Subjects were sacrificed at 96 h. Blood was analysed for cytokines and by flow cytometry for lymphocyte populations. Results. Mortality was 8%, 13% and 47% for FX-SH, WD-TBI and CO-TX groups (P<0.05. TNFα (11/13/139 for FX-SH/WD-TBI/CO-TX; P<0.05, CCL2 (78/96/227; P<0.05 and IL-6 (16/48/281; P=0.05 showed significant increases in the CO-TX group. Lymphocyte populations results for FX-SH, WD-TBI and CO-TX were: CD-4 (31/21/22; P= n.s., CD-8 (7/28/34, P<0.05, CD-4-CD-8 (11/12/18; P= n.s., CD-56 (36/7/8; P<0.05. Conclusion. This study shows that a combination of closed TBI and femur-fracture/ shock results in an increase of the humoral inflammation. More attention to combined injury models in inflammation research is indicated.

  16. Quality of life after multiple trauma: validation and population norm of the Polytrauma Outcome (POLO) chart.

    Science.gov (United States)

    Lefering, R; Tecic, T; Schmidt, Y; Pirente, N; Bouillon, B; Neugebauer, E

    2012-08-01

    Due to an increasing number of survivors after multiple injuries in Western countries, the health-related quality of life (QoL) is considered to be an important outcome parameter. Up to now, measuring instruments used in this field lacked validity and comparability. Within 6 years, our working group developed a new modular instrument, called the Polytrauma Outcome (POLO) chart. This study documents the validation of the trauma-specific module specifically designed for trauma patients, the Trauma Outcome Profile (TOP). A total of 172 multiply injured patients (mean Injury Severity Score [ISS] 26.7) recruited from eight trauma centres participating in the German Trauma Registry were compared with 166 marginally injured patients (mean ISS 3.9). The mean follow-up was 24.2 and 26.4 months, respectively. The validation questionnaires used were the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R), Social Support Questionnaire (F-SOZU-K-22), Barthel Index of Activities of Daily Living (ADL) and the Short Form Health Survey (SF-36). The internal consistency of the different dimensions of QoL assessed with the TOP was good. Factor analysis provides evidence of the construct validity of the questionnaire. Correlation with external measures gives evidence of criterion validity for the various dimensions of QoL and similar exceedance of proposed cut-off points within TOP and external measures is verified. The TOP module is a reliable and valid instrument to assess health-related QoL in patients with multiple injuries. It can be used stand-alone or as part of the POLO chart together with the Glasgow Outcome Scale (GOS), the EuroQoL and the SF-36 as a regular systematic follow-up instrument.

  17. Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture : A Retrospective Cohort Study

    NARCIS (Netherlands)

    Briet, Jan Paul; Houwert, Roderick Marijn; Smeeing, Diederik P J; Dijkgraaf, Marcel G. W.; Verleisdonk, Egbert Jan M M; Leenen, Luke P H; Hietbrink, Falco

    2017-01-01

    Although fracture type and treatment options for ankle fractures are well defined, the differences between mono- and polytrauma patients and low- and high-energy trauma have not been addressed. The aim of the present study was to compare the fracture type and trauma mechanism between mono- and

  18. Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study

    NARCIS (Netherlands)

    Briet, Jan Paul; Houwert, Roderick Marijn; Smeeing, Diederik P. J.; Dijkgraaf, Marcel G. W.; Verleisdonk, Egbert Jan; Leenen, Luke P. H.; Hietbrink, Falco

    2017-01-01

    Although fracture type and treatment options for ankle fractures are well defined, the differences between mono- and polytrauma patients and low- and high-energy trauma have not been addressed. The aim of the present study was to compare the fracture type and trauma mechanism between mono- and

  19. Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture

    NARCIS (Netherlands)

    Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P.H.; Houwert, Roderick M.

    2017-01-01

    Background Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in

  20. [Is polytrauma affordable these days? G-DRG system vs per diem charge based on 1,030 patients with multiple injuries].

    Science.gov (United States)

    Qvick, B; Buehren, V; Woltmann, A

    2012-10-01

    The introduction of diagnosis-related groups (DRG) in Germany comprises the risk of a non-cost-effective reimbursement in complex medical treatments. The aim of this study was to compare the reimbursement between the DRG system and the system of hospital per diem charge in effect until now. The G-DRG (Version 2004) reimbursement was calculated for 1,030 polytrauma patients (average ISS 26.4) treated at the BGU Murnau from 2000 to 2004, using a base value of 2900 euros, and compared to the reimbursement of hospital per diem charge. Just half of all polytrauma patients are classified as a polytrauma according to the DRG (18.7%) or as requiring artificial respiration based on the DRG (29.1%). The average G-DRG reimbursement was 27,157 euros vs 36,387 euros (74.6%). Patients with minor trauma, increasing age, high GCS, ICU stay without artificial respiration, trauma of the upper extremity and patients who survived show the greatest discrepancy. A revision of the G-DRG definition of polytrauma is necessary to ensure adequate reimbursement for management of patients with multiple injuries. The severity of a trauma has to be considered in the DRG system.

  1. A novel evaluation of microvascular damage in critically ill polytrauma patients by using circulating microRNAs

    Directory of Open Access Journals (Sweden)

    Bedreag Ovidiu Horea

    2016-03-01

    Full Text Available The management of the critically ill polytrauma patient is complex due to the multiple complications and biochemical and physiopathological imbalances. This happened due to the direct traumatic injury, or due to the post-traumatic events. One of the most complex physiopathology associated to the multiple traumas is represented by microvascular damage, subsequently responsible for a series of complications induced through the imbalance of the redox status, severe molecular damage, reduction of the oxygen delivery to the cell and tissues, cell and mitochondrial dead, augmentation of the inflammatory response and finally the installation of multiple organ dysfunction syndrome in this type of patients. A gold goal in the intensive care units is represented by the evaluation and intense monitoring of the molecular and physiopathological dysfunctions of the critically ill patients. Recently, it was intensely researched the use of microRNAs as biomarkers for the specific physiopathological dysfunctions. In this paper we wish to present a series of microRNAs that can serve as biomarkers for the evaluation of microvascular damage, as well as for the evaluation of other specific physiopathology for the critically ill polytrauma patient.

  2. Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms?

    Science.gov (United States)

    Falkenberg, Lisa; Zeckey, Christian; Mommsen, Philipp; Winkelmann, Marcel; Zelle, Boris A; Panzica, Martin; Pape, Hans-Christoph; Krettek, Christian; Probst, Christian

    2017-10-30

    Physical impairment is well-known to last for many years after a severe injury, and there is a high impact on the quality of the survivor's life. The purpose of this study was to examine if this is also true for psychological impairment with symptoms of posttraumatic stress disorder or depression after polytrauma. Retrospective cohort outcome study. Level I trauma centre. 637 polytrauma trauma patients who were treated at our Level I trauma centre between 1973 and 1990. Minimum follow-up was 10 years after the injury. Patients were asked to fill in a questionnaire, including parts of the Posttraumatic Stress Diagnostic Scale, the Impact of Event Scale-Revised and the German Hospital Anxiety and Depression Scale, to evaluate mental health. Clinical outcome was assessed before by standardised scores. Three hundred and twenty-four questionnaires were evaluated. One hundred and forty-nine (45.9%) patients presented with symptoms of mental impairment. Quality of life was significantly higher in the mentally healthy group, while the impaired group achieved a lower rehabilitation status. Mental impairment can be found in multiple trauma victims, even after 10 years or more. Treating physicians should not only focus on early physical rehabilitation but also focus on early mental rehabilitation to prevent long-term problems in both physical and mental disability.

  3. Monitoring lung contusion in a porcine polytrauma model using EIT: an application study.

    Science.gov (United States)

    Santos, Susana Aguiar; Wembers, Carlos Castelar; Horst, Klemens; Pfeifer, Roman; Simon, Tim-Philipp; Pape, Hans-Christoph; Hildebrand, Frank; Czaplik, Michael; Leonhardt, Steffen; Teichmann, Daniel

    2017-07-26

    Lung contusion is the most common lung injury following blunt chest trauma which, in turn, is associated with high mortality rates (Gavelli et al 2002 Eur. Radiol. 12 1273-94). Lung contusion is characterized by hemorrhage and edema with consecutively reduced compliance. Objective and Approach: In this study, unilateral lung contusion and other traumata were induced in 12 pigs by using a bolt gun machine. To investigate the pathophysiological consequences of lung contusion, information on clinical parameters was collected and monitored regularly while animals were additionally monitored with electrical impedance tomography (EIT) before trauma, and at 4, 24, 48 and 72 h after polytrauma. Statistical analyses showed significant differences between the measurement time points in terms of lung compliance ([Formula: see text]) and in global EIT parameters, such as absolute global impedance (aGlobImp) ([Formula: see text]), tidal impedance variation (TIV) ([Formula: see text]) and the center of ventilation (CoV) ([Formula: see text]). Additionally, distinct analyses for the left (non-injured) and right (injured) lung were also performed. In this context, during the progress of lung contusion, significant changes were found for the injured lung in TIV ([Formula: see text]), global inhomogeneity ([Formula: see text]), regional ventilation delay ([Formula: see text]), CoV ([Formula: see text]) and in regions of non-ventilation (rNoVent) ([Formula: see text]). Furthermore, TIV and rNoVent were capable to differentiate the injured and the contralateral healthy lung at 4 and 24 h after injury (TIV: [Formula: see text] and [Formula: see text]; rNoVent: [Formula: see text] and [Formula: see text]). TIV reached a sensitivity of 82% (specificity of 100%) at 4 h and sensitivity of 82% (specificity of 82%) at 24 h after injury, in detecting lung contusion specific consequences. The results indicate that EIT might be a valuable tool to detect and to monitor lung injuries

  4. Pharmacological targeting of chemokine (C-X-C motif) receptor 4 in porcine polytrauma and hemorrhage models

    Science.gov (United States)

    Bach, Harold H.; Wong, Yee M.; LaPorte, Heather M.; Gamelli, Richard L.; Majetschak, Matthias

    2016-01-01

    BACKGROUND Recent evidence suggests that chemokine receptor CXCR4 regulates vascular α1-adrenergic receptor function and that the noncognate CXCR4 agonist ubiquitin has therapeutic potential after trauma/hemorrhage. Pharmacologic properties of ubiquitin in large animal trauma models, however, are poorly characterized. Thus, the aims of the present study were to determine the effects of CXCR4 modulation on resuscitation requirements after polytrauma, to assess whether ubiquitin influences survival times after lethal polytrauma-hemorrhage, and to characterize its dose-effect profile in porcine models. METHODS Anesthetized pigs underwent polytrauma (PT, femur fractures/lung contusion) alone (Series 1) or PT/hemorrhage (PT/H) to a mean arterial blood pressure of 30 mmHg with subsequent fluid resuscitation (Series 2 and 3) or 40% blood volume hemorrhage within 15 minutes followed by 2.5% blood volume hemorrhage every 15 minutes without fluid resuscitation (Series 4). In Series 1, ubiquitin (175 and 350 nmol/kg), AMD3100 (CXCR4 antagonist, 350 nmol/kg), or vehicle treatment 60 minutes after PT was performed. In Series 2, ubiquitin (175, 875, and 1,750 nmol/kg) or vehicle treatment 60 minutes after PT/H was performed. In Series 3, ubiquitin (175 and 875 nmol/kg) or vehicle treatment at 60 and 180 minutes after PT/H was performed. In Series 4, ubiquitin (875 nmol/kg) or vehicle treatment 30 minutes after hemorrhage was performed. RESULTS In Series 1, resuscitation fluid requirements were significantly reduced by 40% with 350-nmol/kg ubiquitin and increased by 25% with AMD3100. In Series 2, median survival time was 190 minutes with vehicle, 260 minutes with 175-nmol/kg ubiquitin, and longer than 420 minutes with 875-nmol/kg and 1,750-nmol/kg ubiquitin (p 0.05). CONCLUSION These findings further suggest CXCR4 as a drug target after PT/H. Ubiquitin treatment reduces resuscitation fluid requirements and provides survival benefits after PT/H. The pharmacological effects of

  5. Clinical importance and significance of early evaluation of therapy response in lung cancer; Klinische Notwendigkeit und Bedeutung der Frueherfassung der Therapie-Response beim Bronchialkarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Griesinger, F. [Universitaetsklinik Goettingen (Germany). Abt. Haematologie und Onkologie; Baum, R.P. [Zentralklinik Bad Berka (Germany). Klinik fuer Nuklearmedizin/PET-Zentrum

    2001-04-01

    In solid tumors, especially in non-small cell lung cancer (NSCLC), the TNM staging is the only well defined pretherapeutic risk factor. TNM-staging has a significant impact on prognosis and survival and is used to determine therapeutic stratification. Although numerous molecular and immunologic pretherapeutic risk factors have been described in NSCLC, none of them has been translated into therapeutic stratification. Therefore, the identification of posttherapeutic risk factors in NSCLC is essential. Locally advanced NSCLC are currently treated with preoperative (neoadjuvant) induction regimens. It has been shown that systemic tumor control and long-term disease free survival is correlated with histologic tumor regression. First results are presented in this paper that PET may be highly predictive for histologic tumor regression and long term outcome in NSCLC stage III. These results may establish PET as the first noninvasive posttherapeutic risk factor in locally advanced NSCLC. (orig.) [German] Bei soliden Tumoren, insbesondere beim nichtkleinzelligen Bronchialkarzinom (NSCLC), sind praetherapeutische Risikofaktoren im Westlichen durch das Tumorstadium (TNM-Klassifikation) definiert. Diese Tumorstadien haben eine erhebliche prognostische Relevanz und sind entscheidend fuer die Therapiestratifikation. Obwohl eine Reihe praetherapeutischer molekularer und immunologischer Risikofaktoren beim NSCLC beschrieben wurden, hat keiner von ihnen Eingang in die prospektive Risikostratifikation oder Therapieplanung gefunden. Daher ist die Identifikation posttherapeutischer Risikofaktoren zur Therapiestratifikation des NSCLC essenziell wichtig. Ein innovativer Therapieansatz bei lokal fortgeschrittenen NSCLC ist die neoadjuvante (praeoperative) Induktionstherapie. Hier konnte gezeigt werden, dass die systemische Tumorkontrolle und das Langzeitueberleben mit dem histologischen Ansprechen korrelierte. Erste Untersuchungen zeigen jetzt, dass die FDG-PET vermutlich einen hohen

  6. Aktuelle Technik der Bruststraffung beim Mann nach Gewichtsverlust [Modern technique in male breast contouring after weight loss

    Directory of Open Access Journals (Sweden)

    Stoff, Alexander

    2013-08-01

    Full Text Available [english] The morbid adiposity and its medical consequences demonstrates a growing problem of our current prosperous society. Due to a significant improvement of bariatric techniques and a reduplication of adipose patients during the 20 century, the number of patients, who present to plastic surgeons with a new degree of suffering, has been growing steadily. Initially, the female patients were in the majority, which has been more balanced nowadays.The male breast is a body region that primarily symbolizes masculinity and strenght. In male patients after massive weight loss, this body region remains as an extremly deflated breast envelope without any sign of possible retraction. The plastic surgeon may choose from different single or combinated ltechniques, which are indicated depending on the local and adjacent tissue characteristics.We are presenting our modified technique of male breast reshaping, referring to the technique of Aly, except for a NAC transposition on a central pedicle. The central pedicle is hereby preserved from resection after tremendous liposuction. This central pedicle technique allows a safe and uncomplicated NAC transposition with significant advantages compared to free NAC-Transposition techniques in terms of aesthetical and functional outcome. [german] Die morbide Adipositas mit ihren Langzeitfolgen ist ein zunehmendes Problem unserer heutigen Wohlstandsgesellschaft. Mit einer Verdoppelung der betroffenen Patienten im Laufe des 20. Jahrhunderts ist gleichzeitig durch rasante Verbesserung der bariatrischen Eingriffe auch die Zahl der Patienten signifikant und stetig gestiegen, die sich nach massiver Gewichtsreduktion nun mit neuem Leidensdruck beim Plastischen Chirurgen vorstellen. Hierbei ist die anfängliche Überzahl der weiblichen Patienten in ein ausgewogenes Verhältnis der betroffenen Geschlechter übergegangen. Die männliche Brust, eine Körperregion, die in erster Linie Männlichkeit und Stärke symbolisiert und

  7. Importance of multidetector CT imaging in multiple trauma; Stellenwert der Multidetektor-CT bei Polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Linsenmaier, U. [HELIOS Kliniken Muenchen West, HELIOS Klinik Muenchen Perlach, Institut fuer Diagnostische und Interventionelle Radiologie, Muenchen (Germany); Geyer, L.L.; Reiser, M.; Wirth, S. [Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer Klinische Radiologie, Muenchen (Germany); Koerner, M. [Radiologie Muehleninsel, Landshut (Germany)

    2014-09-15

    zeitnahe Therapie mit dem Ziel, potenziell lebensbedrohliche Verletzungen fruehzeitig zu erkennen und adaequat zu behandeln. Die Basisdiagnostik triagiert zur Sofortoperation und besteht unveraendert aus einer fokussierten Ultraschalluntersuchung (Focused Assessment with Sonography for Trauma, FAST) und Projektionsradiographie (CR), meist limitiert auf eine einzelne Thoraxaufnahme. Die Multidetektor-CT (MDCT) hat sich als standardisierte fruehe Ganzkoerper-CT (''whole-body'', WBCT) etabliert; die Detektionsrate von Verletzungen ist herausragend und die Ueberlebenswahrscheinlichkeit verbessert sich um 20-25 %. Die raeumliche und zeitliche Aufloesung wurde verbessert und die Untersuchungszeit erheblich verkuerzt. Die Dosisexposition ist auch bei einmaliger Akutanwendung nicht unerheblich, durch moderne Scannertechnologie und Dosisreduktion, einschliesslich der iterativen Bildrekonstruktion, konnte eine Dosisreduktion von bis zu 40 % erreicht werden. Die zahlreichen Bilder der WBCT muessen prioritaetenorientiert hergestellt, befundet und archiviert werden, zur schnellen Diagnostik bietet sich das ''volume image reading'' (VIR) an. Die moderne WBCT wir bei Polytrauma frueh, umfassend und individuell adaptiert durchgefuehrt, dabei verbessert die WBCT die Ueberlebenswahrscheinlichkeit um 20-25 %. (orig.)

  8. Evaluation of a dual-room sliding gantry CT concept for workflow optimisation in polytrauma and regular in- and outpatient management

    Energy Technology Data Exchange (ETDEWEB)

    Frellesen, Claudia; Boettcher, Marie; Wichmann, Julian L.; Drieske, Martina; Kerl, J. Matthias; Lehnert, Thomas [Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany); Nau, Christoph; Geiger, Emmanuel; Wutzler, Sebastian [Department of Trauma, Reconstructive and Hand Surgery, Clinic of the Goethe University, Frankfurt (Germany); Ackermann, Hanns [Department of Biostatistics and Mathematical Modelling, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany); Bauer, Ralf W., E-mail: ralfwbauer@aol.com [Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany)

    2015-01-15

    Highlights: • A sliding gantry trauma room CT solution facilitates significantly faster polytrauma management. • Faster and more efficient resumption of regularly scheduled patients due to a two room solution is supported. • Sliding gantry CT achieves the same patient throughput as two separate conventional CT devices. - Abstract: Objectives: To reveal the impact on workflow from introducing a dual-room sliding gantry CT to the trauma room for polytrauma and regularly scheduled in- outpatients with regard to efficiency and degree of capacity utilisation. Materials and methods: Time analysis was performed for 30 polytrauma patients each in 2 different trauma room settings, the new trauma room comprising a sliding gantry CT, the old one a stationary single-room CT. Complete trauma room and diagnostic workup times were manually measured and compared for both groups. In a third scenario, the number of CT scans performed with one single sliding gantry CT and the two-room concept was compared to the number of CT scans performed on two separate regular CT units in a 5 days clinical routine sample. Results: Patients demographics and type of CT examinations were comparable for all patient groups. The median time from patient arrival in the trauma room until beginning of CT scanning was 6 min shorter for the sliding gantry CT group (21 vs.15 min). Sliding gantry CT embedded in a two-room solution achieved 252 CT scans in 5 working days, compared to 250 CT scans on two separate regular CT units with the same man power. Conclusions: Sliding gantry CT in the trauma room allows for significant time saving in the diagnostic workup of polytrauma patients and faster resumption of the regular in- outpatient's CT schedule is possible. With the same man power, the dual-room solution is able to generate the same throughput as two separate CT units.

  9. Evaluation of a dual-room sliding gantry CT concept for workflow optimisation in polytrauma and regular in- and outpatient management

    International Nuclear Information System (INIS)

    Frellesen, Claudia; Boettcher, Marie; Wichmann, Julian L.; Drieske, Martina; Kerl, J. Matthias; Lehnert, Thomas; Nau, Christoph; Geiger, Emmanuel; Wutzler, Sebastian; Ackermann, Hanns; Vogl, Thomas J.; Bauer, Ralf W.

    2015-01-01

    Highlights: • A sliding gantry trauma room CT solution facilitates significantly faster polytrauma management. • Faster and more efficient resumption of regularly scheduled patients due to a two room solution is supported. • Sliding gantry CT achieves the same patient throughput as two separate conventional CT devices. - Abstract: Objectives: To reveal the impact on workflow from introducing a dual-room sliding gantry CT to the trauma room for polytrauma and regularly scheduled in- outpatients with regard to efficiency and degree of capacity utilisation. Materials and methods: Time analysis was performed for 30 polytrauma patients each in 2 different trauma room settings, the new trauma room comprising a sliding gantry CT, the old one a stationary single-room CT. Complete trauma room and diagnostic workup times were manually measured and compared for both groups. In a third scenario, the number of CT scans performed with one single sliding gantry CT and the two-room concept was compared to the number of CT scans performed on two separate regular CT units in a 5 days clinical routine sample. Results: Patients demographics and type of CT examinations were comparable for all patient groups. The median time from patient arrival in the trauma room until beginning of CT scanning was 6 min shorter for the sliding gantry CT group (21 vs.15 min). Sliding gantry CT embedded in a two-room solution achieved 252 CT scans in 5 working days, compared to 250 CT scans on two separate regular CT units with the same man power. Conclusions: Sliding gantry CT in the trauma room allows for significant time saving in the diagnostic workup of polytrauma patients and faster resumption of the regular in- outpatient's CT schedule is possible. With the same man power, the dual-room solution is able to generate the same throughput as two separate CT units

  10. Differential effects of fresh frozen plasma and normal saline on secondary brain damage in a large animal model of polytrauma, hemorrhage and traumatic brain injury

    DEFF Research Database (Denmark)

    Hwabejire, John O; Imam, Ayesha M; Jin, Guang

    2013-01-01

    We have previously shown that the extent of traumatic brain injury (TBI) in large animal models can be reduced with early infusion of fresh frozen plasma (FFP), but the precise mechanisms remain unclear. In this study, we investigated whether resuscitation with FFP or normal saline differed in th...... in their effects on cerebral metabolism and excitotoxic secondary brain injury in a model of polytrauma, TBI, and hemorrhagic shock....

  11. Neuro-, Trauma -, or Med/Surg-ICU: Does it matter where polytrauma patients with TBI are admitted? Secondary analysis of AAST-MITC decompressive craniectomy study

    Science.gov (United States)

    Scalea, Tom; Sperry, Jason; Coimbra, Raul; Vercruysse, Gary; Jurkovich, Gregory J; Nirula, Ram

    2016-01-01

    Introduction Patients with non-traumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without TBI fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. Methods This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study. Twelve Level 1 trauma centers provided clinical data and head CT scans of patients with Glasgow Coma Scale (GCS) ≤13 and CT evidence of TBI. Non-ICU admissions were excluded. Multivariate logistic regression was performed to measure the association between ICU-type and survival and calculate the probability of death for increasing ISS. Polytrauma patients (ISS > 15) with TBI and isolated TBI patients (other AIS polytrauma patients admitted to a TICU had improved survival across increasing ISS (Fig1). Survival for isolated TBI patients was similar between TICU and NICU. Med/Surg ICU carried the greatest probability of death. Conclusion Polytrauma patients with TBI have lower mortality risk when admitted to a Trauma ICU. This survival benefit increases with increasing injury severity. Isolated TBI patients have similar mortality risk when admitted to a Neuro ICU compared to a Trauma ICU. Med/Surg ICU admission carries the highest mortality risk. PMID:28225527

  12. The practicality of including the systemic inflammatory response syndrome in the definition of polytrauma: experience of a level one trauma centre.

    Science.gov (United States)

    Butcher, Nerida E; Balogh, Zsolt J

    2013-01-01

    The systemic inflammatory response syndrome (SIRS) has been advocated as a significant predictor of outcome in trauma. Recent trauma literature has proposed SIRS as a surrogate for physiological derangements characteristic of polytrauma with some authors recommending its inclusion into the definition of polytrauma. The practicality of daily SIRS collection outside of specifically designed prospective trials is unknown. The purpose of this study was to assess the availability of SIRS variables and its appropriateness for inclusion into a definition of polytrauma. We hypothesised SIRS variables would be readily available and easy to collect, thus represent an appropriate inclusion into the definition of polytrauma. A prospective observational study of all trauma team activation patients over 7-months (August 2009 to February 2010) at a University affiliated level-1 urban trauma centre. SIRS data (temperature>38°C or 90 bpm; RR>20/min or a PaCO(2)12.0×10(9)L(-1), or 10 immature bands) collected from presentation, at 24 h intervals until 72 h post injury. Inclusion criteria were all patients generating a trauma team activation response age >16. 336 patients met inclusion criteria. In 46% (155/336) serial SIRS scores could not be calculated due to missing data. Lowest rates of missing data observed on admission [3% (11/336)]. Stratified by ISS>15 (132/336), in 7% (9/132) serial SIRS scores could not be calculated due to missing data. In 123 patients ISS>15 with complete data, 81% (100/123) developed SIRS. For Abbreviated Injury Scale (AIS)>2 in at least 2 body regions (64/336) in 5% (3/64) serial SIRS scores could not be calculated, with 92% (56/61) of patients with complete data developing SIRS. For Direct ICU admissions [25% (85/336)] 5% (4/85) of patients could not have serial SIRS calculated [mean ISS 15(±11)] and 90% (73/81) developed SIRS at least once over 72 h. Based on the experience of our level-1 trauma centre, the practicability of including SIRS into the

  13. Pattern of cytokine (IL-6 and IL-10) level as inflammation and anti-inflammation mediator of multiple organ dysfunction syndrome (MODS) in polytrauma.

    Science.gov (United States)

    Sapan, Heber Bombang; Paturusi, Idrus; Jusuf, Irawan; Patellongi, Ilhamjaya; Massi, Muh Nasrum; Pusponegoro, Aryono Djuned; Arief, Syafrie Kamsul; Labeda, Ibrahim; Islam, Andi Asadul; Rendy, Leo; Hatta, Mochammad

    2016-01-01

    Massive injury remains the most common cause of death for productive age group globally. The current immune, inflammatory paradigm, based on an incomplete understanding of the functional integration of the complex host response, remains a major impediment to the development of effective innovative diagnostic and therapeutic effort. This study attempt to investigate the pattern of inflammatory and anti-inflammatory cytokines such as interleukin-6 and 10 (IL-6 and IL-10) and their interaction in severe injury condition with its major complication as multiple organ dysfunction syndrome (MODS) and failure (MOF) after polytrauma. This is multicenter study held at 4 academic Level-1 Trauma center included 54 polytrauma participants. Inclusion criteria were age between 16-60 years old, had new acute episode of polytrauma which defined as injury in ≥2 body region with Injury Severity Score (ISS) ≥16, and the presence of Systemic Inflammation Response Syndrome (SIRS). Serum level of IL-6 and IL-10 were taken on day 2, 3, and 5 after trauma. During hospitalization, samples were observed for the occurrence of MODS or MOF using Sequential Organ Failure Assessment (SOFA) and mortality rate were also noted. Participant were mostly male with mean of age of 35, 9 years old, endured polytrauma caused by traffic accident. Elevation of cytokines (IL-6, IL-10, and IL-6/IL-10 ratio) had directly proportional with MODS and mortality. Threshold level of compensation for severe trauma is IL-6 of 50 pg/mL and trauma load of ISS ≥30. Inflammation reaction greater than this threshold level would result in downhill level of IL-6, IL-10, or IL-6/IL-10 ratio which associated with poor outcome (MODS and death). The elevation of these cytokines level were represent as compensation/adaptive immune system and its fall represent decompensating/failure of immune system after severe trauma. The pattern of IL-6 and IL-10 after polytrauma represent immune system effort to restore homeostasis

  14. Radioimmunoassay of pancreatic glucagon. Improvement of method and application in order to determine the role of glucagon in the polytrauma

    International Nuclear Information System (INIS)

    Schrezenmeir, J.

    1980-01-01

    Radio-iodizing of glucagon under the application of chloralamine-T was examined and optimized with respect to its dependency on the concentration of the reacting agents, on the duration of reaction and on the pH value. The methods of other authors to purify labeled glucagon were put in contrast with the considerably faster and less complicated batch-procedure, in which Ouso G32 is applied. In order to improve the immunogenity of the weak antigen glucagon, different immunogenic preparations were produced and compared with each other. By the glucagon polymerisation with carbodiimid in guadinin HCl-solution, antibodies of excellent quality were obtained. With the glucagon polymers for the first time an immunogen was found, which produced exclusively so-called specific anti-glucagon sera. The influence of the albumine concentration and of the charcoal quantity on the separation of free and antibody-bound glucagon by means of dextran-covered charcoal was investigated. The early beginning of the investigations, the observation of the course, the temporal correlation of numerous other parameters and the fast application of shock-measures led to new knowledge about glucagon in the polytrauma. (orig./MG) [de

  15. Significance of findings of both emergency chest X-ray and thoracic computed tomography routinely performed at the emergency unit in 102 polytrauma patients. A prospective study

    International Nuclear Information System (INIS)

    Grieser, T.; Buehne, K.H.; Haeuser, H.; Bohndorf, K.

    2001-01-01

    Purpose: To evaluate prospectively whether and to what extent both thoracic computed tomography (Tx-CT) and supine X-ray of the chest (Rx-Tx) are able to show additional findings that are therapeutically relevant. Patients and Methods: According to a fixed study protocol, we performed Rx-Tx and Tx-CT in 102 consecutive, haemodynamically stable polytrauma patients (mean age, 41.2 yrs; age range, 12-93 yrs). Findings of therapeutical relevance drawn from both Tx-CT and Rx-Tx, and urgent interventions indicated by an attending trauma team were documented on a standardized evaluation sheet immediately. Any change in the patient's management that is different from routine life-saving procedures, and any therapeutical intervention done in the emergency room or elsewhere (operating theatre, angiographic facility) were considered therapeutically relevant. Results: Of 102 patients, 43 (42.2%) had a total of 51 therapeutically relevant findings. Rx-Tx alone yielded 23 relevant findings (45.1%) in 23 patients (22.5%). Of them, Tx-CT has shown additional important findings in 7 patients (30.4%). When Tx-CT alone is considered, it revealed 22 new findings of therapeutical relevance (43.2%) in 20 patients (46.5%). Altogether, Tx-CT was able to show 30 relevant findings in 27 patients, i.e., there was a therapeutical benefit for 26.5% of all polytrauma patients included. Most frequently, there was a need for chest-tube insertion (n=29). Conclusions: Polytrauma patients if haemodynamically stable may profit from computed tomography of the chest when therapeutically relevant thoracic injuries are looked for or early therapeutical interventions are to be checked. However, chest X-ray should stay as a 'front-line' screening method because of its superbly quick feasibility and availability. (orig.) [de

  16. Inflammatory and apoptotic alterations in serum and injured tissue after experimental polytrauma in mice: distinct early response compared with single trauma or "double-hit" injury.

    Science.gov (United States)

    Weckbach, Sebastian; Hohmann, Christoph; Braumueller, Sonja; Denk, Stephanie; Klohs, Bettina; Stahel, Philip F; Gebhard, Florian; Huber-Lang, Markus S; Perl, Mario

    2013-02-01

    The exact alterations of the immune system after polytrauma leading to sepsis and multiple-organ failure are poorly understood. Thus, the early local and systemic inflammatory and apoptotic response was characterized in a new polytrauma model and compared with the alterations seen after single or combined injuries. Anesthetized C57BL/6 mice were subjected to either blunt bilateral chest trauma (Tx), closed head injury, right femur fracture including contralateral soft tissue injury, or a combination of injuries (PTx). After 2 hours or 6 hours, animals were sacrificed, and the systemic as well as the local pulmonary immune response (bronchoalveolar lavage [BAL]/plasma cytokines, lung myeloperoxidase [MPO] activity, and alveolocapillary barrier dysfunction) were evaluated along with lung/brain apoptosis (lung caspase 3 Western blotting, immunohistochemistry, and polymorphonuclear leukocytes [PMN] Annexin V). Hemoglobin, PO2 saturation, and pH did not differ between the experimental groups. Local BAL cytokines/chemokines were significantly increased in almost all groups, which included Tx. There was no further enhancement of this local inflammatory response in the lungs in case of PTx. At 2 hours, all groups except sham and closed head injury alone revealed an increased activity of lung MPO. However, 6 hours after injury, lung MPO remained increased only in the PTx group. Increased BAL protein levels were found, reflecting enhanced lung leakage in all groups with Tx 6 hours after trauma. Only after PTx was neutrophil apoptosis significantly decreased, whereas lung caspase 3 and plasma interleukin 6/keratinocyte chemoattractant (KC) were substantially increased. The combination of different injuries leads to an earlier systemic inflammatory response when compared with the single insults. Interestingly, only after PTx but not after single or double hits was lung apoptosis increased, and PMN apoptosis was decreased along with a prolonged presence of neutrophils in the

  17. The Assignment of American Society of Anesthesiologists Physical Status Classification for Adult Polytrauma Patients: Results From a Survey and Future Considerations.

    Science.gov (United States)

    Kuza, Catherine M; Hatzakis, George; Nahmias, Jeffry T

    2017-12-01

    The American Society of Anesthesiologists (ASA) physical status (PS) classification system assesses the preoperative health of patients. Previous studies demonstrated poor interrater reliability and variable ASA PS scores, especially in trauma scenarios. There are few studies that evaluated the assignment of ASA PS scores in trauma patients and no studies that evaluated ASA PS assignment in severely injured adult polytrauma patients. Our objective was to assess interrater reliability and identify sources of discrepancy among anesthesiologists and trauma surgeons in designating ASA PS scores to adult polytrauma patients. A link to an online survey containing questions assessing attitudes regarding ASA PS classification, demographic information, and 8 fictional trauma cases was e-mailed to anesthesiologists and trauma surgeons. The participants were asked to assign an ASA PS score to each scenario and explain their choice. Rater-versus-reference and interrater reliability, beyond that expected by chance, among respondents was analyzed using the Fleiss kappa analysis. A total of 349 participants completed the survey. All 8 cases had inconsistent ASA PS scores; several cases had scores ranging from I to VI and variable emergency (E) designations. Using weighted kappa (Kw) analysis for a subset of 201 respondents (101 trauma surgeons [S] and 100 anesthesiologists [A]), we found moderate (Kw = 0.63; SE = 0.024; 95% confidence interval, 0.594-0.666; P polytrauma patients. Although the ASA PS is used in some trauma risk stratification models, discrepancies of ASA PS scores assigned to trauma cases exist. Future modifications of the ASA PS guidelines should aim to improve the interrater reliability of ASA PS scores in trauma patients. Further studies are warranted to determine the value of the ASA PS score as a trauma prognostic metric.

  18. Outcome after polytrauma in a certified trauma network: comparing standard vs. maximum care facilities concept of the study and study protocol (POLYQUALY).

    Science.gov (United States)

    Koller, Michael; Ernstberger, Antonio; Zeman, Florian; Loss, Julika; Nerlich, Michael

    2016-07-11

    The aim of this study is to evaluate the performance of the first certified regional trauma network in Germany, the Trauma Network Eastern Bavaria (TNO) addressing the following specific research questions: Do standard and maximum care facilities produce comparable (risk-adjusted) levels of patient outcome? Does TNO outperform reference data provided by the German Trauma Register 2008? Does TNO comply with selected benchmarks derived from the S3 practice guideline? Which barriers and facilitators can be identified in the health care delivery processes for polytrauma patients? The design is based on a prospective multicenter cohort study comparing two cohorts of polytrauma patients: those treated in maximum care facilities and those treated in standard care facilities. Patient recruitment will take place in the 25 TNO clinics. It is estimated that n = 1.100 patients will be assessed for eligibility within a two-year period and n = 800 will be included into the study and analysed. Main outcome measures include the TraumaRegisterQM form, which has been implemented in the clinical routine since 2009 and is filled in via a web-based data management system in participating hospitals on a mandatory basis. Furthermore, patient-reported outcome is assessed using the EQ-5D at 6, 12 and 24 months after trauma. Comparisons will be drawn between the two cohorts. Further standards of comparisons are secondary data derived from German Trauma Registry as well as benchmarks from German S3 guideline on polytrauma. The qualitative part of the study will be based on semi-standardized interviews and focus group discussions with health care providers within TNO. The goal of the qualitative analysis is to elucidate which facilitating and inhibiting forces influence cooperation and performance within the network. This is the first study to evaluate a certified trauma network within the German health care system using a unique combination of a quantitative (prospective cohort

  19. A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India.

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, V; Gupta, Shakti Kumar

    2016-07-01

    Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical analysis was performed by Fisher's two tailed t-test. Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

  20. Comparison of PCT, CRP, D-Dimer, Lactate, TNF-α, IL-1β, IL-6 and lL-10 in Development of Systemic Inflammatory Response Syndrome and Sepsis on Patients with Isolated Head Trauma and Polytrauma

    Directory of Open Access Journals (Sweden)

    Emine Dağlı

    2012-12-01

    Full Text Available Objective: In this study, it was aimed to compare the relationship between Glasgow Coma Scale (GKS, ISS values, PCT, CRP, D-Dimer, laktat, TNF-α, IL-1β, IL-6, IL-10 in patients with polytrauma and isolated head trauma in conjunction with SIRS and sepsis. Material and Method: Total of 68 patients (32 polytrauma, 36 isolated head trauma aged between 18-65 years were enrolled in the study. For 7 days of follow up, the biochemical parameters were analysed on the days 0, 1, 3, 5, 7 and the ISS, GCS score and growth rates of SIRS and sepsis were recorded. Results: It was demonstrated that for patients with isolated head trauma, SIRS (80.6%, sepsis (38.9% and mortality values (71.4% were higher and there is a statistically important linear and inverse relationship between ISS and GCS values (p<0.05. During sepsis and SIRS phases, CRP elevated in both groups, whereas PCT only in the polytrauma group. D-Dimer values were investigated high in both groups, but atypically decreased on day 3 in isolated head trauma group. Lactate, TNF-α and, IL-1β were within reference values, IL-6 and IL-10 values were elevated in both groups but were higher in the polytrauma group. Conclusion: Although multiple variations were detected in serum markers of pro-inflamatory and acute phase proteins, we thought that these are inadequate in predicting mortality and complications such as SIRS and sepsis.

  1. Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT

    International Nuclear Information System (INIS)

    Wedegaertner, U.; Lorenzen, M.; Weber, C.; Adam, G.; Nagel, H.D.

    2004-01-01

    Purpose: To compare the radiation dose of whole-body multislice CT (MSCT) and conventional radiography with organ-specific CT in polytrauma. Materials and Methods: The whole-body MSCT encompassing brain, neck and midface, chest, abdomen and pelvis was performed on a Somatom Volume Zoom (Siemens). Conventional radiography consisted of chest and cervical, thoracic and lumbar spine in two views as well as pelvis. Polymat, Siemens. Three combinations of organ specific CT were chosen: CT examination of (1) head and cervical spine, (2) head, cervical spine and chest, (3) head, cervical spine and abdomen. The effective doses of whole-body MSCT and conventional radiography with organ-specific CT were calculated. Results: Effective doses were 20 mSv for whole-body MSCT, 2 mSv for conventional x-ray, and 5 mSv for combination (1), 8 mSv for combination (2) and (3) 16 mSv for combination (3) of the organ-specific CT. The ratio of radiation dose between whole-body MSCT and radiography was 10: 1. This ratio was reduced to 3: 1, 2: 1 and 1: 1 when a combination of radiography and CT was performed. Conclusions: Whole-body MSCT in polytrauma compared to conventional radiography with organ-specific CT induces a threefold increased dose in unfavorable situations and no increased dose in favorable situations. Nevertheless, routine use of whole-body MSCT should be critically evaluated and should be adapted to the clinical benefit. (orig.) [de

  2. Injuries to the upper extremities in polytrauma: limited effect on outcome more than ten years after injury - a cohort study in 629 patients.

    Science.gov (United States)

    Macke, C; Winkelmann, M; Mommsen, P; Probst, C; Zelle, B; Krettek, C; Zeckey, C

    2017-02-01

    To analyse the influence of upper extremity trauma on the long-term outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up study at least ten years after injury (mean age 26.5 years, standard deviation 12.4). The extent of the patients' injury was classified using the Injury Severity Score. Outcome was measured using the Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation duration, and employment status. Outcomes for patients with and without a fracture of the upper extremity were compared and analysed with regard to specific fracture regions and any additional brachial plexus lesion. In all, 307 multiply-injured patients with and 322 without upper extremity injuries were included in the study. The groups with and without upper limb injuries were similar with respect to demographic data and injury pattern, except for midface trauma. There were no significant differences in the long-term outcome. In patients with brachial plexus lesions there were significantly more who were unemployed, required greater retraining and a worse HASPOC. Injuries to the upper extremities seem to have limited effect on long-term outcome in patients with polytrauma, as long as no injury was caused to the brachial plexus. Cite this article: Bone Joint J 2017;99-B:255-60. ©2017 The British Editorial Society of Bone & Joint Surgery.

  3. The effect of polytrauma as a possible confounder in the outcome of monotraumatic vs polytraumatic paraplegic patients: a clinical cohort study.

    Science.gov (United States)

    Putz, C; Schuld, C; Gantz, S; Grieser, T; Akbar, M; Moradi, B; Wiedenhöfer, B; Fürstenberg, C H; Gerner, H J; Rupp, R

    2011-06-01

    Clinical cohort study. To evaluate if the impact of the severity of the trauma as a possible confounding factor influences the neurological and functional recovery in paraplegia during the course of a 6-month follow-up period after injury. Spinal Cord Injury Center, Heidelberg University Hospital, Germany. A retrospective monocentric analysis, from 2002 to 2008, of the Heidelberg European Multicenter Study about spinal cord injury database was performed. We included 31 paraplegic patients (neurological level T1-T12) who were assigned either to a monotrauma (polytraumaschluessel (PTS) 1) or to a polytrauma (PTS≥2) group. The American Spinal Injury Association Impairment Scale, lower extremity motor score, pin prick, light touch and the spinal cord independence measure (SCIM) were obtained at five distinct time points after trauma. Data were analyzed using Mann-Whitney U-test (αpressure sores between 3 and 6 months (P=0.031). The mean length of primary rehabilitation in the polytrauma group was 5.5 vs 3.6 months in monotrauma. The prognosis of polytraumatic paraplegics in terms of neurological recovery is not inferior to those with monotrauma. Multiple-injured patients need a prolonged hospital stay to reach the functional outcome of monotraumatic patients.

  4. Radiation therapy for Morbus Ledderhose - indication and clinical results; Strahlentherapie beim Morbus Ledderhose - Indikation und klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Seegenschmiedt, M.H.; Attassi, M. [Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus, Essen (Germany)

    2003-12-01

    were minimal: during and within 3 months of the RT course only a slight erythema (CTC 1 ) was seen in five treated lesions, while dry skin changes within the RT portal were observed in three cases (11%) in long term FU (> 12 months). Conclusions: radiotherapy is effective in treating ML and may prevent otherwise necessary surgical interventions. Nodules, cords and symptoms regress, but long-term outcome of at least 5 years has to be awaited. Prospective phase III studies should confirm these results. (orig.) [German] Hintergrund: Der morbus ledderhose (ML) ist eine hyperproliferative Erkrankung der Plantaraponeurose, die dem morbus dupuytren (MD) sehr aehnlich ist. Wir prueften, ob eine Bestrahlung die Symptome lindern und die Progression der Erkrankung aufhalten kann. Patienten und Methoden: Von Juni 1996 bis Dezember 2002 wurden zwoelf Frauen und 13 Maenner im Alter von 9-76 (median 56) Jahren mit symptomatischem ML bestrahlt und mindestens 1 Jahr kontrolliert. Insgesamt wurden 36 Fuesse (16 rechts, 20 links) bestrahlt, da elf Patienten beidseits einen Befall hatten. Zwoelf (48%) Patienten hatten auch einen MD. An 36 Fuessen lagen 63 Knoten (mit 0,5-6,5 cm Groesse) und an 13 (52%) Fuessen 20 Straenge (mit 1-4 cm Laenge) vor. Zusaetzlich bestanden 14-mai (56%) starke Fussschmerzen, achtmal (32%) Probleme beim Laufen, zwoelfmal (48%) andere Symptome (Druck, Schwellung, Spannung). Die Orthovolt-Radiotherapie erfasste alle tastbaren Knoten und Straenge. Es wurden zwei Serien zu je 5 x 3 Gy pro Woche (gesamt: 30 Gy) im Abstand von 8-12 Wochen gegeben. Die Auswertung erfolgte am Ende der RT, nach 3 und 12 Monaten und zuletzt im Dezember 2002. Primaerer Endpunkt war die Vermeidung einer Progression bzw. Operation; sekundaere Endpunkte waren mehrere objektive morphologisch-funktionelle sowie subjektive Parameter (visuelle analogskala (VAS)). Ergebnisse: Nach 38 (12-67) Monaten medianem FU war kein Fuss progredient oder musste operiert werden. Bei 11 von 36 (44%) Fuessen nahm

  5. Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries--analysis of 1,867 cases.

    Science.gov (United States)

    Odell, David D; Peleg, Kobi; Givon, Adi; Radomislensky, Irina; Makey, Ian; Decamp, Malcolm M; Whyte, Richard; Gangadharan, Sidhu P; Berger, Robert L

    2013-09-01

    Sternal fractures fall into two distinct categories as follows: (1) isolated sternal fracture (ISF) without associated injury and (2) polytrauma sternal fracture (PSF) with associated extrasternal injury. PSF can be sufficiently severe to require hospitalization, while ISF is usually a mild insult manageable in an ambulatory setting. Nonetheless, most patients with ISF are hospitalized. The disconnect between treatment based on existing evidence and actual clinical practice may be caused in large part by the small patient cohorts in published studies conducive to inaccurate conclusions. This article addresses the issue by analyzing prospectively collected data on a far larger population than hitherto available. The Israeli National Trauma Registry (INTR) collects data prospectively on patients admitted to trauma centers in Israel. We analyzed the INTR database on sternal fractures for demographics, mechanisms and severity of injury, diagnostic evaluation, treatment, and outcomes. Between 1997 and 2008, the INTR received data on 1,867 consecutive patients hospitalized with sternal fractures. The injury was sustained most often during motor vehicle accidents (84.1%), followed by falls (10.3%) and other blunt or penetrating mechanisms (5.6%). ISF was sustained in 26.4%, and PSF was sustained in 73.6%. Associated injuries involved most parts of the body. Cardiac contusions or lacerations were diagnosed in 1.8% of the 1,867 patients. ISF was associated with a lower incidence of cardiorespiratory compromise, more favorable trauma scores (Glasgow Coma Scale [GCS] score > 14, Revised Trauma Score > 11), and use of fewer intensive care facilities or operations compared with PSF. Endotracheal intubation, chest tube insertion, or thoracotomy was not performed in any ISF patient but was performed in 16.9% of the PSF cohort. The differences between ISF and PSF were statistically significant in all analyzed indices of injury severity. This study produced compelling evidence that

  6. Radiography of the equine thorax and its differential diagnosis relevance; Die differenzialdiagnostische Bedeutung der röntgenologischen Thoraxuntersuchung beim Pferd

    Energy Technology Data Exchange (ETDEWEB)

    Klein, H. J. [Klinik fuer Pferde, Tieraerztliche Hochschule Hannover (Germany); Offeney, F.

    1990-07-01

    Commonly chronic obstructive pulmonary disease (COPD) is the cause of dyspnoe or loss of performance in the horse. Tracheobronchoscopy, cytology of tracheobronchial aspirates, interpleural pressure measurement, and arterial blood gas analysis improved diagnosis of equine respiratory disorders. Yet some intrathoraeie diseases, especially chronic pneumonia, are differential diagnosis problems. Radiography of the thorax improves the diagnosis of pneumonia and some other intrathoraeie diseases. The technique of the radiography of the thorax is described and radiographic findings in 166 horses suffering from respiratory diseases are evaluated. Theses horses showed pathologic radiographic findings caused by COPD (n =61), pneumonia (67), pleuritis (12), exercise-induced pulmonary haemorrhage (8), aspiration pneumonia (7), hydrothorax (6), pneumothorax (2), lung abseess (1); mediastinal tumor (1), and diaphragmatie hernia (1) [German] Die chronisch obstruktive Bronchitis (COB) ist die häufigste Ursache von Atembeschwerden oder Leistungsmangel beim Pferd. Tracheobronchoskopie, Tracheobronchialsekretzytologie, interpleurale Druckmessung und arterielle Blutgasanalyse verbesserten die Diagnostik respiratorischer Erkrankungen. Dennoch bestehen Probleme hinsichtlich der Differentialdiagnose zur COB, und zwar insbesondere bei chronischen Pneumonien. Die röntgenologische Thoraxuntersuchung verbessert die Diagnose von Pneumonien und einigen anderen intrathorakalen Erkrankungen. Die Technik der röntgenologischen Thoraxuntersuchung wird beschrieben, und die Befunde von 166 Pferden mit Erkrankungen der Atemorgane werden ausgewertet. Diese Pferde zeigten pathologische Röntgenbefunde als Folge einer COB (n =61), einer Pneumonie (67), einer Pleuritis (12), eines belastungsinduzierten Lungenblutens (8), einer Aspirationspneumonie (7), eines Hydrothorax (6), eines Pneumothorax (2), eines Lungenabszesses (1), eines mediastinalen Tumors (1) und einer Zwerchfellhernie (1)

  7. Volumetry of metastases from renal cell carcinoma. Comparison with the RECIST criteria; Volumetrie von Metastasen beim Nierenzellkarzinom. Vergleich mit den RECIST-Kriterien

    Energy Technology Data Exchange (ETDEWEB)

    Graser, A.; Becker, C.R.; Reiser, M.F. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany); Stief, C.; Staehler, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Klinik und Poliklinik fuer Urologie, Muenchen (Germany)

    2008-09-15

    For patients with metastasized renal cell carcinoma (RCC), imaging techniques are of great importance. Currently, therapy widely relies on antiangiogenic factors, which frequently lead to relatively subtle changes in the size of lesions. From this aspect the commonly used RECIST criteria (response evaluation criteria in solid tumors) must be considered as imprecise for the evaluation of the response to therapy. This article gives a review on new software-based volumetric methods, which allow therapy-induced changes in the size of metastases from RCC to be detected with higher sensitivity and reproducibility. A comparison of RECIST and volumetry was carried out with data from patients with metastasized RCC to demonstrate the higher sensitivity of the 3D volumetric procedure. (orig.) [German] Bei Patienten mit metastasiertem Nierenzellkarzinom werden an die Bildgebung besondere Anforderungen gestellt. Die Therapie beruht heute in den meisten Faellen auf antiangiogenetischen Wirkstoffen, die im Verlauf teils zu relativ geringen Groessenaenderungen von Laesionen fuehren. Daher sind die oftmals verwendeten RECIST-Kriterien (''response evaluation criteria in solid tumors'') bei der Beurteilung des Therapieansprechens als ungenau anzusehen. In diesem Artikel wird ein Ueberblick ueber neue, softwarebasierte volumetrische Methoden gegeben, die es ermoeglichen, therapieinduzierte Groessenaenderungen von Metastasen beim Nierenzellkarzinom mit hoeherer Sensitivitaet und Reproduzierbarkeit zu detektieren. Anhand eigener Daten wird ein Vergleich von RECIST und Volumetrie bei Patienten mit metastasiertem Nierenzellkarzinom durchgefuehrt und die hoehere Sensitivitaet des automatisierten Verfahrens gezeigt. (orig.)

  8. Value of radiographic examination of the knee joint for the orthopedic surgeon; Wertigkeit der radiologischen Bildgebung beim Kniegelenk fuer den Orthopaeden

    Energy Technology Data Exchange (ETDEWEB)

    Pietsch, M.; Hofmann, S. [Allgemeines und Orthopaedisches LKH Stolzalpe (Austria). Abteilung fuer Orthopaedie und orthopaedische Chirurgie

    2006-01-01

    Extended radiographic examinations offer excellent options for diagnosis and strategy for treatment of the knee joint. The whole-leg radiograph is indispensable in measuring alignment for osteotomy or total knee arthroplasty (TKA). Fluoroscopically assisted varus-valgus stress radiographs provide the possibility for verifying mechanical function of the implanted knee prosthesis. Ultrasound examinations have been widely replaced by magnetic resonance imaging (MRI). MRI is the golden standard to examine intra-articular structures of the knee (meniscus, ligaments, cartilage) and surrounding soft tissue. For evaluating femoral and tibial torsion and determining axial rotation of TKA, computed tomography (CT) is best qualified. Imaging of the patellofemoral joint (patella instability) is difficult; CT scans in combination with true lateral radiographs seem to be helpful. (orig.) [German] Die erweiterte Roentgendiagnostik bietet gute Moeglichkeiten der Diagnose und Therapieplanung beim Kniegelenk. Das Ganzbeinroentgen ist unabdingbar zur Achsvermessung bei der Planung einer Umstellungsosteotomie oder der Implantation einer Knietotalendoprothese (KTEP). Varus-/Valgusaufnahmen unter Bildwandler gestatten die Ueberpruefung der Mechanik einer liegenden KTEP. Sonographische Untersuchungen des Kniegelenks sind weitgehend durch die Magnetresonanztomographie (MRT) ersetzt. Die MRT ist die Methode der Wahl zur Beurteilung der Kniebinnenstrukturen (Meniskus, Baender, Knorpel) und der umgebenden Weichteile. Zur Bestimmung der Torsion von Femur und Tibia sowie der Rotation der Komponenten einer KTEP ist die Computertomographie (CT) am besten geeignet. Die Beurteilung des Femorpatellargelenks (Patellainstabilitaet) ist schwierig, am vielversprechendsten erscheint die CT in Kombination mit streng seitlichen Roentgenbildern. (orig.)

  9. About the effect of melted zinc mass additives on the formation on layers during hot galvanizing; Zur Wirkung von Zusaetzen zur Zinkschmelze auf die Schichtbildung beim Feuerverzinken

    Energy Technology Data Exchange (ETDEWEB)

    Schubert, P.; Schulz, W.D. [Institut fuer Korrosionsschutz Dresden GmbH, Gostritzer Str. 61-63, D-01217 Dresden (Germany)

    2002-09-01

    The influence of various melted zinc mass additives on the galvanizing behaviour of steels is examined by way of comparison. The mechanisms influencing the formation of layers are very different. In case tin is added, a material barrier of enriched tin develops in the zinc coating, which inhibits the iron transport. The mechanisms of Ni, Ti and Al in the melted zinc mass are explained by means of a new theory on the formation of layers, which is based on the influence of the growth of layers via hydrogen escaping from the steel surface during hot galvanizing. This behaviour makes it clear why the single melted mass additives only have a layer-thickness reducing effect on steels with very definite Si contents. The different inhibitions of the growth of the layer during hot galvanizing are discussed. (Abstract Copyright[2002], Wiley Periodicals, Inc.) [German] Der Einfluss unterschiedlicher Zinkschmelzezusaetze auf das Verzinkungsverhalten der Staehle wird vergleichend untersucht. Die Mechanismen der Einflussnahme auf die Schichtbildung sind sehr unterschiedlich. Bei Zusatz von Zinn entsteht im Zinkueberzug eine Materialbarriere aus angereichertem Zinn, die den Eisentransport hemmt. Die Wirkungsweise von Ni, Ti und Al in der Zinkschmelze wird mit Hilfe einer neuen Theorie der Schichtbildung erklaert. Diese beruht auf der Beeinflussung des Schichtwachstums durch Wasserstoff, der waehrend des Feuerverzinkens aus der Stahloberflaeche austritt. Diese Erklaerung macht verstaendlich, warum die einzelnen Schmelzezusaetze nur bei Staehlen mit ganz bestimmten Si-Gehalten schichtdickenreduzierend wirken. Die unterschiedlichen Hemmungen des Schichtwachstums beim Feuerverzinken werden diskutiert. (Abstract Copyright[2002], Wiley Periodicals, Inc.)

  10. Early predictors of health-related quality of life outcomes in polytrauma patients with spine injuries: a level 1 trauma center study.

    Science.gov (United States)

    Tee, J W; Chan, C H P; Gruen, R L; Fitzgerald, M C B; Liew, S M; Cameron, P A; Rosenfeld, J V

    2014-02-01

    Study Design Retrospective review on clinical-quality trauma registry prospective data. Objective To identify early predictors of suboptimal health status in polytrauma patients with spine injuries. Methods A retrospective review on a prospective cohort was performed on spine-injured polytrauma patients with successful discharge from May 2009 to January 2011. The Short Form 12-Questionnaire Health Survey (SF-12) was used in the health status assessment of these patients. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, blood sugar level, vital signs, brain trauma severity, comorbidities, coagulation profile, spine trauma-related neurologic status, and spine injury characteristics of the patients. Results The SF-12 had a 52.3% completion rate from 915 patients. The patients who completed the SF-12 were younger, and there were fewer patients with severe spinal cord injuries (American Spinal Injury Association classifications A, B, and C). Other comparison parameters were satisfactorily matched. Multivariate logistic regression revealed five early predictive factors with statistical significance (p ≤ 0.05). They were (1) tachycardia (odds ratio [OR] = 1.88; confidence interval [CI] = 1.11 to 3.19), (2) hyperglycemia (OR = 2.65; CI = 1.51 to 4.65), (3) multiple chronic comorbidities (OR = 2.98; CI = 1.68 to 5.26), and (4) thoracic spine injuries (OR = 1.54; CI = 1.01 to 2.37). There were no independent early predictive factors identified for suboptimal mental health-related qualify of life outcomes. Conclusion Early independent risk factors predictive of suboptimal physical health status identified in a level 1 trauma center in polytrauma patients with spine injuries were tachycardia, hyperglycemia, multiple chronic medical comorbidities, and thoracic spine injuries. Early spine trauma risk factors were shown not to predict suboptimal mental

  11. Computed tomography in multiple trauma patients. Technical aspects, work flow, and dose reduction; Polytrauma-Computertomographie. Technische Grundlagen, Workflow und Dosisreduktion

    Energy Technology Data Exchange (ETDEWEB)

    Fellner, F.A. [AKH Linz - Kepler Universitaetsklinikum/JKU, Zentrales Radiologie Institut, Linz (Austria); Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen (Germany); Krieger, J.; Floery, D. [AKH Linz - Kepler Universitaetsklinikum/JKU, Zentrales Radiologie Institut, Linz (Austria); Lechner, N. [AKH Linz - Kepler Universitaetsklinikum/JKU, Abteilung fuer Medizintechnik, Linz (Austria)

    2014-09-15

    radiologischen Managements sowie auf den verschiedenen Moeglichkeiten der Untersuchungsdurchfuehrung im Routineeinsatz und in Spezialsituationen liegt. Ein weiterer Schwerpunkt sind Moeglichkeiten und Strategien zur Dosisreduktion der Schockraum-CT sowie der Untersuchung polytraumatisierter Kinder. Zahlreiche Studien haben gezeigt, dass eine fruehe Ganzkoerper-CT-Untersuchung positiv mit einer niedrigen Mortalitaet und Morbiditaet korreliert und anderen Bildgebungsverfahren deutlich ueberlegen ist. Die optimale Schockraumversorgung erfordert eine interdisziplinaere Zusammenarbeit von Unfallchirurgen, Anaesthesisten und Radiologen, wobei die Radiologie fuer einen raschen und adaequaten Einsatz der bildgebenden Verfahren und die zeitnahe Kommunikation relevanter Befunde verantwortlich ist. Daneben sollte auch im Rahmen der Schockraum-CT die Patientenstrahlendosis im Hauptaugenmerk des Radiologen stehen. (orig.)

  12. The role of whole body spiral CT in the primary work-up of polytrauma patients - comparison with conventional radiography and abdominal sonography

    International Nuclear Information System (INIS)

    Albrecht, T.; Schlippenbach, J. von; Wolf, K.J.; Stahel, P.F.; Ertel, W.

    2004-01-01

    Purpose: To evaluate the role of routine 'whole body spiral CT' in the primary work-up of polytrauma patients for injuries of the thorax, abdomen and spine, and to compare the results with those of conventional radiography of the chest and spine and abdominal ultrasound. Materials and Methods: Fifty consecutive polytrauma patients underwent contrast-enhanced single slice spiral CT (5 mm collimation) from the vertex to the floor of the pelvis as part of the primary work-up after emergency room admission. Overlapping high resolution sections and sagittal reformations of the spine were obtained. Reports of additional chest radiographs (n=43), abdominal ultrasound examinations (n=47) and spine radiographs (n=36) performed in the emergency room were available for retrospective comparison. The 'final diagnoses', which served as the standard of reference, were taken from the patients' records using all information that became available until discharge or death, such as findings from further imaging, surgery and autopsy. Results: CT showed 109 (97%) of 112 thoracic and abdominal soft-tissue injuries. Relevant injuries missed were an early splenic laceration and an early pelvic hematoma, both of which became clinically apparent several hours later. There were 4 false positive CT findings. Conventional chest radiography demonstrated only 20% of thoracic and sonography 22% of abdominal injuries. Chest radiography and sonography produced 2 false-positive findings each. CT showed 66 (87%) of 76 vertebral fractures including all 19 unstable ones. CT missed 5 anterior vertebral body and 5 spinous/transverse process fractures. Conventional radiography found 71% of vertebral fractures including only 50% of the unstable one. (orig.)

  13. Costs and role of ultrasound follow-up of polytrauma patients after initial computed tomography; Kosten und Stellenwert von Ultraschallverlaufskontrollen bei polytraumatisierten Patienten nach initialer Computertomografie

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H.; Winkler, A.; Powerski, M.J.; Elgeti, F.; Huppertz, A.; Roettgen, R.; Marnitz, T. [Charite - Universitaetsmedizin Berlin (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Wichlas, F. [Charite - Universitaetsmedizin Berlin (Germany). Centrum fuer Muskuloskeletale Chirurgie

    2012-01-15

    Purpose: To assess the costs and diagnostic gain of abdominal ultrasound follow-up of polytrauma patients initially examined by whole-body computed tomography (CT). Materials and Methods: A total of 176 patients with suspected multiple trauma (126 men, 50 women; age 43.5 {+-} 17.4 years) were retrospectively analyzed with regard to supplementary and new findings obtained by ultrasound follow-up compared with the results of exploratory FAST (focused assessment with sonography for trauma) at admission and the findings of whole-body CT. A process model was used to document the staff, materials, and total costs of the ultrasound follow-up examinations. Results: FAST yielded 26 abdominal findings (organ injury and/or free intra-abdominal fluid) in 19 patients, while the abdominal scan of whole-body CT revealed 32 findings in 25 patients. FAST had 81 % sensitivity and 100 % specificity. Follow-up ultrasound examinations revealed new findings in 2 of the 25 patients with abdominal injuries detected with initial CT. In the 151 patients without abdominal injuries in the initial CT scan, ultrasound follow-up did not yield any supplementary or new findings. The total costs of an ultrasound follow-up examination were EUR 28.93. The total costs of all follow-up ultrasound examinations performed in the study population were EUR 5658.23. Conclusion: Follow-up abdominal ultrasound yields only a low overall diagnostic gain in polytrauma patients in whom initial CT fails to detect any abdominal injuries but incurs high personnel expenses for radiological departments. (orig.)

  14. The value of radiotherapy in comparison with extracorporeal shockwave therapy for supraspinatus tendinitis; Die Wertigkeit der Strahlenbehandlung im Vergleich zur extrakorporalen Stosswellentherapie (ESWT) beim Supraspinatussehnensyndrom

    Energy Technology Data Exchange (ETDEWEB)

    Gross, M.W.; Engenhart-Cabillic, R. [Klinik fuer Strahlentherapie und Radioonkologie der Philipps-Univ. Marburg (Germany); Sattler, A.; Haake, M.; Schmitt, J.; Hildebrandt, R. [Orthopaedische Klinik der Philipps-Univ. Marburg (Germany); Mueller, H.H. [Inst. fuer Medizinische Biometrie und Epidemiologie, Philipps-Univ. Marburg (Germany)

    2002-06-01

    Background and Aim: Supraspinatus tendinitis is usually treated by antiinflammatoric drugs, local injections, physiotherapy or low-dose irradiation. A novel approach is the use of extracorporeal shock wave therapy (ESWT) if conservative therapies have failed. So far there has been no controlled study comparing the effectiveness of ESWT with an established conservative method of therapy such as X-ray stimulation radiotherapy. Patients and Methods: 30 patients with chronic supraspinatus tendinitis were admitted into the prospective randomized study. After randomization the patients were treated either with X-ray stimulation radiotherapy with 6 x 0.5 Gy on the ICRU reference point (1 fraction/day) with cobalt 60 gamma rays or three times with 2000 pulses (energy flux density ED+ 0.1 mJ/mm{sup 2}) in 1 week intervals using a Storz Minilith SL1. Primary endpoint was the age-corrected constant score 3 months after intervention. Results: Acute side effects caused by the irradiation were not observed, as expected. One patient described pain and one patient showed a moderate skin irritation after ESWT. In the radiotherapy group average the age-corrected constant score improved from 47.6 through 79.5 points to 87.4 points. In the ESWT group it rose from 50.1 points before ESWT to 91.4 points after 12 weeks and 97.8 after 52 weeks. Conclusion: No statistically significant differences were proven between ESWT and radiotherapy. ESWT appears to be equivalent but not superior to radiotherapy in treating chronic supraspinatus tendinitis syndrome. A comprehensive randomized study is, however, necessary to ensure the equivalence of ESWT. (orig.) [German] Hintergrund und Studienziel: Neben den medikamentoesen Therapieverfahren stehen beim Supraspinatussehnensyndrom die niedrig dosierte Strahlentherapie und, als neuere Methode, die extrakorporale Stosswellentherapie (ESWT) zur Verfuegung. Bislang fehlt jedoch eine kontrollierte Studie, die die Wirksamkeit der ESWT im Vergleich zur

  15. Dimensioning of activation systems using submerged membranes at municipal sewage treatment plants; Bemessung von Membranbelebungsanlagen beim Einsatz zur Reinigung kommunaler Abwaesser

    Energy Technology Data Exchange (ETDEWEB)

    Ohle, P.; Dorgeloh, E. [Technische Hochschule Aachen (DE). Inst. fuer Siedlungswasserwirtschaft (ISA)

    1999-07-01

    Dimensioning of conventional activation systems in Germany as a rule relies on instruction sheet A131 of the Abwassertechnische Vereinigung or follows the Hochschulgruppen approach (HSG). They contain recommendations as to the size of the nitrification and denitrification zones, the amount of oxygen supplied and sludge production, and the size of the final sedimentation tank. For the use of sludge activation techniques by means of submerged membranes at municipal sewage treatment plant there so far do not exist any clues to dimensioning that make allowance for the modified boundary conditions. The present paper analyses instruction sheet A131 for its suitability as a basis in the dimensioning of sludge activation systems with submerged membranes at municipal sewage treatment plant. Then the dimensioning instructions are modified to suit the changed boundary conditions, and recommendations for the dimensioning of activation systems with submerged membranes on the basis of extensive studies carried out at the Institut fuer Siedlungswasserwirtschaft ISA of Aachen Technical University RWTH are given. (orig.) [German] Die Bemessung konventioneller Belebungsverfahren erfolgt in Deutschland i.d.R. auf der Grundlage des Arbeitsblatts A 131 der Abwassertechnischen Vereinigung bzw. nach dem Hochschulgruppenansatz (HSG). Sie enthalten Empfehlungen bezueglich der Dimensionierung von Nitrifikations- und Denitrifikationszone, Sauerstoffversorgung, Schlammproduktion und Nachklaerbecken. Fuer den Einsatz von Membranbelebungsanlagen in kommunalen Klaeranlagen existieren bislang keine Bemessungshinweise, die den veraenderten Randbedingungen Rechnung tragen. Der vorliegende Beitrag analysiert das Arbeitsblatt A 131 in Hinsicht auf die Moeglichkeit zur Anwendung fuer die Bemessung von Membranbelebungsanlagen beim Einsatz zur kommunalen Abwasserreinigung. Im Weiteren erfolgt die Modifikation der Bemessungshinweise hinsichtlich der geaenderten Randbedingungen und die Angabe von

  16. Early decreased TLR2 expression on monocytes is associated with their reduced phagocytic activity and impaired maturation in a porcine polytrauma model

    Science.gov (United States)

    Schimunek, Lukas; Serve, Rafael; Teuben, Michel P. J.; Störmann, Philipp; Auner, Birgit; Woschek, Mathias; Pfeifer, Roman; Horst, Klemens; Simon, Tim-P.; Kalbitz, Miriam; Sturm, Ramona; Pape, Hans-C.; Hildebrand, Frank; Marzi, Ingo

    2017-01-01

    In their post-traumatic course, trauma patients suffering from multiple injuries have a high risk for immune dysregulation, which may contribute to post-injury complications and late mortality. Monocytes as specific effector cells of the innate immunity play a crucial role in inflammation. Using their Pattern Recognition Receptors (PRRs), notably Toll-Like Receptors (TLR), the monocytes recognize pathogens and/or pathogen-associated molecular patterns (PAMPs) and organize their clearance. TLR2 is the major receptor for particles of gram-positive bacteria, and initiates their phagocytosis. Here, we investigated the phagocytizing capability of monocytes in a long-term porcine severe trauma model (polytrauma, PT) with regard to their TLR2 expression. Polytrauma consisted of femur fracture, unilateral lung contusion, liver laceration, hemorrhagic shock with subsequent resuscitation and surgical fracture fixation. After induction of PT, peripheral blood was withdrawn before (-1 h) and directly after trauma (0 h), as well as 3.5 h, 5.5 h, 24 h and 72 h later. CD14+ monocytes were identified and the expression levels of H(S)LA-DR and TLR2 were investigated by flow cytometry. Additionally, the phagocytizing activity of monocytes by applying S. aureus particles labelled with pHrodo fluorescent reagent was also assessed by flow cytometry. Furthermore, blood samples from 10 healthy pigs were exposed to a TLR2-neutralizing antibody and subsequently to S. aureus particles. Using flow cytometry, phagocytizing activity was determined. P below 0.05 was considered significant. The number of CD14+ monocytes of all circulating leukocytes remained constant during the observational time period, while the percentage of CD14+H(S)LA-DR+ monocytes significantly decreased directly, 3.5 h and 5.5 h after trauma. The percentage of TLR2+ expressing cells out of all monocytes significantly decreased directly, 3.5 h and 5.5 h after trauma. The percentage of phagocytizing monocytes decreased

  17. 49. and 50. annual meeting of the Civil Defence Commission of the Federal Ministry of the Interior. Proceedings; 49. und 50. Jahrestagung der Schutzkommission beim Bundesminister des Innern. Vortraege

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-07-01

    The publication contains the proceedings of the 2000 and 2001 annual meetings. Subjects were: Disaster medicine, public alarm, proliferation of weapons of mass destruction, epidemic hygiene and control, therapy of organophosphate poisoning, airborne energy and dose equivalent profiles by microdosimetry, zoning system for floods, backwater, heavy rains, health services, information security in transition, heavy-duty concretes, building and infrastructure protection. [German] Der Band umfasst die Vortraege der Jahrestagungen 2000 und 2001 der Schutzkommission beim Bundesminister des Innern. Die Vortraege beschaeftigten sich mit folgenden Themen: Katastrophenmedizin, Warnung der Bevoelkerung, Proliferation von Massenvernichtungswaffen, Seuchenhygiene und Seuchenbekaempfung, Therapie von Organophosphatvergiftung, Energie- und Aequivalentdosisleistungsprofile mittels Microdosimetrie in Flugzeugen, Zonierungssystem Ueberschwemmung Rueckstau Starkregen, Gesundheitsdienst, Informationssicherheit im Wandel, Hochleistungsbetone, Baulicher Schutz und Schutz von Infrastruktur. (uke)

  18. Das biochemische Rezidiv beim Prostatakarzinom

    Directory of Open Access Journals (Sweden)

    Rauchenwald M

    2010-01-01

    Full Text Available Als biochemisches Rezidiv (BCR wird der Wiederanstieg des nach kurativer Therapie des Prostatakarzinoms (PCa abgefallenen PSA-Werts bezeichnet. Der PSA-Verlauf nach kurativer Therapie ist von der primären Behandlungsmethode abhängig, weshalb auch unterschiedliche Definitionen dafür vorliegen. Der Verlauf selbst scheint prognostische Bedeutung zu haben. Ein Wiederanstieg des PSA-Werts geht der klinischen Progression voraus, wodurch frühzeitig eine Therapie eingeleitet werden kann. Der ideale Zeitpunkt für eine Sekundärbehandlung ist allerdings noch ungenügend definiert. Fast die Hälfte der BCR treten innerhalb der ersten 2 Jahre, ¾ innerhalb der ersten 5 Jahre nach Primärtherapie auf. Als Risikofaktoren für einen BCR werden ein primäres Tumorstadium ≥ T2c, PSA 15, Samenblaseninvasion, Lymphknotenbefall sowie Gleason-Score ≥ 8 angesehen. Von klinischer Bedeutung ist vor allem die Unterscheidung zwischen lokoregionärem und systemischem Rezidiv. Hierzu werden als Parameter neben dem primären Tumorstadium und Gleason-Score das posttherapeutische Intervall und die PSA-Dynamik empfohlen. Als diagnostische Maßnahmen erscheinen nur die Skelettszintigraphie und die Positronenemissionstomographie mit Acetat- oder Cholintracern und diese ebenfalls nur bei entsprechend hohen PSA-Werten sinnvoll. Therapeutisch kommt nach primärer Radikaloperation und Verdacht auf einen lokalen Progress in erster Linie die Salvagebestrahlung zur Anwendung, nach primärer Radiatio wird allerdings vorwiegend die hormonelle Manipulation einer Salvageoperation oder alter“nativen lokaltherapeutischen Maßnahmen vorgezogen.

  19. Βιβλιοκρισία:P. SCHREINER-E. VOGT(eds., Karl Krumbacher. Leben und Werk, München, Verlag der Bayerischen Akademie der Wissenschaften in Kommission beim Verlag C. H. Beck, München 2011

    Directory of Open Access Journals (Sweden)

    Walter PUCHNER

    2013-04-01

    Full Text Available Βιβλιοκρισία: P. Schreiner-E. Vogt (eds., Karl Krumbacher. Leben und Werk, München, Verlag der Bayerischen Akademie der Wissenschaften in Kommission beim Verlag C. H. Beck, München 2011 (Bayerische Akademie der Wissenschaften, Philosophisch-historische Klasse, Sitzungsberichte, Jahrgang 2011, Heft 4, σελ. 147, 5 εικ., ΙSBN 978 3 7696 1569 0.

  20. Defining Platelet Function During Polytrauma

    Science.gov (United States)

    2014-04-01

    scaffold of the clot after its thrombin-induced polymerization to fibrin fibers. Formation of a stiff fibrin fiber network and its contraction by platelet...In another study (PROTEC T) Refused Participat ion (Yes=Y, No=N, W=Unqua lified , Refused further draws (agreed to keep previous data

  1. Influence of antithyroid medication on effective half-life and uptake of {sup 131}I following radioiodine therapy; Einfluss thyreostatischer Medikation beim Morbus Basedow auf die Kinetik von 131-Iod waehrend einer Radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Moka, D.; Voth, E.; Schicha, H. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    1997-12-01

    Aim of this study was to assess the influence of antithyroid drugs (ADT) on the kinetics of {sup 131}I. Therefore, 56 patients with Graves` disease and with shortened effective half-life of {sup 131}I were examined under stationary conditionary conditions. In 38 patients ATD was stopped three days after radioiodine therapy (RIT). The progress of the first RIT and of a second RIT, which still was necessary in 12 patients, was compared to 18 patients receiving ATD continuously. Values of effective half-life for {sup 131}I rose significantly from 3.4 to 5.7 days 2-3 days after stopping ATD. There was an increase of the {sup 131}I-uptake of a second RIT after stopping ATD from 29.0 to 38.4%. In contrast, {sup 131}I-uptake of a second RIT decreased significantly in patients receiving ATD continuously. Effective half-life and uptake of {sup 131}I were affected significantly by ATD. Interrupting ATD after RIT is useful to improve an apparantly insufficient RIT in thyrotoxic patients receiving ATD. (orig.) [Deutsch] Ziel dieser Studie war es, beim M. Basedow die Kinetik von {sup 131}I unter dem Einfluss thyreostatischer Medikation (tM) zu untersuchen. Dazu wurden die 56 Patienten mit immunogener Hyperthyreose M. Basedow (MB) und mit einem erhoehten `turn over` von {sup 131}I unter tM untersucht. Bei 38 Patienten wurde die tM am 3. Tag nach RITh abgesetzt. Der Verlauf der 1. RITh bzw. einer Nachtherapie wurde mit 18 Patienten unter fortlaufender tM verglichen. 2-3 Tage nach Absetzen der tM stieg die effektive Halbwertzeit (HWZ{sub eff.}) von {sup 131}I signifikant von 3,4 auf 5,7 Tage und der {sup 131}I-Uptake bei der Nachtherapie von 29,0 auf 38,4% an, waehrend er unter fortlaufender tM signifikant abfiel. Beide Effekte zeigen, dass tM die {sup 131}I-Kinetik der Schilddruese sehr schnell beeinflussen kann. Gezieltes Absetzen der tM eignet sich deshalb, um bei ausgewaehlten Patienten eine primaer unzureichende RITh noch waehrend des stationaeren Aufenthaltes zu steuern und

  2. Optimization of radiotherapy planning for Non-Small Cell Lung Cancer (NSCLC) by {sup 18}FDG-PET; Optimierung der Bestrahlungsplanung beim nicht-kleinzelligen bronchialkarzinom (NSCLC) mit Hilfe von {sup 18}FDG-PET

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, S.; Nestle, U.; Kirsch, C.M. [Abt. fuer Nuklearmedizin, Universitaetskliniken des Saarlandes, Homburg/Saar (Germany); Walter, K. [Abt. fuer Strahlentherapie, Marienkrankenhaus Amberg (Germany); Licht, N.; Schnabel, K. [Abt. fuer Strahlentherapie, Universitaetskliniken des Saarlandes, Homburg/Saar (Germany); Ukena, D. [Innere Medizin V, Universitaetskliniken des Saarlandes, Homburg/Saar (Germany)

    2002-10-01

    Aim: In recent years, FDG-PET examinations have become more important for problems in oncology, especially in staging of bronchogenic carcinoma. In the retrospective study presented here, the influence of PET on the planning of radiotherapy for patients with non-small-cell lung cancer (NSCLC) was investigated. Methods: The study involved 39 patients with NSCLC who had been examined by PET for staging. They received radiotherapy on the basis of the anterior/posterior portals including the primary tumour and the mediastinum planned according to CT- and bronchoscopic findings. The results of the PET examination were not considered in initial radiotherapy planning. The portals were retrospectively redefined on the basis of FDG uptake considering the size and localization of the primary tumour; and FDG activities outside the mediastinal part of the portals. Results: In 15 out of 39 patients, the CT/PET-planned portals differed from the CT-planned ones. In most cases (n = 12) the CT/PET field was smaller than the CT field. The median geometric field size of the portals was 179 cm{sup 2}, after redefinition using PET 166 cm{sup 2}. In 20 patients with disturbed ventilation caused by the tumour (atelectosis, dystelectosis), a correction of the portal was suggested significantly more frequently than in the other patients (p = 0.03). Conclusions: Our results demonstrate the synergism of topographical (CT) and metabolic (FDG-PET) information, which could be helpful in planning radiotherapy of bronchial carcinoma, especially for patients with disturbed ventilation. (orig.) [German] Ziel: Die FDG-PET-Untersuchung hat in den vergangenen Jahren bei onkologischen Fragestellungen insbesondere beim Staging des Bronchialkarzinoms wachsende Bedeutung erlangt. In der vorliegenden retrospektiven Untersuchung wurde der Einfluss der PET auf die Strahlentherapieplanung bei Patienten mit non-small-cell lung cancer (NSCLC) untersucht. Methoden: Die Untersuchung umfasste 39 Patienten mit

  3. Kognitive Prozesse der Adressatenantizipation beim Schreiben

    OpenAIRE

    Linnemann, Markus

    2014-01-01

    Im Fokus dieser Untersuchung stand die Textproduktion aus kognitiver Sicht. Diese umfasst im Wesentlichen vier Wissensbereiche. Neben dem thematischen und linguistischen Wissen, widmete sich die Arbeit vor allem dem pragmatischen, insbesondere dem Adressatenwissen und den dazugehörenden Prozessen. Es wurde dargestellt, dass der Adressat aufgrund seiner räumlichen und zeitlichen Distanz vom Schreiber antizipiert werden muss, wenn er erfolgreich kommunizieren will. Adressatenantizipation wurde ...

  4. Brain tumors in children; Hirntumoren beim Kind

    Energy Technology Data Exchange (ETDEWEB)

    Harting, I.; Seitz, A. [Universitaetsklinikum Heidelberg (Germany). Abt. Neuroradiologie

    2009-06-15

    Brain tumors are common in children; in Germany approximately 400 children are diagnosed every year. In the posterior fossa, cerebellar neoplasms outnumber brainstem gliomas. In contrast to their rarity in adults, brainstem gliomas are not uncommon in children. Supratentorial tumors can be subdivided by location into neoplasms of the cerebral hemispheres, suprasellar and pineal tumors. Astrocytoma is the most common pediatric brain tumor followed by medulloblastoma, ependymoma and craniopharyngeoma. The combination of imaging morphology, tumor localisation and patient age at manifestation form the basis of the neuroradiological differential diagnosis. (orig.)

  5. Körperliche Fitness beim alternden Mann

    Directory of Open Access Journals (Sweden)

    Rauchenwald M

    2001-01-01

    Full Text Available Die derzeitige Diskussion um die Substitution von Hormonen zur Therapie altersbedingter Leistungseinbußen und Befindlichkeitsstörungen führte zu der Frage, ob diese Veränderungen bzw. die entsprechenden Hormonspiegel nicht auch durch körperliches Training günstig beeinflußt werden können. Altern ist mit einem kontinuierlichen Abfall der körperlichen Fitness und der Erektionsfähigkeit verbunden. Die Risikofaktoren für Erektionsstörungen, wie z. B. Übergewicht, sind sehr ähnlich jenen von Herz-Kreislauf-Erkrankungen. Mehrere Studien konnten eine positive Korrelation von körperlicher Aktivität und Erektionsfähigkeit nachweisen. Regelmäßige Bewegung führt zu einer Gewichtsreduktion und zu einem Stressabbau. Die mit dem Alterungsprozeß assoziierten Hormone stehen untereinander als auch mit dem körperlichen Fitnesszustand in Zusammenhang. Ausdauertraining erhöht den Testosteronspiegel stärker als Krafttraining, zu hohe Belastungen führen zu einem Abfall desselben, v.a. in der Erholungsphase, und es besteht eine positive Korrelation von körperlicher Aktivität mit Testosteron und mit Wachstumshormon. Ältere Männer haben allerdings einen schlechteren Response als Jüngere (z. T. kein Effekt bei Krafttraining. Auch für Untrainierte scheint eine mäßige Kreislaufbelastung günstig zu sein und zumindest vorübergehend eine geringe Testosteron-Erhöhung zu bewirken. Ein Zusammenhang zwischen Fitness bzw. Lipidprofil einerseits und dem DHEAS-Spiegel andererseits ist in der Literatur bekannt. Körperliches Training führt auf physiologischem Wege zu Müdigkeit, besserem Schlaf und folglich zu höheren Wachstumshormonspiegeln. Weiters werden das Selbstbewußtsein, die Erektionsfähigkeit, die Muskelmasse und das Gefäßsystem günstig beeinflußt und Stress abgebaut. Regelmäßiges Training 3-5 x pro Woche für 30-60 Minuten mit einer Intensität von 60-80% des Maximalpulses wird als Ausdauertraining empfohlen. Regelmäßige körperliche Aktivität ist ein wichtiger Bestandteil erfolgreichen Alterns.

  6. Metallurgical phenomena in laser finishing: Interdependences between solidification morphologies and hot cracking in laser welding of mostly austenitic materials. Final reportc; Metallkundliche Phaenomene der Laserstrahlmaterialbearbeitung. Teilvorhaben: Zusammenhaenge zwischen Erstarrungsmorphologien und Heissrissentstehung beim Laserschweissen von vornehmlich austenitischen Werkstoffen. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Schobbert, H.

    2000-06-01

    be performed by using measuring results of this newly developed test assembly. For the first time, different types of hot cracks in correlation to the change of primary solidification mode could be detected. The primary austenitic weld metals of the materials 1.4828 and 1.4306, which formed due to the change of solidification mode, showed a susceptibility to DDC. The results of this research project are a contribution to quantify the change of solidification mode and thus, the restriction of hot cracking resistance of the tested materials. (orig.) [German] Als ein spezifisches Problem des Laserschweissens stellt sich bei den wirtschaftliche wuenschenswerten hohen Schweissgeschwindigkeiten jedoch heraus, dass besonders austenitische Staehle mit einer Zusammensetzung in der Naehe der eutektischen Rinne ihren Erstarrungsmodus aendern und damit die Heissrisssicherheit eingeschraenkt sein kann. Vor diesem Hintergrund sind in der Forschungsarbeit die beim Laserschweissen entstehenden Erstarrungsmorphologien dieser Staehle in der Naehe der eutektischen Rinne besonders unter dem Aspekt kurzeitmetallurgisch bedingter kinetischer Effekte unter den Bedingungen einer schneller Erstarrung untersucht worden. Fuer drei im praktischen Einsatz weit verbreitete nichtrostende Staehle (1.4828, 1.4306 und 1.4404) wird ein von der Erstarrungsgeschwindigkeit abhaengiger Wechsel des primaeren Erstarrungsmodus von primaer ferritsch zu primaer austenitisch nachgewiesen. Die kritische Erstarrungsgeschwindigkeit kann in guter Naeherung mit einem neu entwickelten Modell durch eine geometrische Analyse der Erstarrungsstrukturen ermittelt werden. Die von der Zusammensetzung der Werkstoffe abhaengige kritische Erstarrungsgeschwindigkeit fuer den Wechsel der Primaererstarrung betraegt fuer diese Werkstoffe groessenordnungsmaessig etwa 1 m/min. Als ein wesentliches Ergebnis wird fuer die zu primaer austenitisch gewechselten Erstarrungsmorphologien die zunaechst vermutete Beeintraechtigung der

  7. Pacientes vítimas de politrauma com insuficiência renal aguda na unidade de terapia intensiva Pacientes víctimas de politrauma con insuficiência renal aguda en la unidad de cuidados intensivos Patient victim of polytrauma with acute renal failure in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Rita de Cássia Helú Mendonça Ribeiro

    2008-01-01

    evitar las complicaciones de la IRA y la respectiva mortalidad.OBJECTIVE: To identify the characteristics of patients with acute renal failure (ARF, polytrauma victims hospitalized in an Intensive Care Unit (ICU. METHODS: A retrospective analysis was performed on 357 records of patients with ARF in the period of 2002 to 2003. These patients presented a creatinine index of 1.8 to 4 mg/dl. Of these patients, 10.6% in the ICU were polytrauma victims. RESULTS: Of the 38 (10.6% patients with ARF and polytrauma victims, 78.9% of were males; 47.3% were aged between 16 and 45 years; 84.3% presented oliguria; 92.1% received no treatment for ARF during hospitalization; 50% remained from one to five days in the ICU; 47.3% had not presented any underlying disease and mortality occurred in 50%. CONCLUSION: Daily control of the renal function in polytrauma victims is important to prevent ARF complications and consequent mortality.

  8. The role of whole body spiral CT in the primary work-up of polytrauma patients - comparison with conventional radiography and abdominal sonography; Die Rolle der Ganzkoerper-Spiral-CT bei der Primaerdiagnostik polytraumatisierter Patienten - Vergleich mit konventioneller Radiographie und Abdomensonographie

    Energy Technology Data Exchange (ETDEWEB)

    Albrecht, T.; Schlippenbach, J. von; Wolf, K.J. [Klinik und Poliklinik fuer Radiologie und Nuklearmedizin, Charite - Campus Benjamin Franklin (Germany); Stahel, P.F.; Ertel, W. [Klinik fuer Unfall- und Wiederherstellungschirurgie, Charite - Campus Benjamin Franklin (Germany)

    2004-08-01

    Purpose: To evaluate the role of routine 'whole body spiral CT' in the primary work-up of polytrauma patients for injuries of the thorax, abdomen and spine, and to compare the results with those of conventional radiography of the chest and spine and abdominal ultrasound. Materials and Methods: Fifty consecutive polytrauma patients underwent contrast-enhanced single slice spiral CT (5 mm collimation) from the vertex to the floor of the pelvis as part of the primary work-up after emergency room admission. Overlapping high resolution sections and sagittal reformations of the spine were obtained. Reports of additional chest radiographs (n=43), abdominal ultrasound examinations (n=47) and spine radiographs (n=36) performed in the emergency room were available for retrospective comparison. The 'final diagnoses', which served as the standard of reference, were taken from the patients' records using all information that became available until discharge or death, such as findings from further imaging, surgery and autopsy. Results: CT showed 109 (97%) of 112 thoracic and abdominal soft-tissue injuries. Relevant injuries missed were an early splenic laceration and an early pelvic hematoma, both of which became clinically apparent several hours later. There were 4 false positive CT findings. Conventional chest radiography demonstrated only 20% of thoracic and sonography 22% of abdominal injuries. Chest radiography and sonography produced 2 false-positive findings each. CT showed 66 (87%) of 76 vertebral fractures including all 19 unstable ones. CT missed 5 anterior vertebral body and 5 spinous/transverse process fractures. Conventional radiography found 71% of vertebral fractures including only 50% of the unstable one. (orig.)

  9. Arbitration in environmental matters. An interdisciplinary introduction; Studienbrief Umweltmediation. Eine interdisziplinaere Einfuehrung

    Energy Technology Data Exchange (ETDEWEB)

    Claus, F; Fietkau, H J; Fuchs, G [and others

    2000-07-01

    This textbook provides a comprehensive and systematic introduction to the process of arbitration in environmental matters, both for self-studies and for participants in the seminars on which it is based. The interdisciplinary readership is reflected in the interdisciplinary group of authors. The publication can be used as a training programme. [German] Mit Vorliegen dieses Studienbriefs wird erstmals eine Moeglichkeit geboten, sich umfassend und systematisch, im Eigenstudium oder im Rahmen des dazugehoerigen Seminarprogramms, mit dem Verfahren der Umweltmediation vertraut zu machen. Der Vielfalt der angesprochenen Zielgruppen (Politik, Verwaltung, Wirtschaft, Rechtswesen usw.) wurde in der interdisziplinaeren Zusammensetzung des Autorenkreises Rechnung getragen. Das Layout wurde so gestaltet, dass es die inhaltliche Orientierung erleichert. Zusaetzlich kann der Studienbrief auch als Bauelement fuer eine umfassendere Wissensaneignung dienen: Erstens ist es moeglich, sich ueber das oben genannte Ausbildungsprogramm fuer Praktiker zum Mediator fortzubilden. Zweitens besteht die Chance, das erworbene Wissen durch einen Lehrgang zur Agenda-Moderation des Wissenschaftsladen Bonn e.V. um weitere konsens- und handlungsorientierte Verfahren zu erweitern. Informationen koennen ueber den Foerderverein Umweltmediation e.V., Matthias-Gruenewald-Str. 1-3, 53175 Bonn, Tel. 0228/3 72 99 27, eingeholt werden. (orig.)

  10. Interdisciplinary approach to the management of childhood ependymomas; Die interdisziplinaere Therapie von Ependymomen im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Timmermann, B.; Kortmann, R.D.; Bamberg, M. [Abt. Strahlentherapie der Univ. Tuebingen (Germany); Kuehl, J. [Kinderklinik der Univ. Wuerzburg (Germany); Willich, N. [Abt. Strahlentherapie der Univ. Muenster (Germany)

    2002-09-01

    Material and Method: Based on historical reports, the recent literature, present guidelines, and ongoing trials an overview is provided for the management of ependymomas in childhood. Results: Local tumor control is the most important aim. Recurrences occur predominantly at the primary tumor region. The main instrument is surgery to effect maximal tumor resection. The addition of radiotherapy could improve survival significantly from 10% to 50%. Regarding the volume of irradiation there is confidence today that local fields are sufficient for all non-disseminated ependymomas. Local dose escalation has been introduced using hyperfractionated schedules. In recent studies this has been shown to increase local control up to 70%. Regarding chemotherapy in ependymomas trials have shown limited efficacy to date. For metastatic disease standard treatment has shown to be insufficient and high dose chemotherapy regimens to increase survival are in study. In younger children radiotherapy should be delayed using early chemotherapy. With preirradiation chemotherapy survival rates of 63.3% for children under age of 3 were achieved. (orig.) [German] Material und Methode: Auf der Grundlage der historischen Entwicklung, aktueller Literatur, geltender Leitlinien und laufender Studien wird ein Ueberblick ueber das Management von Ependymomen gegeben. Ergebnisse: Die lokale Tumorkontrolle ist von ausschlaggebender prognostischer Bedeutung; nur wenige Rezidive treten ausserhalb des Primaertumorgebietes auf. Daher dominiert eine moeglichst komplette Resektion das Therapiekonzept. Bei intrakraniellen Tumoren hat die postoperative Strahlentherapie die Ueberlebenschance deutlich verbessern koennen von ehemals 10 auf ueber 50%. Bei der Zielvolumendefinition hat bei nicht metastasierten Ependymomen unabhaengig von Histologie oder Tumorsitz die ausschliessliche Behandlung der Tumorregion aehnliche Erfolge gezeigt wie eine Liquorraumbehandlung. Mit lokaler Dosiseskalation durch Hyperfraktionierung konnte nach amerikanischen Ergebnissen eine Steigerung der lokalen Tumorkontrolle auf 70% erreicht werden. Eine Chemotherapie hat in den bisherigen Studien keine sicheren Ueberlebensvorteile gezeigt. Metastasierte Erkrankungen konnten mit den bisherigen Therapiekonzepten nur ungenuegend beherrscht werden und fuehrten zur Einfuehrung intensiverer Behandlungsprotokolle. Bei juengeren Kindern konnte durch eine hoch dosierte postoperative Chemotherapie der Beginn der Strahlentherapie verzoegert werden, um die Reifung des Gehirns nicht zu beeintraechtigen, und fuehrte zu einer 5-Jahres-Ueberlebenswahrscheinlichkeit von 63,3%. (orig.)

  11. Infektion beim Menschen und beim Hund mit der Milbe Cheyletiella yasguri Smiley

    DEFF Research Database (Denmark)

    Brandrup, F; Andersen, Klaus Ejner; Kristensen, S

    1979-01-01

    The infection with the mite Cheyletiella yasguri Smiley in 3 dogs and 5 out of 6 persons exposed to infestation is reported. Two of the dogs appeared to have been infected during a stay in a kennel. The dogs presented with moderate itching and slight to massive floury squamation on the back. In t...

  12. Clinical value of FDG hybrid-PET in staging and restaging of malignant lymphoma. Compared with conventional diagnostic methods; Klinische Wertigkeit der Befunde von FDG-PET mittels Koinzidenz-Gammakamera beim Staging und Restaging maligner Lymphome. Ein Vergleich zu konventioneller Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Pichler, R.; Maschek, W.; Hatzl-Griesenhofer, M.; Huber, H. [Allgemeines Krankenhaus Linz (Austria). Inst. fuer Nuklearmedizin; Wimmer, G.; Wahl, G.; Fridrik, M. [Allgemeines Krankenhaus Linz (Austria). I. Medizinische Abt.

    2000-09-01

    Therapieplan. Insgesamt wurden 29 Personen zwecks posttherapeutischem Restaging untersucht. Bei allen wurden Computertomographie- und Lymphknoten-Ultraschalluntersuchungen angewendet. Die Ergebnisse wurden durch den klinischen Verlauf validiert, in drei Faellen wurde ein Rezidiv durch Biopsie bestaetigt. Ergebnisse: CT und US zeigten beim praetherapeutischen Staging 77 Herde verglichen mit 100 durch Doppelkopf-(DK-)PET dargestellten, dieser Unterschied war im Fisher-T-Test jedoch nicht signifikant (p>0,05). Bei der Erkennung residualer Erkrankungsaktivitaet erzielte DK-Koinzidenz-PET eine Sensitivitaet von 93%, eine Spezifitaet von 79%, einen positiven von 82% und einen negativen praediktiven Wert von 92%. Fuer CT+US ergaben sich entsprechend 87%, 64%, 72% und 88%. Schlussfolgerung: FDG-DK-PET erzielt beim Prestaging maligner Lymphome mindestens so genaue Ergebnisse wie ueblicherweise eingesetzte morphologische Diagnoseverfahren. Zusaetzlich ergibt sich ein erkennbarer Vorteil im therapeutischen Monitoring residualer Lymphome durch den Einsatz von Positronen-Koinzidenz-Detektion mittels einer 3/4-Zoll-Kristall-Gammakamera. (orig.)

  13. Gruppenleistungen beim Review von Multiple-Choice-Fragen - Ein Vergleich von face-to-face und virtuellen Gruppen mit und ohne Moderation [Review of multiple-choice-questions and group performance - A comparison of face-to-face and virtual groups with and without facilitation

    Directory of Open Access Journals (Sweden)

    Schüttpelz-Brauns, Katrin

    2010-11-01

    Full Text Available [english] Background: Multiple choice questions (MCQs are often used in exams of medical education and need careful quality management for example by the application of review committees. This study investigates whether groups communicating virtually by email are similar to face-to-face groups concerning their review process performance and whether a facilitator has positive effects.Methods: 16 small groups of students were examined, which had to evaluate and correct MCQs under four different conditions. In the second part of the investigation the changed questions were given to a new random sample for the judgement of the item quality.Results: There was no significant influence of the variables “form of review committee” and “facilitation”. However, face-to-face and virtual groups clearly differed in the required treatment times. The test condition “face to face without facilitation” was generally valued most positively concerning taking over responsibility, approach to work, sense of well-being, motivation and concentration on the task.Discussion: Face-to-face and virtual groups are equally effective in the review of MCQs but differ concerning their efficiency. The application of electronic review seems to be possible but is hardly recommendable because of the long process time and technical problems.[german] Einleitung: Multiple-Choice-Fragen (MCF werden in vielen Prüfungen der medizinischen Ausbildung verwendet und bedürfen aus diesem Grund einer sorgfältigen Qualitätssicherung, beispielsweise durch den Einsatz von Review-Komitees. Anhand der vorliegenden empirischen Studie soll erforscht werden, ob virtuell per E-Mail kommunizierende Review-Komitees vergleichbar sind mit face-to-face Review-Komitees hinsichtlich ihrer Leistung beim Review-Prozess und ob sich Moderation positiv auswirkt.Methodik: 16 Kleingruppen von Psychologie-Studenten hatten die Aufgabe unter vier verschiedenen Versuchsbedingungen MCF zu bewerten und zu

  14. Significance of findings of both emergency chest X-ray and thoracic computed tomography routinely performed at the emergency unit in 102 polytrauma patients. A prospective study; Relevanz der Befunde von Thoraxroentgen und Thorax-CT im routinemaessigen Schockraumeinsatz bei 102 polytraumatisierten Patienten. Eine prospektive Studie

    Energy Technology Data Exchange (ETDEWEB)

    Grieser, T.; Buehne, K.H.; Haeuser, H.; Bohndorf, K. [Zentralklinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie

    2001-01-01

    Purpose: To evaluate prospectively whether and to what extent both thoracic computed tomography (Tx-CT) and supine X-ray of the chest (Rx-Tx) are able to show additional findings that are therapeutically relevant. Patients and Methods: According to a fixed study protocol, we performed Rx-Tx and Tx-CT in 102 consecutive, haemodynamically stable polytrauma patients (mean age, 41.2 yrs; age range, 12-93 yrs). Findings of therapeutical relevance drawn from both Tx-CT and Rx-Tx, and urgent interventions indicated by an attending trauma team were documented on a standardized evaluation sheet immediately. Any change in the patient's management that is different from routine life-saving procedures, and any therapeutical intervention done in the emergency room or elsewhere (operating theatre, angiographic facility) were considered therapeutically relevant. Results: Of 102 patients, 43 (42.2%) had a total of 51 therapeutically relevant findings. Rx-Tx alone yielded 23 relevant findings (45.1%) in 23 patients (22.5%). Of them, Tx-CT has shown additional important findings in 7 patients (30.4%). When Tx-CT alone is considered, it revealed 22 new findings of therapeutical relevance (43.2%) in 20 patients (46.5%). Altogether, Tx-CT was able to show 30 relevant findings in 27 patients, i.e., there was a therapeutical benefit for 26.5% of all polytrauma patients included. Most frequently, there was a need for chest-tube insertion (n=29). Conclusions: Polytrauma patients if haemodynamically stable may profit from computed tomography of the chest when therapeutically relevant thoracic injuries are looked for or early therapeutical interventions are to be checked. However, chest X-ray should stay as a 'front-line' screening method because of its superbly quick feasibility and availability. (orig.) [German] Ziel: Die prospektive Studie soll klaeren, ob und inwieweit eine Thoraxcomputertomographie (Tx-CT) unter Schockraumbedingungen gegenueber der Roentgen

  15. Investigations on avoidance of hot cracks during laser welding of austenitic Cr-Ni steels and nickel-based alloys using temperature field tailoring. Final report; Untersuchungen zur Vermeidung von Heissrissen beim Laserstrahlschweissen von austenitischen Cr-Ni-Staehlen und Nickelbasislegierungen mittels Temperaturfeld-Tailoring. Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-08

    . Zweitens wird bei rotationssymmetrischen Bauteilen, die mittels einer Axial-Rundnaht zu verschweissen sind, mit einem relativ einfachen Temperaturfeld, das durch Erwaermung des innen liegenden Fuegepartners vor und waehrend des Schweissens aufgebaut wird, ein Spannungsfeld erzeugt, das die Bildung von Heissrissen verhindert. Schliesslich konnte drittens ein heissrissfreies Laserstrahlschweissen des Stahls 1.4305 und der Nickelbasislegierung Udimet 720 bereits ohne den Einsatz zusaetzlicher Temperaturfelder erreicht werden. Die Grenzen der Einsetzbarkeit des Verfahrens bei Cr-Ni-Staehlen werden dann erreicht, wenn Quer-Heissrisse oder parallel zur Blechoberflaeche liegende Heissrisse entstehen. Die zur Vermeidung dieser Risse noetigen Druckspannungen in den Richtungen parallel zur Schweissnaht bzw. senkrecht zur Blechoberflaeche koennen mittels induktiver Erwaermung von der Blechoberseite aus nicht in der erforderlichen Groesse erzeugt werden. Ebenso stoesst das Verfahren an seine Grenzen, wenn Wiederaufschmelzungsrisse auftreten, was beim hier verwendeten Stahl 1.4435 der Fall war. Die Spannungen, die zur Verhinderung einer Rissoeffnung an den Korngrenzen der Waermeeinflusszone erforderlich waeren, konnten durch Temperaturfeld-Tailoring nicht erreicht werden. Die Moeglichkeit des heissrissfreien Schweissens des Stahls 1.4305 auch ohne Temperaturfeld-Tailoring ergibt sich hauptsaechlich aus dem primaer ferritischen Erstarrungsmodus des Stahls in der vorliegenden Legierungszusammensetzung. Ein industrieller Einsatz des Laserstrahlschweissens fuer diesen oft als nicht schweissbar klassifizierten Stahl erscheint moeglich, wenn bei der Legierungszusammensetzung auf niedrige Anteile der Austenitbildner Nickel, Kohlenstoff und Stickstoff Wert gelegt wird und damit eine stabil primaer ferritische Erstarrung erreicht wird. Fuer diesen Fall kommt es nicht zur Schwefelanreicherung an den Korngrenzen, wodurch die Bildung niedrigschmelzender Phasen und damit die Heissrissentstehung

  16. Die Internen Und Externen Interferenzfehler Beim Lernprozess Des Deutschen Als Zweitfremdsprache Für Türkische Muttersprachler Und Vorschläge Zur Fehlertherapie Internal And External Interference Errors In The Process Of Learning German As A Second Foreign Language And Methods To Prevent Mistakes

    Directory of Open Access Journals (Sweden)

    Adnan OFLAZ

    2013-09-01

    Full Text Available Das Ziel dieser Untersuchung liegt darin, die verschiedenen Arten von Interferenzen, die beim Lernprozess der deutschen Sprache auftreten, zuerst theoretisch aufzuklären, dann systematisch mit der kontrastiven Methode durch eine Fehleranalyse zu bestimmen und danach auszuwerten. Die Beeinflussung der Sprache von einer anderen Sprache verursacht Überschneidungen. Interferenzfehler können wir in den Bereichen “Phonologie, Orthographie, Morphologie, Syntax, Semantik, Pragmatik oder auch Textlinguistik erkennen. Anschließend werden Vorschläge zur Fehlerkorrektur auf den grammatikalischen, ortographischen und lexikalischen Ebenen vorgenommen. Betrachtet man dies aus dem kognitiven Blickwinkel, kann jeder unschwer erkennen, dass die Vorkenntnisse retroaktive und proaktive Effekte haben. Das heißt, diese Kenntnisse können den Lernprozess entweder positiv oder negativ beeinträchtigen. Von diesem Ausgangspunkt aus werden in dieser Arbeit die Wechselwirkungen, die sowohl von der erstgelernten Fremdsprache als auch von der Muttersprache abhängig sind, der Reihe nach identifiziert, klassifiziert und abschliessend analysiert. Auf den Ergebnissen dieser Fehleranalyse basierend, machen Studenten unter dem Einfluss der interlingualen Interferenzen meist Fehler bei der Wortstellung, der Zeitform „Perfekt“, Pluralbildung, der Deklination der Adjektive, der Groß- bzw Kleinschreibung und bei dem Gebrauch der Konjunktionen sowie auf den lexikalischen Ebenen. Unter dem Einfluss der intralingualen Interferenzen machen sie Fehler bei der Bildung der Zeitformen „Perfekt und Präteritum“ und bei der Konjugation des Verbs. The primary aim of this study is to analyze the different types ofinterferences that may occur in the process of learning the Germanlanguage both theoretically and systematically by making use of thecontrastive method in order to detect and evaluate common errors. In asecond step, methods to correct these errors on a grammatical

  17. Focal lesions in whole-body MRI in multiple myeloma. Quantification of tumor mass and correlation with disease-related parameters and prognosis; Fokale Laesionen in der Ganzkoerper-MRT beim multiplen Myelom. Quantifizierung der Tumorlast und Korrelation mit krankheitstypischen Parametern und Prognose

    Energy Technology Data Exchange (ETDEWEB)

    Brandelik, S.C.; Kauczor, H.U. [Universitaetsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Krzykalla, J.; Hielscher, T. [Deutsches Krebsforschungszentrum (dkfz), Biostatistik, Heidelberg (Germany); Hillengass, J. [Universitaetsklinikum Heidelberg, Haematologie und Onkologie, Heidelberg (Germany); Kloth, J.K. [Radiologie Loebau, Loebau (Germany); Weber, M.A. [Universitaetsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsmedizin Rostock, Diagnostische und Interventionelle Radiologie, Rostock (Germany)

    2018-01-15

    In this study, we evaluated methods of quantification of tumor mass in whole-body MRI (wb-MRI) in multiple myeloma and correlated these with disease-related parameters in serum and bone marrow. We retrospectively evaluated wb-MRIs of 52 patients with focal infiltration pattern and a total of 700 focal lesions (subsequently called lesions). We determined the longest diameter (LD), the segmented volume (SV), and the morphology (spherical or non-spherical). We correlated total number/volume of the lesions with clinical parameters and prognosis and furthermore LD with SV. After that we analyzed the agreement of SV and estimated volume (EV) using the volume formula of a sphere based on LD. Results showed no significant correlations of total number/volume with prognosis or clinical parameters. The latter were situated predominantly in the normal range. Furthermore, 10% of lesions were spherical. SV and LD correlated significantly in single lesions and on patient level. SV was in lesions <6 cm{sup 3} systematically larger and in lesions ≥6 cm{sup 3} smaller than EV. In 95%, we found in small lesions a deviation of EV versus SV from +0.9 cm{sup 3} to -4.6 cm{sup 3} and in large lesions from +160 cm{sup 3} to -111 cm{sup 3} (EV-SV). Quantification of tumor mass in the focal infiltration pattern is performed more accurately by volumetry than LD due to the predominant existence of non-spherical lesions. The patient cohort with clinical parameters predominantly in the normal range is distributed to ISS stage I and partly pretreated, a fact that makes interpretation of absent correlations more difficult. Consider also a variation in activity of lesions and a diffuse infiltration not detectable by MRI. (orig.) [German] In dieser Studie wurden Methoden der Tumorlastquantifizierung in der Ganzkoerper-Magnetresonanztomographie (GK-MRT) beim Multiplen Myelom untersucht und mit krankheitstypischen Parametern in Serum und Knochenmark korreliert. Die GK-MRT von 52 Patienten mit

  18. Beginn und Dosisanpassung einer intensivierten konventionellen Insulintherapie (ICT beim Erwachsenen

    Directory of Open Access Journals (Sweden)

    Lohr R

    2012-01-01

    Full Text Available Eine intensivierte Insulintherapie (ICT ist die Behandlung der Wahl bei Diabetes mellitus Typ 1 und auch bei vielen Menschen mit insulinpflichtigem Typ-2-Diabetes. Bei Therapiebeginn müssen individuell Insuline ausgewählt und die richtige Dosierung festgelegt werden. Im weiteren Verlauf ist dann die Anpassung der Insulintherapie an besondere Alltagssituationen wie Sport oder akute Erkrankungen vorrangig. Eine gute Patientenschulung und eine gute Zusammenarbeit zwischen Betroffenem und Behandlerteam sind entscheidend, um diese komplizierte Therapie erfolgreich umzusetzen.

  19. Finally clarity when energy saving; Endlich Klarheit beim Energiesparen

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2012-07-01

    How much money do users in mechanical engineering and plant construction save in the implementation of energy efficiency measures? What actions bring which savings? Festo AG and Co. KG (Esslingen, Federal Republic of Germany) provides answers to these questions in terms of the pneumatic control system.

  20. Epidemiologische Studie zur Verbreitung porziner Circoviren beim Wildschwein in Deutschland

    OpenAIRE

    Knell, Sebastian Christoph

    2007-01-01

    PMWS, weltweit die wirtschaftlich bedeutendste Erkrankung in der Schweineinproduktion, wird mit PCV 2 assoziiert. Weitere Erkrankungen wie Reproduktionsstörungen und der „porcine respiratory disease Complex (PRDC)“ werden mit dem Virus assoziiert und das Virus gilt als ein Faktor für das „Porzine Dermatitis und Nephropathie Syndrom“ (PDNS). Porzine Circoviren vom Typ I, die als Zellkulturkontaminante entdeckt wurden, gelten als nicht pathogen. Der Erreger beider Typen ist in den Hausschweine...

  1. Bone scintigraphy for horses; Die Skelettszintigrafie beim Pferd

    Energy Technology Data Exchange (ETDEWEB)

    Jahn, Werner [Pferdeklinik Bargteheide (Germany)

    2010-03-15

    Scintigraphy (bone scan) is being used approximately since 1980 in the horse under general anaesthesia. With the construction of custom-made overhead gantries for gamma-cameras scintigraphy found widespread entry in big equine referral hospitals for bone-scanning of the standing horse. Indications for the use of a bone scan in the horse are inflammatory alterations in the locomotor apparatus. It is primarily used for diagnosis of lameness of unknown origin, suspect of stress fracture or hairline fracture and for horses with bad riding comfort with suspected painful lesions in the spine. (orig.)

  2. Radiotherapy for shoulder impingement; Bestrahlung beim Impingementsyndrom des Schultergelenks

    Energy Technology Data Exchange (ETDEWEB)

    Adamietz, B. [Universitaetsklinikum Erlangen (Germany). Inst. fuer Radiologie; Sauer, R.; Keilholz, L. [Universitaetsklinikum Erlangen (Germany). Strahlentherapeutische Klinik

    2008-05-15

    Background and Purpose: Up to now, degenerative shoulder diseases were summarized by the term 'periarthritis humeroscapularis'. Actual shoulder diseases can be differentiated etiopathologically according to a primary and secondary impingement syndrome. Narrowing of the subacromial space, which is caused by an osseous shape variant, leads to primary impingement. Secondary impingement develops, when the subacromial space is reduced by swelling tissue below the osseous shoulder roof. This study aimed for the exact diagnosis to indicate therapy and to classify the results according to the Constant score. Patients and Methods: From August 1999 to September 2002, 102 patients with 115 shoulder joint conditions underwent radiation therapy (RT). All joints received two RT series (6 x 0.5 Gy/series) applied in two to three weekly fractions, totaling a dosage of 6.0 Gy (250 kV, 15 mAs, 1-mm Cu filter). The second RT course started 6 weeks after the end of the first. 115 shoulders were examined before RT, 6 weeks after the second RT course and, finally, during the follow-up from January to May 2003. Results: Pain relief was achieved in 94/115 shoulder joints (82%) after 18-month follow-up (median). A significant difference existed between secondary impingement and primary/non-impingement according to response. Tendinosis calcarea, bursitis subdeltoidea, tendovaginitis of the long biceps tendon, and capsulitis adhaesiva responded well to therapy. Conclusion: Shoulder diseases of secondary impingement demonstrate a good response to RT. Less or no benefit was found in primary impingement syndrome or complete rotator cuff disruption and acute shoulder injuries, respectively. (orig.)

  3. Der Strafgrund beim untauglichen und baim tauglichen Versuch / Claus Roxin

    Index Scriptorium Estoniae

    Roxin, Claus

    2017-01-01

    Kuritegelikust kavatsusest kuriteokatse toimepanekul Saksa ja Hispaania karistusõiguses. Ajakirjanumber sisaldab erinevaid artikleid Hispaania ja Saksa karistusõigusest ning on pühendatud hispaania õigusteadlase Santiago Mir Puig'i 70. sünnipäevale

  4. Trichinella britovi beim Rotfuchs (Vulpes vulpes) in Österreich

    DEFF Research Database (Denmark)

    Krois, E.; Nöckler, K.; Duscher, G.

    2005-01-01

    infections in foxes. Materials and methods: Masseter and tongue samples from 1,546 foxes with known origin (sample coordinates from the provinces of Carinthia [n=401], Salzburg [108], Styria [493], Tyrol [395] and Vorarlberg [149] were determined by Geographic Information System), sent to the State...... Veterinary Laboratory in Moedling for rabies testing, were examined for Trichinella with the compression technique. Positive samples were evaluated quantitatively by digestion and differentiated by PCR. Results: 24 foxes (1.55%) were positive (Carinthia: 1.52%, Salzburg: 2.77%, Styria: 1.62%, the Tyrols: 1.......26%, Vorarlberg: 1.44%). In addition to the formerly known distribution of vulpine trichinellosis, positive animals were also found close to the border to Slovenia. Highest numbers of larval per gram muscle tissue (lpg) were found in the tongues (1-257 lpg compared to 0-43 lpg in masseter muscle tissue...

  5. Transkriptionelle Regulation des Wachstumsfaktors Gastrin beim kleinzelligen- und nichtkleinzelligen Bronchialkarzinom

    OpenAIRE

    Zippert, Renate

    2000-01-01

    Die transkriptionelle Regulation der Expression von Gastrin in SCLC- und NSCLC-Zellen war bisher nicht untersucht worden. Die Klonierung der 5´-flankierenden Sequenzen des Gastringens und die Herstellung von Gastrinpromotor-Reportergenkonstrukten ermöglichte eine vergleichende funktionelle Untersuchung der Gastrinpromotor-Aktivität in der SCLC-Zellinie H69, der NSCLC-Zellinie 32M1 und der Mesotheliom-Zellinie MSTO-211H. Die vorliegenden Untersuchungen konnten so eine zelltypspezifisc...

  6. Verletzungspotential für Kinder und Jugendliche beim Trampolinspringen

    OpenAIRE

    Kosev, I; Folz, B

    2015-01-01

    Hintergrund: 62% der Deutschen haben ein Trampolin in ihrem Garten. Die Sprunggeräte gehören inzwischen fast zur Standardspielausrüstung. Im Rahmen unserer Beobachtungen über Unfallverletzungen der Kopf-Hals-Region zeigte sich, dass das Trampolinspringen mit Verletzungen im Kopf/Hals-Bereich einhergehen kann. In der vorliegenden Arbeit handelt es sich um eine prospektive Analyse der in den letzten Jahren an unserer Klinik behandelten Patienten mit Trampolinverletzungen. Methode: In dieser Ü...

  7. Advanced thermal management of diesel engines; Neues Thermomanagement beim Dieselmotor

    Energy Technology Data Exchange (ETDEWEB)

    Wenzel, Wolfgang; Becker, Michael [BorgWarner, Ludwigsburg (Germany). Konzernvorentwicklung fuer Pkw-Antriebssysteme; Shutty, John [BorgWarner, Auburn Hills (United States). Regelung und Simulation in der Konzernvorentwicklung

    2013-05-01

    The potential of thermal management with respect to CO{sub 2} reduction is given by faster warm-up of engine and drivetrain, reduced losses from water pump and fan and finally the operation of the engine in an optimal temperature range. In a new approach, BorgWarner applies a variable coolant pump and a controlled coolant valve to a conventional cooling system. Both components, as well as the viscous fan clutch, are controlled by a newly developed controls approach.

  8. Imaging of appendicitis in adults; Bildgebung der Appendizitis beim Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Karul, M.; Berliner, C.; Keller, S.; Yamamura, J. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology; Tsui, T.Y. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of General, Visceral- and Thoracic Surgery

    2014-06-15

    Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2 mm, cross-sectional diameter greater than 6 mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. (orig.)

  9. Radiotherapy and radiooncology: An interdisciplinary approach. 4. tot. new rev. and enl. ed.; Strahlentherapie und Radioonkologie aus interdisziplinaerer Sicht

    Energy Technology Data Exchange (ETDEWEB)

    Karstens, J.H.; Bremer, M.; Meyer, A.; Warszawski, A.; Bruns, F. (eds.) [Medizinische Hochschule Hannover (Germany). Abt. fuer Strahlentherapie und Spezielle Onkologie

    2005-07-01

    This is the 4th, completely revised edition of the successful book on modern cancer therapy. The focus of this edition is on interdisciplinary cooperation. Current knowledge, both legal and medical, is presented in a clear and well-structured form. The text is supplemented by many illustrative drawings and pictures. The book addresses students and other readers interested in oncology and provides useful and detailed information on radiation therapy of benign and malignant diseases. (orig.)

  10. The ENTRIA project. Selected disciplinary and interdisciplinary research topics; Das ENTRIA-Projekt. Ausgewaehlte disziplinaere und interdisziplinaere Forschungsthemen

    Energy Technology Data Exchange (ETDEWEB)

    Roehlig, Klaus-Juergen [Technical Univ. Clausthal, Clausthal-Zellerfeld (Germany); Hocke, Peter [KIT Karlsruhe (Germany). Inst. for Technology Assessment and Systems Analysis; Smeddinck, Ulrich [Braunschweig Technical Univ. Braunschweig (Germany); Walther, Clemens [Hannover Univ. (Germany). Inst. for Radioecology and Radiation Protection

    2015-07-01

    ENTRIA (''Disposal Options for Radioactive Residues: Interdisciplinary Analyses and Development of Evaluation Principles'', www.entria.de) is a joint research project carried out by twelve departments and institutes from German universities and major research institutions and one partner from Switzerland. It is financed by the German Ministry of Education and Research (BMBF). Scientists representing natural sciences, civil engineering, philosophy, law, social and political sciences, and technology assessment carry out disciplinary and interdisciplinary research addressing three options to manage especially high-level radioactive waste: - Final disposal in deep geological formations without any arrangements for retrieval, - disposal in deep geological formations with arrangements for monitoring and retrieval, and - (prolonged) surface (or near-surface) storage. In the paper, the following selected research topics - both disciplinary and interdisciplinary - are briefly introduced in order to provide an impression of the project scope: - Surface storage, - reference concepts for emplacement in deep geological formations with retrievability and monitoring, - radiation exposure and justification of measures, - interdisciplinary perspectives on dose limits, - comparative studies on nuclear waste governance, - nuclear waste governance in Switzerland, - public involvement and the German Site Selection Act, and - citizens' jury.

  11. Pan computed tomography for blunt polytrauma: Are we doing too ...

    African Journals Online (AJOL)

    organ injuries, and better selection of patients needing intensive care or those ... Trauma Service, Pietermaritzburg, South Africa, during the 12-month period .... technology.[14] .... emergency room, while in our setting, pan CT is only performed.

  12. The wrong and wounding road: Paediatric polytrauma admitted to a ...

    African Journals Online (AJOL)

    first 5 years of life,[2] and much effort has been put into reducing these causes. Death from ..... Mars M, Hadley GP. Gunshot injuries in infants and children in KwaZulu-Natal: An emerging epidemic, S Afr Med J 1998;88(4):444-447. 11. Campbell NM, Colville JG, van der Heyde Y, et al. Firearm injuries to children in Cape ...

  13. Pseudoaneurysm of the superior gluteal artery following polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dennis [Vancouver General Hospital, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Legiehn, Gerald M. [Vancouver General Hospital, Interventional Radiology, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Munk, Peter L. [Vancouver General Hospital, MSK Section, University of British Columbia and Department of Radiology, Vancouver, BC (Canada)

    2007-09-15

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

  14. Whole-body computed tomography in polytrauma: techniques and management

    International Nuclear Information System (INIS)

    Linsenmaier, Ulrich; Kroetz, Michael; Rock, Clemens; Rieger, Johannes; Pfeifer, Klaus Juergen; Reiser, Maximilian; Haeuser, Hannes; Bohndorf, Klaus

    2002-01-01

    An interdisciplinary team should be involved in the diagnosis and management of severely injured patients. The adoption of criteria for starting treatment for multiple trauma avoids underestimation of seriousness of injury. These criteria are established by the circumstances of the accident, the patterns of trauma, and the vital findings. Basic diagnosis comprises a limited number of plain films in the trauma room, including supine chest, lateral cervical spine, and pelvis, and ultrasound of abdomen, pleura, and pericardium. Organ diagnosis using CT is complementary and depends on the clinical findings and findings from the basic investigations. We recommend spiral CT (skull base 2/2/4 mm, cerebrum 8/8/8 mm native) and after intravenous contrast medium thoracic (5/7.5/5 mm) and abdominal CT (8/12/8 mm). Image reconstruction of bony structures can be added. The CT and the trauma center should be in close proximity; time-consuming transfers must be avoided. If this is not possible, a CT can be integrated in the trauma room. Our hospital trauma registry contains over 2200 entries. A quality committee has been established and external quality control is implemented. (orig.)

  15. Pseudoaneurysm of the superior gluteal artery following polytrauma

    International Nuclear Information System (INIS)

    Lee, Dennis; Legiehn, Gerald M.; Munk, Peter L.

    2007-01-01

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

  16. Heterotopic bone formation as a result of abdominal polytrauma

    International Nuclear Information System (INIS)

    Petkov, G.; Penev, B.; Kirova, G.; Ruskova, E.; Karagiozov, P.

    2015-01-01

    Full text: Heterotopic bone formation within the abdominal cavity is a rare complication of the posttraumatic abdominal surgery. There are only few cases reported in the medical literature and most of them involve the mesentery or the abdominal wall. A case of 49y-old men is presented who developed intraabdominal heterotopic ossifications as a consequence of numeral exploratory laparotomies performed after a blunt abdominal trauma. The condition was detected during the follow-up MDCT 11 months later. The case is of interest because of the rarity of the condition and the diffuse character of the calcifications in the abdominal structures, which could pose some differential diagnostic difficulties

  17. Mesenchymal Stem Cells after Polytrauma: Actor and Target

    Directory of Open Access Journals (Sweden)

    Markus Huber-Lang

    2016-01-01

    Full Text Available Mesenchymal stem cells (MSCs are multipotent cells that are considered indispensable in regeneration processes after tissue trauma. MSCs are recruited to damaged areas via several chemoattractant pathways where they function as “actors” in the healing process by the secretion of manifold pro- and anti-inflammatory, antimicrobial, pro- and anticoagulatory, and trophic/angiogenic factors, but also by proliferation and differentiation into the required cells. On the other hand, MSCs represent “targets” during the pathophysiological conditions after severe trauma, when excessively generated inflammatory mediators, complement activation factors, and damage- and pathogen-associated molecular patterns challenge MSCs and alter their functionality. This in turn leads to complement opsonization, lysis, clearance by macrophages, and reduced migratory and regenerative abilities which culminate in impaired tissue repair. We summarize relevant cellular and signaling mechanisms and provide an up-to-date overview about promising future therapeutic MSC strategies in the context of severe tissue trauma.

  18. Whole-body computed tomography in polytrauma: techniques and management

    Energy Technology Data Exchange (ETDEWEB)

    Linsenmaier, Ulrich; Kroetz, Michael; Rock, Clemens; Rieger, Johannes; Pfeifer, Klaus Juergen; Reiser, Maximilian [Department of Radiology, Klinikum der Universitaet Muenchen (Germany); Haeuser, Hannes; Bohndorf, Klaus [Department of Radiology, Klinikum Augsburg (Germany)

    2002-07-01

    An interdisciplinary team should be involved in the diagnosis and management of severely injured patients. The adoption of criteria for starting treatment for multiple trauma avoids underestimation of seriousness of injury. These criteria are established by the circumstances of the accident, the patterns of trauma, and the vital findings. Basic diagnosis comprises a limited number of plain films in the trauma room, including supine chest, lateral cervical spine, and pelvis, and ultrasound of abdomen, pleura, and pericardium. Organ diagnosis using CT is complementary and depends on the clinical findings and findings from the basic investigations. We recommend spiral CT (skull base 2/2/4 mm, cerebrum 8/8/8 mm native) and after intravenous contrast medium thoracic (5/7.5/5 mm) and abdominal CT (8/12/8 mm). Image reconstruction of bony structures can be added. The CT and the trauma center should be in close proximity; time-consuming transfers must be avoided. If this is not possible, a CT can be integrated in the trauma room. Our hospital trauma registry contains over 2200 entries. A quality committee has been established and external quality control is implemented. (orig.)

  19. Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

    Science.gov (United States)

    2015-10-01

    Gould , 1994; Yu et al ., 2004; Montaron et al ., 2006); with males showing...ety, and depression (Gentilini et al ., 1985; Schoenhuber and Gentilini, 1988 ; Ponsford et al ., 1995). Blast induced traumatic brain injury (bTBI...into neuronal circuits (Kempermann, 2002a; Kozorovitskiy and Gould , 2003; Abrous et al ., 2005; Hagg, 2005; Ming and Song, 2005; Zhao et al .,

  20. Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

    Science.gov (United States)

    2014-11-01

    detail elsewhere.13,41 After silver staining, sections were washed thoroughly in distilled water, mounted on gelatin -coated slides, and counterstained...neuropathological changes resulting from a single BOP exposure are modest and largely consist of limited fiber degeneration that is evident in silver -stained...Walter Reed Army Institute of Research, Silver Spring, MD 20910 Age-dependent variations in the pathophysiology of blast-induced traumatic brain

  1. Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

    Science.gov (United States)

    2010-05-28

    devoid of any obvious cell loss or injury when assessed using either Nissl or Fluoro Jade stains , they consistently showed widespread fiber degeneration...injured brain after thionine (l) or silver (r) staining . experimental parameters (e.g. driver volume, tube position, Mylar membrane thickness, and type...5. Thionine- (top) and silver- (bottom) stained brain sections following exposure to 126 kPa airblast at the mouth of the tube. From Long et al

  2. Severe Blunt Hepatic Trauma in Polytrauma Patient - Management and Outcome.

    Science.gov (United States)

    Doklestić, Krstina; Djukić, Vladimir; Ivančević, Nenad; Gregorić, Pavle; Lončar, Zlatibor; Stefanović, Branislava; Jovanović, Dušan; Karamarković, Aleksandar

    2015-01-01

    Despite the fact that treatment of liver injuries has dramatically evolved, severe liver traumas in polytraumatic patients still have a significant morbidity and mortality. The purpose of this study was to determine the options for surgical management of severe liver trauma as well as the outcome. In this retrospective study 70 polytraumatic patients with severe (American Association for the Surgery of Trauma [AAST] grade III-V) blunt liver injuries were operated on at the Clinic for Emergency Surgery. Mean age of patients was 48.26±16.80 years; 82.8% of patients were male. Road traffic accident was the leading cause of trauma, seen in 63 patients (90.0%). Primary repair was performed in 36 patients (51.4%), while damage control with perihepatic packing was done in 34 (48.6%). Complications related to the liver occurred in 14 patients (20.0%). Liver related mortality was 17.1%. Non-survivors had a significantly higher AAST grade (p=0.0001), higher aspartate aminotransferase level (p=0.01), lower hemoglobin level (p=0.0001), associated brain injury (p=0.0001), perioperative complications (p=0.001) and higher transfusion score (p=0.0001). The most common cause of mortality in the "early period" was uncontrolled bleeding, in the "late period" mortality was caused by sepsis and acute respiratory distress syndrome. Patients with high-grade liver trauma who present with hemorrhagic shock and associated severe injury should be managed operatively. Mortality from liver trauma is high for patients with higher AAST grade of injury, associated brain injury and massive transfusion score.

  3. An interesting case report of vertebral artery dissection following polytrauma

    Directory of Open Access Journals (Sweden)

    Vikas Acharya

    2016-01-01

    Conclusion: Our report displays select images related to this case report and emphasizes the consideration of routine imaging in head and neck traumatic injuries to diagnose internal carotid and/or vertebral artery dissections much earlier.

  4. The CURE project as an example of international and interdisciplinary cooperation; Das CURE-Projekt als Beispiel internationaler und interdisziplinaerer Zusammenarbeit

    Energy Technology Data Exchange (ETDEWEB)

    Giussani, Augusto [Bundesamt fuer Strahlenschutz, Oberschleissheim (Germany). Arbeitsgruppe Externe und Interne Dosimetrie, Biokinetik

    2017-10-01

    The CURE project was a European activity of biologists, epidemiologists, statisticians, mathematicians and dosimetry experts from 9 institutions in 6 European countries. The contribution summarizes the success of the project the focus of the work, the importance of European cooperative research in the field of radiation protection. Advantages and problems arising in the team work of persons from different countries and different scientific background are discussed.

  5. Smart Metering. Between technical challenge and societal acceptance - Interdisciplinary status quo; Smart Metering. Zwischen technischer Herausforderung und gesellschaftlicher Akzeptanz - Interdisziplinaerer Status Quo

    Energy Technology Data Exchange (ETDEWEB)

    Westermann, Dirk; Doering, Nicola; Bretschneider, Peter (eds.)

    2013-04-01

    The international research project RESIDENS (more efficient energy utilization by means of system technical integration of the private ultimate consumer) investigates the technology of smart metering that is the utilization of intelligent smart meters in private households. The interdisciplinary character of the RESIDENS project becomes visible by different sub-projects examining different formulations of a question from perspectives of different scientific disciplines: First of all, chapter 2 of the contribution under consideration follows up the question, what impact the media coverage on smart metering has on the perception of this technology in the population at large. Chapter 3 reports on the state of the art of the smart metering. Chapter 4 illustrates how a load control of private consumers can be performed by means of the smart meter technology. Chapter 5 reports on the impacts of the smart metering on the procurement of energy in the liberalised energy market. Chapter 6 investigates the smart metering from the customer's point of view. Concretely, the user-friendliness of an internet portal is evaluated by which the customers may follow up their consumption of electricity by means of an intelligent smart meter continuously. Chapter 7 illustrates legal aspects of smart metering from the perspective of the customer, electricity suppliers and distribution system operators. Chapter 8 presents the conception and implementation of an online gaming operation for the promotion of competency of private power customers: In line with this game, the participants may learn to handle smart metering and flexible electricity tariffs in an entertaining manner. Finally, chapter 9 reports on an expert interview in which the smart metering technology is evaluated by public utilities being involved in this project.

  6. Radiation therapy in patients with cardiac pacemakers or implantable cardioverter defibrillators. Interdisciplinary safety recommendations; Strahlentherapie bei Patienten mit Herzschrittmachern oder implantierbaren Kardioverter-Defibrillatoren. Interdisziplinaere Sicherheitsempfehlungen

    Energy Technology Data Exchange (ETDEWEB)

    Dorenkamp, M.; Haverkmap, W.; Roser, M. [Charite Universitaetsmedizin Berlin, Campus Virchow-Klinikum (Germany). Medizinische Klinik mit Schwerpunkt Kardiologie; Stromberger, C.; Wust, P. [Charite Universitaetsmedizin Berlin (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Heymann, C. von [Charite Universitaetsmedizin Berlin, Campus Virchow-Klinikum (Germany). Klinik fuer Anaesthesiologie mit Schwerpunkt operative Intensivmedizin

    2013-01-15

    Background: With increasing numbers of implanted pacemakers and implantable cardioverter defibrillators (ICD) and a rising incidence of malignant tumors, there is a growing probability of radiation-mediated device dysfunction. The only guidelines for the management of patients with cardiac pacemakers in the case of radiation therapy were published in 1994 and have not been updated since then. Based on the current evidence and modern device technology, the present paper aims to develop contemporary and interdisciplinary safety recommendations for the minimization of patient risk. Methods and results: A systematic literature research was carried out including the most relevant medical electronic databases. The search yielded 147 articles published between 1994 and 2012 of which 45 met the selection criteria and of these studies 34 presented primary data (9 in vitro and 25 in vivo studies). The impact of ionizing radiation varied significantly between implanted devices and ranged from no functional changes to complete loss of function. Important device dysfunctions included changes in sensing capability, altered pacing pulses or rate, changed or disabled tachyarrhythmia ICD therapies, early battery depletion and loss of telemetry. Modern pacemakers and ICDs are more sensitive to radiation than older models. Potentially life-threatening complications were observed after exposure of the pulse generator to comparatively low radiation doses (0.11 Gy). Conclusions: Practical recommendations for patient management and safety are presented that can be readily adopted by any institution carrying out radiation therapy. (orig.)

  7. Disposal options for radioactive residues. Development of interdisciplinary evaluation principles in ENTRIA; Entsorgungsoptionen fuer hoch radioaktive Abfaelle. Die Schaffung interdisziplinaerer Bewertungsgrundlagen in ENTRIA

    Energy Technology Data Exchange (ETDEWEB)

    Walther, C. [Hannover Univ. (Germany). Inst. fuer Radiooekologie und Strahlenschutz; Chaudry, S.; Plischke, E.; Roehlig, K.J. [TU Clausthal, Clausthal-Zellerfeld (Germany). Inst. fuer Endlagerforschung; Hocke, P. [Karlsruher Institut fuer Technologie, Karlsruhe (Germany). Inst. fuer Technikfolgenabschaetzung und Systemanalyse; Eckhardt, A. [risicare GmbH, Zollikerberg (Switzerland); Ott, K. [Kiel Univ. (Germany). Philosophisches Seminar

    2016-07-01

    ENTRIA, short for ''Disposal Options for Radioactive Residues: Interdisciplinary Analyses and Development of Evaluation Principles'', is a joint project of twelve institutes or departments of German universities and research institutions as well as a partner from Switzerland. The fundamentally new approach here is the plurality of represented disciplines. ENTRIA analyzes radioactive waste management subjects from the viewpoint of natural sciences, engineering, arts, law and social science. ENTRIA works independently from politics, operators und interest groups. ENTRIA performs purely scientific research analyzing the three most important radioactive waste management option:''Final disposal in deep geological formations without any arrangements for retrieval (maintenance-free deep geological disposal)'', ''disposal in deep geological formations with arrangements for monitoring and retrieval'' and ''surface storage''. Based on these options ENTRIA developed generic ''reference models'' and generic host-rockdependent container models (ENCON). All these models are of generic character, but are elaborated to an extent, e.g. with respect to reversibility time scales, as is necessary for a comparative differentiated evaluation. Long-term surface storage is considered and evaluated because of the increasingly apparent need to address interim storage not only as (temporary) alternative, but also as a necessary part of the overall process. Besides disciplinary work packages performed in ENTRIA several tasks combine the expertise and perspective of disciplines which could classically be considered ''far apart''. A key task is the creation of interdisciplinary evaluation principles. This article provides insight into interdisciplinary working within ENTERIA and describes the present status of this work from the perspective of the authors. However, this is not a final result agreed on by all ENTRIA partners but subject to ongoing discussion and changes.

  8. Electromagnetic fields and health complaints - interdisciplinary case evaluations in an environmental medicine counselling project; Elektromagnetische Felder und Gesundheitsbelastungen - Interdisziplinaere Fallabklaerungen im Rahmen eines umweltmedizinischen Beratungsprojektes

    Energy Technology Data Exchange (ETDEWEB)

    Huss, A.; Braun-Fahrlaender, C. [Inst. fuer Sozial- und Praeventivmedizin, Basel (Switzerland); Kuechenhoff, J. [Psychiatrische Universitaetsklinik Basel (Switzerland); Bircher, A. [Kantonsspital Basel, Allergologie, Basel (Switzerland); Niederer, M. [Kantonales Lab., Basel (Switzerland); Tremp, J. [Amt fuer Umwelt und Energie, Liestal (Switzerland); Waeber, R. [Bundesamt fuer Gesundheit, Abt. Chemikalien, Bern (Switzerland)

    2005-07-01

    Background: During 2001, persons who attributed their health problems to environmental exposures, e.g. electromagnetic fields (EMF), were counselled in an interdisciplinary environmental medicine pilot project in the Basel area. Methods: All participants had a medical and a psychological-psychiatric examination and were visited at home by an environmental hygienist. High and low frequency EMF measurements were conducted at the homes of those participants who attributed their health complaints specifically to EMF. The plausibility of a relation between health complaints and EMF exposure was discussed in joint case conferences. Plausibility was judged on the basis of the following criteria: EMF levels had to exceed a tenth of the Swiss threshold values to be considered in the case conference (low frequency: 10 V/m, 0.1 {mu}T, high frequency: 0.6 V/m). The exposure had to occur in an area where the participant spent at least several hours or more every day. Prerequisite was that the exposure occurred before the onset of symptoms. Results: 25 of 63 (40%) of participants suspected EMF as cause of their health complaints. All EMF measurements yielded fields below the Swiss threshold values. Despite of the difficulties in assessing an exposure-response relation in an individual case and the controversial scientific evidence related to health effects of EMF exposures, the project team concluded that in 8 of the 25 (32%) participants, at least one of the reported symptoms was plausibly related to the EMF exposure. An evaluation interview half a year after counselling yielded that around 45% of the participants reported that they had benefited from the project and their health problems had improved following participation. Conclusions: Although none of the threshold values was exceeded, the project team rated an EMF exposure a plausible cause of the reported health complaints of few participants. Due to the high complexity in these cases, only an interdisciplinary team is likely to be able to adequately diagnose environmental related health problems and provide suitable advice to concerned persons. (orig.)

  9. Clinical relevance and indications for cardiac magnetic resonance imaging 2013. An interdisciplinary expert statement; Klinischer Stellenwert und Indikationen zur Magnetresonanztomografie des Herzens 2013. Ein interdisziplinaeres Expertenstatement

    Energy Technology Data Exchange (ETDEWEB)

    Hergan, Klaus [Universitaetsklinikum Salzburg (Austria). Universitaetsinst. fuer Radiologie; Globits, S. [Herz-Kreislauf-Zentrum Gross Gerungs (Austria); Schuchlenz, H. [Landeskrankenhaus Graz-West (Austria). Dept. fuer Kardiologie/Intensivmedizin] [and others

    2013-03-15

    During the last years the indications of Cardiac Magnetic Resonance Imaging (CMRI) have been continuously expanded. However, the acceptance of the method by cardiologists and radiologists does not correlate with respect to the diagnostic potential. Several factors, such as expensive equipment, relatively long examination times, high technical know how and lack of remuneration, limit the application of CMRI in everyday clinical practice. Furthermore, doctors tend to apply more conventional, well established diagnostic procedures, the access to the method is still limited and there exist difficulties in the interdisciplinary collaboration. The interdisciplinary Austrian approach to Cardiac Imaging is aimed to improve the aforementioned problems and to support the implementation of CMRI in the diagnostic tree of cardiac diseases thus enabling a cost efficient management of patients in cardiology. (orig.)

  10. MRI for troubleshooting detection of prostate cancer; MRT zur Problemloesung beim Nachweis des Prostatakarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Beyersdorff, D.; Hamm, B. [Universitaetsmedizin Berlin, Charite Mitte (Germany)

    2005-06-01

    Prostate cancer is the most common malignancy in males. Men aged 50 and older are recommended to undergo an annual digital rectal examination (DRE) and determination of prostate-specific antigen (PSA) in serum for early detection. However, prostate biopsies guided by transrectal ultrasound (TRUS) come up negative for cancer in many patients despite having PSA levels above 4 ng/ml. T2-weighted Magnetic Resonance Imaging (MRI) is able to represent the prostate including the surrounding anatomy and depict suspicious areas of low intensity within a high-intensity peripheral zone. MRI has a higher sensitivity for detecting prostate carcinomas than DRE and TRUS in patients having an elevated PSA value and a negative core biopsy. However, its specificity is poor since other abnormalities such as prostatic intraepithelial neoplasia (PIN), prostatitis, scars, or haemmorrhage have a similar MRI appearance. The use of additional techniques such as MR spectroscopy and contrast-enhanced dynamic MRI improves sensitivity, but in particular it improves the specificity of tumor detection. Newly developed biopsy devices enable the performance of targeted biopsies in areas that appear suspicious in the MRI. (orig.)

  11. Neues Punktionsinstrumentarium: Provox-Vega®-Punktionsset: Anwendung beim Einbringen einer Stimmprothese nach Laryngektomie

    NARCIS (Netherlands)

    Lorenz, K.J.; Hilgers, F.M.; Maier, H.

    2013-01-01

    Background The use of voice prostheses has been considered the gold standard in voice rehabilitation following laryngectomy for the last 20 years. Insertion is generally performed as a primary procedure during laryngectomy or as a secondary procedure with a re-usable trocar or rigid esophagoscope, a

  12. Freizeit beim Feind. US-amerikanische Soldaten in Ost-Berlin

    Directory of Open Access Journals (Sweden)

    Stefanie Eisenhuth

    2018-04-01

    Full Text Available This article focuses on an almost forgotten type of ›border crosser‹ in the divided city of Berlin: the members of the American military community. To them (as well as to the members of the French and British forces, the Berlin Wall marked the front line of the Cold War. At the same time, though, they were allowed to cross the border and spend their free time in East Berlin. Especially in the 1970s and 1980s, when the dollar was tumbling, American families took advantage of the favourable exchange rate and crossed the border for cheap shopping, dining and entertainment. Due to Berlin’s status, the GDR government had to tolerate this kind of tourism, but nevertheless tried to prevent any personal contact between Americans and East Germans. The regime could also benefit financially from the Western tourists. This demonstrates the ambivalence of the Honecker era, the concurrence of an increased openness and internal erosion. The study is based on documents from the GDR’s Ministry for State Security, the West Berlin Senate Chancellery and the US Berlin Brigade as well as on contemporary newspaper articles. * * * Der Aufsatz widmet sich einer ungewöhnlichen Gruppe von Berliner Grenzgängern: den vor Ort stationierten US-Soldaten. Für sie (wie auch für die Soldaten der britischen und französischen Armee markierte die Mauer einerseits die Front des Kalten Krieges, andererseits durften sie diese ohne große Kontrollen passieren und ihre Freizeit in Ost-Berlin verbringen – was sie besonders in den 1970er- und 1980er-Jahren auch intensiv taten, denn in Zeiten der Dollarkrise versprach die östliche Stadthälfte viel Vergnügen, Restaurantbesuche und Einkaufsmöglichkeiten für wenig Geld. Die DDR-Regierung war genötigt, die Grenzgänge zu tolerieren. Von dieser Form des Tourismus konnte sie finanziell profitieren, versuchte konkrete Kontaktaufnahmen aber zu vermeiden. Der Umgang mit den Grenzgängen amerikanischer Soldaten und ihrer Familien verdeutlicht somit auch die Ambivalenz von politischer Öffnung und zunehmender Überwachung, von internationaler Verflechtung und Binnenerosion in der Ära Honecker. Der Beitrag stützt sich vor allem auf Dokumente des Ministeriums für Staatssicherheit (MfS, der Berliner Senatskanzlei und der amerikanischen Berlin Brigade sowie auf zeitgenössische Presseartikel.

  13. Die trinitarische Spekulation und göttliche Freiheit beim späten Schelling

    Czech Academy of Sciences Publication Activity Database

    Landa, Ivan

    -, č. 3 (2011), s. 74-86 ISSN 0010-3713 R&D Projects: GA AV ČR(CZ) KJB900090902 Institutional research plan: CEZ:AV0Z90090514 Keywords : trinity * freedom * God * Schelling * Hegel Subject RIV: AA - Philosophy ; Religion

  14. Rekonstruktion mit Netz beim komplexen Prolaps der Frau: Was hilft es der Patientin wirklich?

    Directory of Open Access Journals (Sweden)

    Hierl J

    2010-01-01

    Full Text Available Einleitung: Der komplexe Genitaldeszensus der Frau geht oftmals mit einer deutlichen Einschränkung der Lebensqualität (LQ einher. Dennoch ist der Endpunkt der meisten klinischen Analysen rein anatomischer und funktioneller Natur. In der vorliegenden Untersuchung wurden die Einflüsse der operativen Rekonstruktion mit einem Netz prospektiv auf die LQ evaluiert. Patienten und Methoden: Bei insgesamt 111 Patientinnen mit Deszensus erfolgte zwischen 08/2005 und 12/2007 eine operative Versorgung mittels vaginaler Netzeinlage (anteriorer bzw. kompletter Mesh-Repair. Die LQ wurde prospektiv prä- und postoperativ anhand standardisierter LQ-Fragebögen erfasst. Ergebnisse: Präoperativ zeigte sich bei den Patientinnen eine signifikant reduzierte LQ gegenüber einem Normalkollektiv (p 0,01. Bei 7 % der Patientinnen mit anteriorem, und bei 11 % mit komplettem Mesh-Repair lag postoperativ kein adäquates klinisches Ergebnis vor. In diesem Kollektiv zeigte sich kein signifikanter Unterschied in den LQ-Tests prä- und postoperativ. Bei gutem postoperativem Ergebnis zeigte sich in der Gruppe mit anteriorer Netzeinlage lediglich bei 45 % (p = 0,021, bei kompletter Netzeinlage nur bei 31 % (p = 0,041 eine signifikant verbesserte LQ. Bei kleiner Fallzahl und kurzem Nachbeobachtungszeitraum kann eine gültige Aussage bezüglich der LQ nach Deszensuschirurgie mit Netzeinlage jedoch noch nicht getroffen werden.

  15. Postoperative Verlaufskontrollen beim Ulcus cruris nach Shave-Operation und Hauttransplantation

    OpenAIRE

    Pantelaki, Ioanna

    2016-01-01

    \\(\\bf Hintergrund:\\) Die Arbeit hat das Ziel die Shave-Operation mit Meshgraft-Deckung hinsichtlich der Einheilungsrate und der Schmerzreduktion zu untersuchen. \\(\\bf Methoden:\\) 56 Patienten mit einem Ulcus cruris unterzogen sich dem genannten Eingriff. Vor und 6 Monate nach der Operation wurden die Ulkusgröße, die bakterielle Besiedlung und die Schmerzintensität analysiert. \\(\\bf Ergebnis:\\) Bei 42,86% der Patienten konnte eine Abheilung erreicht werden, wobei die Ergebnisse hoch sign...

  16. Radiological interventional procedures for the acute abdomen; Radiologisch-interventionelle Massnahmen beim akuten Abdomen

    Energy Technology Data Exchange (ETDEWEB)

    Trumm, C.; Hoffmann, R.T.; Reiser, M.F. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2010-03-15

    In patients with acute thrombo-embolic occlusion of the superior mesenteric artery, catheter-assisted thrombolytic therapy represents a procedure of increasing importance in addition to surgery and intensive care treatment. The thrombolytic drugs utilized for this purpose are urokinase, streptokinase and recombinant tissue plasminogen activator (rtPA). Therapeutic embolization is predominantly used in the treatment of arterial bleeding from the gastro-intestinal tract, the liver, the intestines (due to an aneurysm or vascular malformation) and in bleeding from intestinal anastomoses. Polyvinyl alcohol particles, embospheres, gelfoam and microcoils can be utilized as embolic agents. Percutaneous transhepatic cholangiodrainage and stent implantation are applied in patients with biliary obstructions caused by inoperable tumors of the gall bladder or bile ducts, of the pancreatic head or duodenum and by metastases located in the liver parenchyma or hepatic hilum. Image-guided percutaneous drainage is a valuable option in the management of abscesses in the peritoneal cavity; less common indications are lymphoceles, biliomas, urinomas, hematomas, necrosis and pseudocysts. (orig.) [German] Die kathetergestuetzte thrombolytische Therapie stellt im Kontext einer chirurgischen und intensivmedizinischen Versorgung von Patienten mit thrombembolisch bedingter mesenterialer Ischaemie ein unterstuetzendes Behandlungsverfahren von zunehmender Bedeutung dar. Als thrombolytische Agenzien werden Urokinase, Streptokinase und der rekombinante Gewebeplasminogenaktivator (rtPA) verwendet. Die therapeutische Embolisation kommt neben der endoskopischen und chirurgischen Blutungsstillung bei arteriellen Blutungen im Gastrointestinaltrakt, aus der Leber, im Darm (als Folge eines Aneurysmas oder einer vaskulaeren Malformation) sowie bei blutenden intestinalen Anastomosen zum Einsatz. Zur Embolisation koennen Polyvinylalkoholpartikel, Embosphaeren, Gelfoam oder Mikrocoils verwendet werden. Die perkutane transhepatische Cholangiodrainage und die biliaere Stentimplantation bei malignem Ikterus kommen bei inoperablen Tumoren der Gallenblase oder Gallenwege, Tumoren des Pankreaskopfs oder Duodenums sowie Metastasen im Bereich von Leber oder Leberpforte zum Einsatz. Indikationen fuer die bildgesteuerte perkutane Drainage sind abdominelle Abszesse, weniger haeufig Lymphozelen, Biliome, Urinome, Haematome, Nekrosen sowie Pseudozysten. (orig.)

  17. Neuro-MRI-findings in patients with primary panhypopituitarism; Neuro-MR-Befunde beim primaeren Panhypopituitarismus

    Energy Technology Data Exchange (ETDEWEB)

    Fellner, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie]|[Oberoesterreichische Landesnervenklinik Wagner Jauregg, Linz (Austria). Inst. fuer Neuroradiologie; Triebe, S.; Baum, U.; Schmitt, R.; Flottemesch, J.; Bautz, W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie; Hensen, J. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Endokrinologie und Stoffwechsel

    1998-12-31

    We report a case of congenital panhypopituitarism. MR imaging of the brain revealed a hypoplastic adenohypophysis and a hypoplastic pituitary stalk which was interrupted in its superior segment. An ectopic neurohypophysis was found located in the area of the hypothalamus (``hypothalamic hot spot``). The ectopic neurohypophysis showed strong enhancement after intravenous application of Gd-DTPA. MR imaging of the hypothalamic-hypophyseal axis is well suited for the differentiation between congenital and acquired forms of panhypopituitarism in clinically uncertain cases. (orig.) [Deutsch] Wir berichten ueber einen Patienten mit kongenitalem Panhypopituitarismus. Die MRT des Zerebrums zeigte eine hypoplastische Adenohypophyse sowie ein hypoplastisches Infundibulum hypophysis. Es fand sich eine ektope Neurohypophyse im Areal des Hypothalamus (`hypothalamic hot spot`). Die ektope Neurohypophyse zeigte nach Gadoliniumgabe eine kraeftige Kontrastmittelanreicherung. Die MRT der hypothalamisch-hypophysaeren Achse eignet sich somit in klinisch unklaren Faellen fuer die Differentialdiagnostik zwischen angeborenen und erworbenen Formen des Panhypopituitarismus. (orig.)

  18. Lean-burn stratified combustion at gasoline engines; Magere Schichtverbrennung beim Ottomotor

    Energy Technology Data Exchange (ETDEWEB)

    Breitbach, Hermann [Daimler AG, Stuttgart (Germany). Entwicklung Einspritzung und Betriebsstoffe; Waltner, Anton [Daimler AG, Stuttgart (Germany). Verbrennungsentwicklung Pkw-Ottomotoren; Landenfeld, Tilo [Robert Bosch GmbH, Schwieberdingen (Germany). Hochdruckeinspritzung Piezo; Porten, Guido [Robert Bosch GmbH, Schwieberdingen (Germany). Systementwicklung Benzindirekteinspritzung

    2013-05-01

    Spray-guided lean-burn combustion is an integral part of the Mercedes-Benz technology strategy for highly efficient and clean gasoline engines. With regard to the excellent fuel efficiency combined with outstanding specific power, a good combustion system robustness and the low particulate emissions, the concept offers a very good cost/benefit ratio especially for the Euro 6 emission legislation. Thus, Mercedes-Benz believes, that the sprayguided lean-burn combustion offers the by far highest future viability of gasoline engine combustion systems.

  19. Einsatzverhalten genuteter CBN-Schleifscheiben mit keramischer Bindung beim Außenrund-Einstechschleifen

    OpenAIRE

    Kirchgatter, Mathias

    2010-01-01

    Industrielle Schleifprozesse für Bauteile aus gehärteten Stahlwerkstoffen werden vermehrt mit keramisch gebundenen CBN-Schleifscheiben durchgeführt, die sich bei vielen Anwendungen aufgrund ihres Eigenschaftsprofils und der erweiterten Einstellbarkeit der Bindungsspezifikationen gegenüber anderen Schleifwerkzeugtypen durchsetzen. Der Optimierungsdruck der Großserien- und Massenfertigungsprozesse hat bereits zu einer beachtlichen Entwicklung hinsichtlich der Leistungsfähigkeit dieses Werkzeugt...

  20. Lebensdauer von Stahlseilen beim kombinierten Lauf über Treib- und Ablenkscheiben unterschiedlicher Rillenform

    OpenAIRE

    Berner, Oliver Roger

    2011-01-01

    Die Lebensdauer von Stahldrahtseilen in Treibscheibenaufzügen wird von unterschiedlichen Faktoren beeinflusst. Bei allen Anwendungen, bei denen Seile über Rollen laufen, erfahren die Seile eine Zug- und Biegebeanspruchung, die zu einer Materialermüdung und zu einem Verschleiß der Drähte an der Seiloberfläche und im Inneren der Seile führt. Darüber hinaus findet man bei Treibscheibenaufzügen systembedingt weitere anwendungsspezifische Beanspruchungen, die zu einer zusätzlichen Lebensdauerminde...

  1. Signatures of dynamics in charge transport through organic molecules; Dynamisches Verhalten beim Ladungstransport durch organische Molekuele

    Energy Technology Data Exchange (ETDEWEB)

    Secker, Daniel

    2008-06-03

    The aim of the thesis at hand was to investigate dynamical behaviour in charge transport through organic molecules experimentally with the help of the mechanically controlled break junction (MCBJ) technique. the thesis concentrates on the complex interaction between the molecular contact configuration and the electronic structure. it is shown that by variation of the electrode distance and so by a manipulation of the molecule and contact configuration the electronic structure as well as the coupling between the molecule and the electrodes is affected. The latter statement is an additional hint how closely I-V-characteristics depend on the molecular contact configuration. Depending on the applied voltage and so the electric field there are two different configurations preferred by the molecular contact. A potential barrier between these two states is the origin of the hysteresis. A central part of the thesis is dealing with measurements of the current noise. Finally it can be concluded that the detailed discussion reveals the strong effect of dynamical interactions between the atomic configuration of the molecular contact and the electronic structure on the charge transport in single molecule junctions. (orig.)

  2. Fundamentals of hydraulic piston pump applications in chemical engineering; Verfahrenstechnische Grundsaetze beim Einsatz von hydraulischen Kolbenpumpen

    Energy Technology Data Exchange (ETDEWEB)

    Haubold, H.J. [Putzmeister AG, Putzmeister Industrial Technology (PIT), Aichtal (Germany)

    2007-07-01

    This paper describes design features as well as criteria for the selection of the required piston pump under the circumstance of high viscose sludge. These kind of sludges are mostly contaminated with foreign bodies. Life cycle costs and professional service management are influencing factors of a successful pump operation. This paper will show in detail criteria's for the pipe transportation. For example the influence of the calculation for the pressure loss against the necessary pump pressure. In focus are all structural measures to reduce pressure peaks, as well as the reduction of pressure variation and their elimination in the delivery flow. This under the circumstance of a high pulsating pump delivery. This paper will be concluded with a reference of examples of applications and show new developments of piston pump design. (orig.)

  3. Who has priority during the regulation?; Wer hat Vorrang beim Abregeln?

    Energy Technology Data Exchange (ETDEWEB)

    Janzing, Bernward

    2013-04-15

    The remote control of wind power plants by direct marketers raises questions - not only on the technology, but also on the hierarchy of actors. From the technical perspective, the current practice of feed-in is not particularly well developed. So far, the regulation of wind turbines via radio ripple control is carried out in stages to 60, 30 and 0 %. The traditional ripple control technology does not send a message back to the sender if the wind turbine has received the signal and reacts to it. Smart meter and digital control technology can provide assistance in this case. Consequences for the plant safety result from this regulation: The performance of a wind turbine shall be reduced only with a gradient of ten percent of the initial output per minute. If the data transfer is interrupted, the reduction of the power will be closed automatically after 30 minutes.

  4. Webbasierte linguistische Forschung: Möglichkeiten und Begrenzungen beim Umgang mit Massendaten

    Directory of Open Access Journals (Sweden)

    Juska-Bacher, Britta

    2013-12-01

    Full Text Available Over the past ten to fifteen years, web-based methods of sociological research have emerged alongside classical methods such as interviews, observations and experiments, and linguistic research is increasingly relying upon them as well. This paper provides an overview of three web-based approaches, i.e. online surveys, crowd-sourcing and web-based corpus analyses. Examples from specific projects serve to reflect upon these methods, address their potential and limitations, and make a critical appraisal. Internet-based empirical research produces vast and highly diverse quantities of (speaker-based or textual data, presenting linguistic research with new opportunities and challenges. New procedures are required to make effective use of these resources.

  5. Knee and ankle injuries from playing football; Knie- und Sprunggelenkverletzungen beim Fussballspiel

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, J.; Scheurecker, G. [Roentgeninstitut am Schillerpark, Linz (Austria)

    2010-05-15

    Soccer is the most common sport activity worldwide. Over the last two decades the increase in soccer players has mainly been due to increased interest by females. In general, soccer is a relatively safe sport activity, especially if minor injuries resulting in short periods of absence from playing or training are neglected. However, due to the high number of soccer players severe injuries are also frequent. These are a problem not only for the injured player and the team but may also become problematic for the socio-economic system. In up to 80-90% structures of the lower extremities are injured. For sufficient radiological diagnosis knowledge of the biomechanics of the soccer game and some details about the history of the injury may be of help. To prevent soccer injuries or keep the degree of injury low, special programs had been developed. (orig.) [German] Fussball ist die weltweit am meisten verbreitete Sportart. Der Zuwachs an Fussballspieler(innen) in den letzten beiden Jahrzehnten wird jedoch hauptsaechlich auf das verstaerkte Interesse an weiblichen Spielern zurueckgefuehrt. Das Fussballspiel gilt grundsaetzlich, insbesondere wenn man geringfuegige Verletzungen, die keine therapeutischen Massnahmen notwendig machen, sondern lediglich eine kurzfristige Trainings- oder Spielpause bedingen, als eine relativ sichere Sportart. Auf Grund der Vielzahl an SpielerInnen kommt es allerdings doch zu einer betraechtlichen Anzahl durchaus sehr schwerer Verletzungen. Diese Tatsache stellt ein Problem fuer Spieler und Team dar und mag moeglicherweise auch fuer das soziooekonomische System problematisch werden. Von Verletzungen sind v. a. auf Grund der Natur des Spieles die unteren Extremitaeten betroffen. Zur Durchfuehrung einer suffizienten radiologischen Diagnostik sind Kenntnisse der moeglichen Verletzungsmechanismen und eine Anamneseerhebung von nicht zu unterschaetzendem Wert. Um jedoch derartige Laesionen zu vermeiden bzw. gering zu halten, wurde ueber die Jahre hinweg immer mehr Wert auf Praevention gelegt. (orig.)

  6. Gefuge und Eigenschaften - Modellierung der Keimbildungs- und Wachstumskinetik der Verbindungsschicht beim Nitrieren von Reineisen

    DEFF Research Database (Denmark)

    Somers, Marcel A.J.; Friehling, Peter B.

    2002-01-01

    to explain the accellerating effect of an oxidizing pretreatment on the nucleation on iron nitrides. A model was developed for describing growth of a double layer, which consists of epsilon-Fe2N1-z at the surface und gamma’-Fe4N1-x at the substrate. The model takes the dynamic state at the surface...... into account, and was fitted to experimental data for double layer growth....

  7. Procedure and accuracy in the Eurotunnel breakthrough. Vorgehensweise und Genauigkeit beim Durchschlag des Eurotunnels

    Energy Technology Data Exchange (ETDEWEB)

    Korittke, N. (DMT-Gesellschaft fuer Forschung und Pruefung mbH, Essen (Germany, F.R.). Inst. fuer Lagerstaette und Vermessung (ILV))

    1991-02-14

    After a construction time of about 2.5 years the first link was made in the Eurotunnel between France and England, viz. the service tunnel, on 1 December 1990. Thanks to the accurate Gyromat measurements of the Institute for Mineral Deposits and Surveying of the Deutsche Montan Technologie (DMT) a transverse deviation of only 361 mm, a longitudinal deviation of 69 mm and a vertical deviation of 58 mm were determined in the breakthrough of the 22.3 and 15.6 km long tunnel sections. (orig.).

  8. Drivage and surveying during construction of the Channel tunnel. Vortrieb und Vermessung beim Bau des Eurotunnels

    Energy Technology Data Exchange (ETDEWEB)

    Korittke, N. (DMT-Gesellschaft fuer Forschung und Pruefung mbH, Essen (Germany, F.R.). Inst. fuer Lagerstaette und Vermessung)

    1990-07-26

    The Institut fuer Lagerstaette und Vermessung (ILV) (Institute for Deposits and Surveying) of Deutsche Montan Technology (DMT) (German Mining Technology) is participating in many respects in the surveying work for construction of the Channel Tunnel. Three precision survey gyroscopes of the Gyromat type were supplied by the ILV to the Anglo-French tunnel construction consortium for indication of the direction during drivage of the Channel Tunnel from both ends. ILV inclinometers are integral parts of the control systems for two tunneling machines on the French side. ILV carries out main check measurements at regular intervals both on the French and British side. The position and height of a total of 62 km driven tunnel were checked in the course of five measuring series in 1989 and 1990. The DMT is one of the few German companies assisting in construction of the Eurotunnel on both sides of the Channel. Probably the most spectacular tunnel construction project this century together with the procedure, results and accuracies in the main check measurements are described. (orig.).

  9. Die kognitiv-metaphorische Motiviertheit beim Erlernen von Idiomen am Beispiel eines Aufgabenblattes

    Directory of Open Access Journals (Sweden)

    Kispál, Tamás

    2011-01-01

    Full Text Available The cognitive metaphorical motivation of idioms is one of the most treated subjects in English-language articles about teaching of idioms. In German-language phraseodidactic literature it is a rather rare phenomenon. The metaphorical motivation of several idiomatic expressions is undoubted. In this article we argue for their cognitive metaphorical motivation. It is hypothesized that the joint representation of several typical context examples, with idioms of the same conceptual metaphor, not only promotes the recognition and understanding of idioms but also the detection of cognitive metaphorical motivation of idioms. Context-sensitive tasks make a significant contribution to uncovering and learning the metaphorical idioms for learners of German as a foreign language. The learning-enhancing role of this method for the acquisition of idioms and their meanings are to be illustrated with the example of the conceptual metaphor life is a journey, the metaphorical idioms based on this conceptual metaphor, and an example worksheet.

  10. Nuclear radiation in warfare. A SIPRI publication. Strahlungswirkungen beim Einsatz von Kernwaffen. Eine SIPRI-Publikation

    Energy Technology Data Exchange (ETDEWEB)

    Rotblat, J.

    1986-01-01

    The subject is covered in chapters, entitled: introduction; digest of nuclear weaponry (characteristics of nuclear weapons; effects of nuclear weapons other than ionizing radiation (fire-ball, fall-out, thermal radiation, blast wave, electromagnetic pulse); the nuclear arms race; war scenarios; biological effects of radiations on man (radiation doses; natural sources of radiation; acute effects of radiation; long-term somatic effects; genetic effects; factors affecting the biological response to radiation; internal exposure; synergistic effects; protection against radiation effects); radiations from nuclear explosions (initial radiation; fall-out; effects of fall-out on animal and plant life; contamination of water and food supplies by fall-out); radiation casualties in a nuclear war; effectiveness of civil defence; other warlike uses of radiation (attacks on civilian nuclear power installations; radiological warfare; terrorist activities); conclusion.

  11. Einfluss freier Fettsäuren auf die Insulinsekretion beim Menschen

    OpenAIRE

    Steigenberger, Mirjam Elisabeth

    2008-01-01

    Zu den pathophysiologischen Grundlagen des Diabetes mellitus Typ 2 gehören die Insulinresistenz und die gestörte Insulinsekretion. Ziel dieser Arbeit war es, zu untersuchen, ob der Spiegel der freien Fettsäuren im Nüchternplasma bei Risikopersonen für Diabetes mellitus Typ 2 die Insulinsekretion beeinträchtigt. Hierfür untersuchten wir in einer Querschnittsuntersuchung 1055 Probanden mit positiver Familienanamnese für Typ 2 Diabetes mellitus. Unabhängig von Alter, Geschlecht, Insulinsensitivi...

  12. MRI of experimental focal cerebral ischemia in sheep; MR-Bildgebung eines experimentellen Schlaganfallmodells beim Schaf

    Energy Technology Data Exchange (ETDEWEB)

    Foerschler, A. [Universitaetsklinikum Leipzig (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Abt. fuer Neuroradiologie; Boltze, J. [Universitaetsklinikum Leipzig (Germany). Inst. fuer Klinische Immunologie und Transfusionsmedizin; Fraunhofer-Inst. fuer Zelltherapie und Immunologie (Germany); Waldmin, D. [Leipzig Univ. (Germany). Veterinaer-Anatomisches Inst.; Gille, U. [Fraunhofer-Inst. fuer Zelltherapie und Immunologie (Germany); Leipzig Univ. (Germany). Veterinaer-Anatomisches Inst.; Zimmer, C. [Technische Univ. Muenchen (Germany). Klinikum rechts der Isar, Abt. fuer Neuroradiologie

    2007-05-15

    Purpose: With respect to the specific characteristic of rete mirabile epidurale rostrale in sheep, the aim of this study was to investigate the use of time of flight (TOF) magnetic resonance angiography (MRA) to observe vascular anatomy and to validate MCA occlusion in a new model of experimental focal cerebral ischemia by permanent middle cerebral artery (MCA) occlusion in sheep (designed to study stroke therapy using autologous stem cells from umbilical cord blood). Furthermore, we wanted to assess the extent and natural time course of ischemic focal brain injury in sheep using functional and morphological magnetic resonance imaging (MRI). Materials and Method: 13 Merino sheep were examined. In 4 of the animals all, in 5 sheep 1 or 2 MCA branches were occluded and in 1 one case touched (sham operation). 4 controls did not undergo a surgical procedure. 23 MRI sessions were performed in 10 sheep. These sessions included T1, T2, T2{sup *} sequences, diffusion-weighted imaging (DWI) and TOF MRA before and 2 - 46 days after the onset of stroke using a 1.5T clinical MR scanner. Corrosion casts of the cerebral arteries of 3 sheep were prepared and compared to MRA. Results: The MRA visualized the vessel anatomy or occlusion distal to the rete mirabile. Anatomical variants concerning the variant origin of the MCA and inconstant arteria choroidea rostralis and communicans rostralis were revealed. Sheep with occluded left MCA showed space occupying lesions with a drop in ADC values. Depending on the number of preserved MCA branches (0; 1; 2), highly significant (p < 0.001) differences in lesion size (21 {+-} 5.7; 13; 1.7 {+-} 1.3 ml) could be found. No indication of ischemia but minimal contusion damage was observed in the sham operated animal. (orig.)

  13. Safety requirements to the operation of hydropower plants; Sicherheit beim Betrieb von Wasserkraftwerken

    Energy Technology Data Exchange (ETDEWEB)

    Lux, Reinhard [Berufsgenossenschaft Energie Textil Elektro Medienerzeugnisse (BG ETEM), Koeln (Germany)

    2011-07-01

    Employers have to take into account various safety and health requirements relating to the design, construction, operation and maintenance of hydropower plants. Especially the diversity of the hydropower plant components requires the consideration of different safety and health aspects. In 2011 the ''Fachausschuss Elektrotechnik'' (expert committee electro-technics) of the institution for statutory accident insurance and prevention presented a new ''BG-Information'' dealing with ''Safe methods operating hydropower plants''. The following article gives an introduction into the conception and the essential requirements of this new BG-Information. (orig.)

  14. Infektion mit Epstein-Barr-Virus und Tumor-Entstehung beim Menschen

    Science.gov (United States)

    Kirchner, H.

    1981-08-01

    The Epstein-Barr Virus (EBV) is the only infectious agent for which a close association with human malignant tumors has been clearly demonstrated. These tumors are one type of nasopharyngeal carcinoma which is frequent in parts of East Asia and the Burkitt lymphoma which predominantly occurs in parts of Africa and New Guinea. Nonetheless, the EBV is the causative agent of infectious mononucleosis (IM), a benign, self-limiting lymphoproliferative disease of adolescents. The major difference between the countries in which the EBV-induced tumors occur and those in which IM occurs is the late primary EBV infection in the latter, whereas primary infection with EBV occurs in the first year of life in the former. All theories of viral carcinogenesis have to explain the long latency period between primary infection and tumor growth and how an ubiquitous virus may be oncogenic. Thus, invariably, one has to assume a role of cofactors, which may be of cytogenetic nature or may be represented by additional infections or by chemical agents. Since most modern theories of carcinogenesis consider a multi-step development of tumors, the theory that infection with an ubiquitous virus at the right time of life represents one step to carcinogenesis seems to be tenable.

  15. The clinical use of mammography in the male; Klinische Relevanz der Mammographie beim Mann

    Energy Technology Data Exchange (ETDEWEB)

    Merkle, E [Ulm Univ. (Germany). Abt. Radiologie; Mueller, M [Ulm Univ. (Germany). Abt. Radiologie; Vogel, J [Ulm Univ. (Germany). Abt. Radiologie; Klatt, S [Ulm Univ. (Germany). Abt. Innere Medizin I; Goerich, J [Ulm Univ. (Germany). Abt. Radiologie; Berger, H G [Ulm Univ. (Germany). Allgemeinchirurgische Abt.; Brambs, H J [Ulm Univ. (Germany). Abt. Radiologie

    1996-01-01

    During a period of four years 104 mammograms were performed in 89 men. Mastectomies were carried out on 23 men (group 1). 66 patients (group 2) were followed up clinically and in 15 patients serial mammograms were obtained. In group 1 there were 5 patients with bilateral gynaecomastia, 9 with unilateral gynaecomastia and two with pseudogynaecomastia and there were 7 patients with malignancies. In group 2 there were 46 patients with bilateral gynaecomastia and 10 patients with unilateral gynaecomastia. Pseudogynaecomastia was found in 25 patients. There were 7 malignancies, of which 5 had been suspected clinically and one had been diagnosed as gynaecomastia by mammography. Two carcinomas in situ were missed clinically and also by mammography. When malignancy is not suspected on clinical grounds the first examination should be sonography. Where, however, malignancy is suspected, and for follow-up, mammography retains its primary position. (orig./MG) [Deutsch] In einem 4-Jahres-Zeitraum wurden bei 89 Maennern insgesamt 104 Mammogramme angefertigt. 23 Maenner (=Gruppe 1) wurden mastektomiert. 66 Patienten (=Gruppe 2) wurden klinisch und zum Teil mammographisch kontrolliert. Alle Mammogramme wurden in Unkenntnis des klinischen Befundes retrospektiv ausgewertet und, wenn moeglich, dem histologischen Ergebnis gegenuebergestellt. In der Gruppe 1 fand sich eine beidseitige Gynaekomastie in 5/23 Faellen, eine einseitige Form in 9/23 Faellen, eine Pseudogynaekomastie in 2/23 Faellen und ein Malignom in 7/23 Faellen. In Gruppe 2 ergab sich eine beidseitige Gynaekomastie in 46/81 Faellen gegenueber einer einseitigen Form in 10/81 Faellen. Eine Pseudogynaekomastie fand sich in 25/81 Faellen. Von 7 Malignomen waren 5 klinisch suspekt, wobei eines mammographisch als Gynaekomastie imponierte. Zwei In-situ-Karzinome waren sowohl mammographisch als auch klinisch okkult. Klinisch nicht malignomsuspekte Befunde sollten primaer der Mammasonographie zugefuehrt werden. Bei Malignomverdacht und in der Tumornachsorge hingegen hat die Mammographie auch weiterhin ihren festen Platz. (orig./MG)

  16. System for reducing emissions during coke oven charging; System zur Emissionsverringerung beim Fuellen von Koksoefen

    Energy Technology Data Exchange (ETDEWEB)

    Schuecker, Franz-Josef [ThyssenKrupp Industrial Solutions AG, Dortmund (Germany). Head of Oven Machine Dept., Coke Plant Technologies

    2014-10-01

    This article describes a process which reduces emissions from coke production in coke plants. The focus is on the charging process, which can be partly responsible for the fact that statutory emissions limits, which were originally met, are exceeded as coke plants get older. This article presents a solution in the form of a newly developed system that allows the oven charging system - the charging car - to respond to age-related changes in the geometry of a coke oven and thereby reduce the level of emissions.

  17. Potentials and limits of downsizing a diesel engine; Potenziale und Grenzen des Downsizings beim Dieselmotor

    Energy Technology Data Exchange (ETDEWEB)

    Mauch, Andreas; Tophoven, Jens; Trzebiatowski, Tobias; Raatz, Thorsten [Robert Bosch GmbH, Stuttgart (Germany). Bereich Forschung und Vorausentwicklung

    2011-07-15

    In order to reach lowest CO{sub 2} emissions, Bosch modified a three-cylinder diesel engine regarding its turbo-charging and fuel injection system and integrated it into a mid-size luxury car. So it is possible to determine both, the potentials concerning fuel consumption and emissions of this downsizing approach as well as its limits. (orig.)

  18. Diagnosis and differential diagnosis of hydrocephalus in adults; Diagnostik und Differenzialdiagnostik des Hydrozephalus beim Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Langner, Soenke; Mensel, Birger; Kuehn, Jens Peter; Kirsch, Michael [Univ. Medicine Greifswald (Germany). Inst. for Diagnostic Radiology and Neuroradiology; Fleck, Steffen; Baldauf, Joerg [Univ. Medicine Greifswald (Germany). Dept. of Neurosurgery

    2017-08-15

    Hydrocephalus is caused by an imbalance of production and absorption of cerebrospinal fluid (CSF) or obstruction of its pathways, resulting in ventricular dilatation and increased intracranial pressure. Imaging plays a crucial role in the diagnosis, differential diagnosis and planning of treatment. This review article presents the different types of hydrocephalus und their typical imaging appearance, describes imaging techniques, and discusses differential diagnoses of the different forms of hydrocephalus. Imaging plays a central role in the diagnosis of hydrocephalus. While magnetic resonance (MR) imaging is the first-line imaging modality, computed tomography (CT) is often the first-line imaging test in emergency patients.

  19. Modern imaging techniques in patients with multiple myeloma; Moderne Bildgebungsverfahren beim Multiplen Myelom

    Energy Technology Data Exchange (ETDEWEB)

    Bannas, Peter; Adam, G.; Derlin, T. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie; Kroeger, N. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Stammzelltransplantation

    2013-01-15

    Imaging studies are essential for both diagnosis and initial staging of multiple myeloma, as well as for differentiation from other monoclonal plasma cell diseases. Apart from conventional radiography, a variety of newer imaging modalities including whole-body low-dose-CT, whole-body MRI and 18F-FDG PET/CT may be used for detection of osseous and extraosseous myeloma manifestations. Despite of known limitations such as limited sensitivity and specificity and the inability to detect extraosseous lesions, conventional radiography still remains the gold standard for staging newly diagnosed myeloma, partly due to its wide availability and low costs. Whole-body low-dose CT is increasingly used due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions, and is replacing conventional radiography at selected centres. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI or 18F-FDG PET/CT. Diffuse bone marrow infiltration may be visualized by whole-body MRI with high sensitivity. Whole-body MRI is at least recommended in all patients with normal conventional radiography and in all patients with an apparently solitary plasmacytoma of bone. To obtain the most precise readings, optimized examination protocols and dedicated radiologists and nuclear medicine physicians familiar with the complex and variable morphologies of myeloma lesions are required. (orig.)

  20. Cardiac computed tomography in patients with acute coronary syndrome; Kardiale CT beim akuten Koronarsyndrom

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, C.L. [Universitaetsklinikum, Heidelberg (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Alkadhi, H. [Universitaetsspital, Zuerich (Switzerland); Bamberg, F. [Universitaetsklinikum, Tuebingen (Germany). Diagnostische und Interventionelle Radiologie

    2014-09-15

    Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

  1. Imaging techniques and investigation protocols in pediatric emergency imaging; Aufnahmetechnik und Untersuchungsprotokolle beim paediatrischen Notfall

    Energy Technology Data Exchange (ETDEWEB)

    Scharitzer, M.; Hoermann, M.; Puig, S.; Prokop, M. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2002-03-01

    Paediatric emergencies demand a quick and efficient radiological investigation with special attention to specific adjustments related to patient age and radiation protection. Imaging modalities are improving rapidly and enable to diagnose childhood diseases and injuries more quickly, accurately and safely. This article provides an overview of imaging techniques adjusted to the age of the child and an overview of imaging strategies of common paediatric emergencies. Optimising the imaging parameters (digital radiography, different screen-film systems, exposure specifications) allows for substantial reduction of radiation dose. Spiral- and multislice-CT reduce scan time and enable a considerable reduction of radiation exposure if scanning parameters (pitch setting, tube current) are properly adjusted. MRI is still mainly used for neurological or spinal emergencies despite the advent of fast imaging sequences. The radiologist's task is to select an appropriate imaging strategy according to expected differential diagnosis and to adjust the imaging techniques to the individual patient. (orig.) [German] Das akut erkrankte Kind erfordert eine rasche radiologische Abklaerung mit besonderer Beruecksichtung der geaenderten Untersuchungsparameter bei gleichzeitig hohem Anspruch an den Strahlenschutz. Hochaufloesende Schallkoepfe, Multislice-CT und schnelle MR-Sequenzen erlauben eine bessere Anpassung der Untersuchungsmethoden an die Beduerfnisse in der Kinderradiologie. Ziel dieses Artikels ist eine Uebersicht ueber die verschiedenen radiologischen Untersuchungstechniken sowie deren Anpassung an kindliche Anforderungen und die Angabe von Untersuchungsalgorithmen der haeufigsten paediatrischen Notfaelle. In der Projektionsradiographie erlaubt die Optimierung der Aufnahmetechnik (digitale Radiographie, unterschiedliche Klassen von Film-Folien-Systemen, Belichtungsparameter) eine deutliche Reduktion der Strahlendosis bei diagnostisch ausreichender Qualitaet. Spiral- oder Multislice-CT ermoeglichen eine Verkuerzung der Untersuchungsdauer und eine exaktere Anpassung der Expositionsparameter (Pitchfaktor, mAs-Produkt) mit deutlicher Senkung der Strahlenbelastung. Die MRT wird trotz schneller Sequenzen vorwiegend bei neurologischen und spinalen Notfaellen eingesetzt. Die Aufgabe des Radiologen liegt darin, in Abhaengigkeit von den erwarteten paediatrischen Differenzialdiagnosen die korrekte Untersuchungsmodalitaet zu waehlen und die Untersuchungstechnik individuell anzupassen. (orig.)

  2. Spiral CT for evaluation of chest trauma; Spiral-CT beim Thoraxtrauma

    Energy Technology Data Exchange (ETDEWEB)

    Roehnert, W. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Weise, R. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik

    1997-07-01

    After implementation of spiral CT in our department, we carried out an analysis for determining anew the value of CT as a modality of chest trauma diagnosis in the emergency department. The retrospective study covers a period of 10 months and all emergency patients with chest trauma exmined by spiral CT. The major lesions of varying seriousness covered by this study are: pneumothorax, hematothorax, pulmonary contusion or laceration, mediastinal hematoma, rupture of a vessel, injury of the heart and pericardium. The various fractures are not included in this study. In many cases, spiral CT within relatively short time yields significant diagnostic findings, frequently saving additional angiography. A rigid diagnostic procedure cannot be formulated. Plain-film chest radiography still remains a diagnostic modality of high value. (Orig.) [Deutsch] Nach Einfuehrung der Spiral-CT in unserer Einrichtung versuchten wir, den Stellenwert der Computertomographie in der Notfalldiagnostik des Thoraxtraumas neu zu bestimmen. Dazu wurden retrospektiv ueber einen Zeitraum von 10 Monaten alle mittels Spiral-CT untersuchten Notfallpatienten mit Thoraxverletzungen ausgewertet. Im Vordergrund standen folgende Befunde unterschiedlichen Schweregrades: Pneumothorax, Haematothorax, Lungenkontusion/-lazeration, Mediastinalhaematom, Gefaessruptur, Herz- und Herzbeutelverletzung. Auf die unterschiedlichen Frakturen wird bewusst nicht naeher eingegangen. In vielen Faellen liefert die Spiral-CT mit relativ geringem Zeitaufwand wesentliche diagnostische Aussagen. Haeufig kann auf eine Angiographie verzichtet werden. Ein starres diagnostisches Stufenschema laesst sich nicht definieren. Die Thoraxuebersichtsaufnahme besitzt einen unveraendert hohen Stellenwert. (orig.)

  3. Multi-parametric MR imaging for prostate carcinoma; Multiparametrische MR-Bildgebung beim Prostatakarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Schlemmer, Heinz-Peter [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Abt. Radiologie

    2017-03-15

    Multi-parametric NMR imaging in case of prostate carcinoma can improve diagnostics, allows reliable prognostic estimations and helps to find the optimum individual therapy. The contribution is focused to deliver the needed methodological tools and background knowledge for the daily routine.

  4. Safety relief valve instabilities; Instabiles Verhalten beim Betrieb von direkt belasteten Sicherheitsventilen

    Energy Technology Data Exchange (ETDEWEB)

    Neuhaus, Thorsten; Bloemeling, Frank; Jung, Andreas; Schaffrath, Andreas [TUeV NORD SysTec GmbH und Co. KG, Hamburg (Germany)

    2012-11-01

    The opening and closing of safety relief valves induce pressure vibrations and respective loads on the piping system. The quantification of the internal pressure load and the pipe segment forces for the proof of the structural integrity of the piping system and the supports is performed using the code DYVRO. It is not clear whether the calculated result of high-frequent opening and closing shows a realistic behavior or is caused by a simplified modeling. The contribution offers strategic recommendations to avoid unrealistic calculations.

  5. Schweißbereichsdiagramme Instrumente zur Qualitätssicherung beim Widerstandspunktschweißen

    DEFF Research Database (Denmark)

    Weber, G.; Widmer, R.; Rasmussen, Mogens Hørslev

    2001-01-01

    and electrode force, the influence of the sheet material, of the welding current form and of the electrode cape shape is examined. By the example of a medium frequency inverter welding gun, an optimization of the welding parameters of welding current, welding time and electrode force with three...

  6. Radiation exposure on flights; Strahlenexposition beim Fliegen. Ein Fall fuer den Strahlenschutz

    Energy Technology Data Exchange (ETDEWEB)

    Blettner, Maria [Mainz Univ. (Germany). Inst. fuer Medizinische Biometrie, Epidemiologie und Informatik (IMBEI); Boehm, Theresia; Eberbach, Frieder [Vereinigung Cockpit e.V. Main Airport Center (MAC), Frankfurt (Germany). AG Strahlenschutz; Bottollier-Depois, Jean-Francois [Institut de Radioprotection et de Surete Nucleaire (IRSN), Fontenay-aux-Roses (France); Clairand, Isabelle; Huet, Christelle [Institut de Radioprotection et de Surete Nucleaire (IRSN), Fontenay-aux-Roses (France). Ionizing Radiation Dosimetry Lab.; Frasch, Gerhard [Bundesamt fuer Strahlenschutz, Oberschleissheim/Neuherberg (Germany). Beruflicher Strahlenschutz und Strahlenschutzregister; Hammer, Ga el P. [Laboratoire National de Sante E.P., Dudelange (Luxembourg). Registre Morphologique des Tumeurs; Mares, Vladimir; Ruehm, Werner [Helmholtz Zentrum Muenchen Deutsches Forschungszentrum fuer Gesundheit und Umwelt GmbH, Neuherberg (Germany); Voelkle, Hansruedi [Fribourg Univ. (Switzerland). Physikdept.

    2014-09-01

    Extend and effects of radiation doses occuring during flights are treated under various aspects. Part of them are, in the first line, radiation exposure of the flying staff and the results of epidemiologic studies regarding the health consequences, as well as aspects of practical radiation protection for the flying staff. Computer programs for dose calculation on flights round off the theme. (orig.)

  7. Incorporation monitoring during handling of medically used radionuclides; Inkorporationsueberwachung beim Umgang mit medizinisch genutzten Radionukliden

    Energy Technology Data Exchange (ETDEWEB)

    Buchholz, Werner; Gerstmann, Udo [Bundesamt fuer Strahlenschutz, Oberschleissheim (Germany). FB Strahlenschutz und Gesundheit; Scholl, Clemens [Landesinstitut fuer Arbeitsgestaltung NRW, Duesseldorf (Germany). Inkorporationsmessstelle; Wanke, Carsten [Medizinische Hochschule Hannover (Germany). Strahlenschutz und Medizinische Physik

    2017-08-01

    The necessity of incorporation monitoring in nuclear medicine is dependent of the incorporation factor. For important applications, such as Tc-99m diagnostics and the radioiodine therapy specific measuring programs allow the determination of the incorporation factor. These factors are usually marginal so that a periodic monitoring is either not necessary or replaced by simple threshold measurements. Experiences of incorporation measuring stations show that incorporation might occur but does not induce significant doses.

  8. Oxidative Stress and Antioxidant Therapy in Critically Ill Polytrauma Patients with Severe Head Injury

    Directory of Open Access Journals (Sweden)

    Luca Loredana

    2015-05-01

    Full Text Available Traumatic Brain Injury (TBI is one of the leading causes of death among critically ill patients from the Intensive Care Units (ICU. After primary traumatic injuries, secondary complications occur, which are responsible for the progressive degradation of the clinical status in this type of patients. These include severe inflammation, biochemical and physiological imbalances and disruption of the cellular functionality. The redox cellular potential is determined by the oxidant/antioxidant ratio. Redox potential is disturbed in case of TBI leading to oxidative stress (OS. A series of agression factors that accumulate after primary traumatic injuries lead to secondary lesions represented by brain ischemia and hypoxia, inflammatory and metabolic factors, coagulopathy, microvascular damage, neurotransmitter accumulation, blood-brain barrier disruption, excitotoxic damage, blood-spinal cord barrier damage, and mitochondrial dysfunctions. A cascade of pathophysiological events lead to accelerated production of free radicals (FR that further sustain the OS. To minimize the OS and restore normal oxidant/antioxidant ratio, a series of antioxidant substances is recommended to be administrated (vitamin C, vitamin E, resveratrol, N-acetylcysteine. In this paper we present the biochemical and pathophysiological mechanism of action of FR in patients with TBI and the antioxidant therapy available.

  9. Relation between lifespan polytrauma typologies and post-trauma mental health.

    Science.gov (United States)

    Contractor, Ateka A; Brown, Lily A; Weiss, Nicole H

    2018-01-01

    Most individuals experience more than one trauma. Hence, it is important to consider the count and types of traumas (polytraumatization) in relation to post-trauma mental health. The current study examined the relation of polytraumatization patterns to PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and alterations in arousal and reactivity [AAR]), depression, and impulsivity facets (lack of perseverance, lack of premeditation, negative urgency, sensation seeking) using a web-based sample of 346 participants. Age, gender, race, and ethnicity were covariates. Results of latent class analyses indicated a three-class solution: Low Experience, Moderate Experience - Predominent Threat/Indirect PTEs (Moderate Experience), and High Experience - Predominant Interpersonal PTEs (High/Interpersonal). Multinomial logistic regression results indicated that ethnicity and gender were significant covariates in predicting Low versus High/Interpersonal Class, and Moderate Experience versus High/Interpersonal Class membership, respectively. The High/Interpersonal Class had higher scores on most PTSD clusters, depression, and the impulsivity facets of lack of perseverance and negative urgency compared to the other classes. The Low and Moderate Experience Classes differed on PTSD's avoidance and AAR clusters (lower in the former). Individuals exposed to multiple PTE types, particularly interpersonal traumas, may be at risk for more severe post-trauma symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Early clinical phase of patient's management after polytrauma using 1- and 4-slice helical CT

    International Nuclear Information System (INIS)

    Kloeppel, R.; Kahn, T.; Schreiter, D.; Dietrich, J.; Josten, C.

    2002-01-01

    In the early clinical phase the comprehensive imaging of patients with multiple trauma using helical CT is already established. Aim of this study was to assess whether MSCT may improve the patient management and the diagnostic results.The procedure is designed as follows: after life-thretening treatment x-ray of chest and ultrasound are carried out in the emergency room. Then the patient is moved to CT. From 1998 to december 2000 241 patients were examined using a single slice helical CT (Somatom plus 4), in 2001 79 patients using a 4-slice helical CT (Somatom VZ, Siemens Med.Sol.). After CT selected radiograms of the extremities were taken.359 of 360 procedures were carried out successfully. Excluding 1 case (death during 1-sl. h CT) all relevant lesions of head, neck, and body were diagnosed. Although the patients had an injury severity score of ∼30. The change from 1slice-helical CT to 4 slice-helical CT allowed us to reduce the stay in the CT room from 28 to 16 min. The total lethality decreased by ∼4%.Advantages for the patient arose from the standardized examination protocol using multislice CT. If integrated in an interdisciplinary management concept, it is a good compromise between examination time, comprehensive diagnostic imaging, life-saving therapeutic procedures, and therapy planning. (orig.) [de

  11. Is the early percutaneous spine total care to treat the polytrauma patient a good way?

    Directory of Open Access Journals (Sweden)

    Gabriele Falzarano

    2015-03-01

    Full Text Available The “ideal“ timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of “damage control orthopedics” is expressed. We presented a case report of a 27 years' old male who sustained a multilevel spine fractures associated a floating knee (Fraser's Type A, ulna fracture and carpal scaphoid fracture in July 2014 after car accident (very high energy trauma. All these fractures were treated in early total care. We reported a case control to discuss about the early spinal total care associated at orthopedic total care in patients with multiple trauma.

  12. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

    International Nuclear Information System (INIS)

    Poletti, Pierre-Alexandre; Becker, Christoph D.; Wintermark, Max; Schnyder, Pierre

    2002-01-01

    Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

  13. Split bolus technique in polytrauma: a prospective study on scan protocols for trauma analysis

    NARCIS (Netherlands)

    Beenen, Ludo F. M.; Sierink, Joanne C.; Kolkman, Saskia; Nio, C. Yung; Saltzherr, Teun Peter; Dijkgraaf, Marcel G. W.; Goslings, J. Carel

    2015-01-01

    For the evaluation of severely injured trauma patients a variety of total body computed tomography (CT) scanning protocols exist. Frequently multiple pass protocols are used. A split bolus contrast protocol can reduce the number of passes through the body, and thereby radiation exposure, in this

  14. Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre.

    Science.gov (United States)

    Naqvi, G; Johansson, G; Yip, G; Rehm, A; Carrothers, A; Stöhr, K

    2017-01-01

    Introduction Paediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK. Methods This retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region. Results A total of 213 patients were included in the study, with a mean age of 7.8 years (standard deviation [SD]: 5.2 years). The most common cause of injury was vehicle related incidents (46%). The median length of hospital stay was 5 days (interquartile range [IQR]: 4-10 days). Approximately half (52%) of the patients had to stay in the intensive care unit, for a median of 1 day (IQR: 0-2 days). The mortality rate was 6.6%. The mean injury severity score was 19 (SD: 10). Pearson's correlation coefficient showed a positive correlation for injury severity score with length of stay in hospital (p<0.001). Conclusions There is significant variation in mechanism of injury, severity and pattern of paediatric trauma across age groups. A multidisciplinary team approach is imperative, and patients should be managed in specialist centres to optimise their care and eventual functional recovery. Head injury remained the most common, with significant mortality in all age groups. Rib fractures and pelvic fractures should be considered a marker for the severity of injury, and should alert doctors to look for other associated injuries.

  15. CONTINUOUS THROMBOPROPHYLAXIS DURING SURGICAL TREATMENT OF PATIENT WITH POLYTRAUMA IN A MULTIDISCIPLINARY HOSPITAL (CASE REPORT

    Directory of Open Access Journals (Sweden)

    I. G. Belenky

    2017-01-01

    Full Text Available The paper presents  a clinical case of a staged surgical treatment according  to damage control  protocol  for a patient with multiple limb fractures, sternum  trauma as well as brain injury due to traffic accident. Following temporary external fixation during emergency treatment, 6 internal fixation procedures were performed on the patient during three surgical sessions. 4,5 months  postoperatively the authors  observed  consolidation of all fractures  with good restoration of joints function. Prophylaxis of venous thromboembolic events included low molecular heparins administration prior to the first and consequent surgical  sessions as well as oral anticoagulants during  intervals between  procedures and for extended prophylaxis. Apart from medicinal prophylaxis  the authors  utilized therapeutic exercises at all treatment stages.

  16. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

    Energy Technology Data Exchange (ETDEWEB)

    Poletti, Pierre-Alexandre; Becker, Christoph D. [Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Wintermark, Max; Schnyder, Pierre [Department of Diagnostic and Interventional Radiology, CHUV, Lausanne (Switzerland)

    2002-05-01

    Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

  17. Injúria Renal Aguda no paciente politraumatizado Acute Renal Injury in polytrauma patients

    Directory of Open Access Journals (Sweden)

    Thiago Gomes Romano

    2013-03-01

    Full Text Available A Injúria Renal Aguda (IRA no contexto do paciente politraumatizado ocorre, na maioria das vezes, por uma conjuntura de fatores que passam por eventos correlacionados à ressuscitação volêmica inicial, ao grau de resposta inflamatória sistêmica associada ao trauma, ao uso de contraste iodado para procedimentos diagnósticos, à rabdomiólise e à síndrome compartimental abdominal. Atualmente, passamos por uma fase de uniformização dos critérios diagnósticos da IRA com o Acute Kidney Injury Network (AKIN, sendo a referência mais aceita. Consequentemente, o estudo da IRA no politraumatismo também passa por uma fase de reformulação. Esta revisão da literatura médica visa trazer dados epidemiológicos, fisiológicos e de implicação clínica para o manuseio destes pacientes, bem como expor os riscos do uso indiscriminado de expansores volêmicos e particularidades sobre a instituição de terapia renal substitutiva em indivíduos sob risco de hipertensão intracraniana.Acute Kidney Injury (AKI in trauma is, in most cases, multifactorial. Factors related to the initial ressuscitation protocol, degree of the systemic inflamatory response to trauma, contrast nephropathy in diagnostic procedures, rhabdomyolysis and abdominal compartment syndrome are some of those factors. Nowadays a uniformization in diagnostic criteria for AKI has been proposed by the Acute Kidney Injury Network (AKIN and as a result the incidence of AKI and its impact in outcomes in trauma patients also needs to be reconsider. In this review we aim to approach epidemiologic, physiologic and clinical relevant data in the critical care of patients victims of trauma and also to expose the risks of indiscriminate use of volume expanders and the interaction between renal replacement theraphy and intracranial hypertension.

  18. Polytrauma in the elderly: predictors of the cause and time of death

    Directory of Open Access Journals (Sweden)

    Muwanga Cyrus

    2010-05-01

    Full Text Available Abstract Background Increasing age and significant pre-existing medical conditions (PMCs are independent risk factors associated with increased mortality after trauma. Our aim was to review all trauma deaths, identifying the cause and the relation to time from injury, ISS, age and PMCs. Methods A retrospective analysis of trauma deaths over a 6-year period at the study centre was conducted. Information was obtained from the Trauma Audit and Research Network (TARN dataset, hospital records, death certificates and post-mortem reports. The time and cause of death, ISS, PMCs were analysed for two age groups ( Results Patients ≥ 65 years old were at an increased risk of death (OR 6.4, 95% CI 5.2-7.8, p 15 and died within the first 24 hours of admission, irrespective of age, from causes directly related to their injuries. Twelve patients with an ISS of Conclusion Elderly patients with minor injuries and PMCs have an increased risk of death relative to their younger counterparts and are more likely to die of medical complications late in their hospital admission.

  19. Cross-disciplinary management of polytrauma patients: radiological screening and comparison

    International Nuclear Information System (INIS)

    Messmer, P.; Loew, R.; Jacob, A.L.

    2001-01-01

    The comprehensive survey addresses the various modalities available today for trauma screening and presents a comparative assessment of their value in respect of type of trauma and evidence provided. (orig./CB) [de

  20. Complex pelvic ring injuries associated with floating knee in a poly-trauma patient

    OpenAIRE

    Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

    2017-01-01

    Abstract Rationale: Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage ...

  1. [Terrorist attack trauma - an individual entity of polytrauma : A 10-year update].

    Science.gov (United States)

    Güsgen, C; Franke, A; Hentsch, S; Kollig, E; Schwab, R

    2017-10-01

    The incidence of terrorist attacks is increasing worldwide, and they have also become a permanent threat in European cities. Due to its complexity, terrorist attack trauma places high demands on the strategy of surgical treatment. The combination of various mechanisms, explosions and gunshot injuries, with the characteristic pressure (blast) damage and a high proportion of penetrating trauma with simultaneous burns are characteristic features. Unlike in military conflicts, injuries to people of all ages and without ballistic body protection (body armor) are to be expected. The mechanism of the attack and its local conditions are of relevance for the assessment of the situation and the expected injury patterns. Thus, suicide attacks result in several times higher numbers of fatalities and casualties. Explosions on free ground lead to different types of injury than those in closed or semi-enclosed spaces. The treatment principles of the Advanced Trauma Life Support (ATLS®) are based on the intrahospital care of casualties as well as damage control strategies with trigger factors. In order to prepare and educate clinics and surgeons in Germany for such scenarios, various course formats of the professional societies, the German Society for General and Visceral Surgery (DGAV) and the German Society for Trauma Surgery (DGU) have now been established.

  2. The high-risk polytrauma patient and inferior vena cava filter use.

    Science.gov (United States)

    Berber, Onur; Vasireddy, Aswin; Nzeako, Obi; Tavakkolizadeh, Adel

    2017-07-01

    The aim of this study was to assess the impact on practice of vena cava filter insertion guidelines (Eastern Association for the Surgery of Trauma: practice management guidelines). The study was performed at a level 1 trauma centre with data from the 'Trauma Audit and Research Network' cross-referenced to hospital data. A total of 1138 specific 'high-risk' major trauma patients were identified over a 6-year period. The mean age was 46 years (18-102) and the male to female ratio was 3.3:1. The average Injury Severity Score was 23.6 (4-75). The overall DVT rate was 2.6% and the PE rate was 1.8%. A retrievable IVC filter was inserted in 42 cases (3.8%). The filter retrieval rate was 23.8% at a mean of 68.5days (4-107). Only one complication was reported of a breakthrough PE despite filter. Applying the EAST guidelines to this cohort would have suggested filter insertion in 279 (24.6%) cases. The kappa concordance value between observed practice and the 'EAST filter group' was 0.103 (poor). The PE rate in the 'EAST filter group' was 2.2% vs 1.6% in the 'no filter group' (p=0.601, no statistical difference) and the observed odds ratio was 0.814 (95% CI 0.413, 1.602). The EAST guidelines are useful but may be overestimating the need for filter insertion. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Research Advances In Medical Care For Polytrauma Injuries And Blast Injuries

    Science.gov (United States)

    2011-01-25

    instead it uses a thin, hot ceramic membrane that has a voltage applied to it. It is insensitive to environmental conditions. Benefits The...Ceramic Oxygen Generator uses a metal reinforced composite, thin-film ceramic membrane to generate oxygen. Producing 1 liter of oxygen requires 30

  4. Shock index as a mortality predictor in patients with acute polytrauma

    Institute of Scientific and Technical Information of China (English)

    Kevin Fernando Montoya; Jos Daniel Charry; Juan Sebastin Calle-Toro; Luis Ramiro Niez; Gustavo Poveda

    2015-01-01

    Objective: To evaluate whether the shock index (SI), given by the formula SI = heart rate /systolic blood pressure (HR / SBP), is useful for predicting mortality at 24 h in trauma patients admitted to the emergency department of a university hospital in Colombia. Methods: A database of trauma patients admitted between January 2013 and December 2013 was constructed; the result according to the shock index was determined, generating a dichotomous variable with two groups: Group A (SI 0.9). Univariate analysis was performed. Results: A total of 666 patients were analyzed, 83.3% (555) had SI 0.9. The mean age for Groups A and B was 32.4 and 35.4 respectively. The average injury severity score for both groups was 9.6 and 17.6 respectively. Mortality at 24 h after injury for both groups was 3.1% (P = 0.032) and 59.5% (P = 0.027) respectively. Conclusions: An initial shock index greater than 0.9 implies a worse prognosis 24 h after injury. The shock index predicts mortality in multiple trauma patients in the emergency department, and is also a quick and applicable in all hospital.

  5. Physical rehabilitation following polytrauma. The Canadian Forces Physical Rehabilitation Program 2008-2011.

    Science.gov (United States)

    Besemann, Markus

    2011-12-01

    As a consequence of Canada's involvement in the war in Afghanistan, many members of the Canadian Forces have experienced debilitating injuries. Despite the Canadian Forces Health Services (CFHS) having outstanding relationships with many civilian care providers for the rehabilitation of injured soldiers, it became apparent early on that the high-level goals and aspirations of these returning soldiers were sometimes beyond the capability of these centres to facilitate. From this reality grew the need to develop a Physical Rehabilitation Program within the CFHS. This article describes the lessons learned since the creation of the program and outlines the future vision in terms of unique challenges and opportunities. The primary purpose of this article is to describe a hybrid model of civilian-military rehabilitation for injured soldiers and discuss the benefits and challenges of such a model of care.

  6. Extracorporeal life support and multiorgan donation in a severe polytrauma patient: A case report

    Directory of Open Access Journals (Sweden)

    Paolo Balsorano

    2015-01-01

    Conclusion: : Besides it’ role in non heart beating donors, ECLS is emerging as an adjunctive tool for brain dead donors management when standard treatment fails, potentially allowing a substantial increase in organ availability.

  7. Strategies in interventional radiology. Formation of an interdisciplinary center of vascular anomalies. Chances and challenges for effective and efficient patient management; Strategien in der interventionellen Radiologie. Gruendung eines Interdisziplinaeres Zentrum fuer Gefaessanomalien. Chancen und Herausforderungen fuer effektives und effizientes Patientenmanagement

    Energy Technology Data Exchange (ETDEWEB)

    Sadick, Maliha; Dally, Franz Josef; Schoenberg, Stefan O. [University Medical Center Mannheim (Germany). Interdisciplinary Center for Vascular Anomalies; Stroszczynski, Christian [University Hospital Regensburg (Germany). Dept. of Radiology; Wohlgemuth, Walter A. [University Hospital Halle (Germany). Interdisciplinary Center for Vascular Anomalies

    2017-10-15

    Radiology is an interdisciplinary field dedicated to the diagnosis and treatment of numerous diseases and is involved in the development of multimodal treatment concepts. Interdisciplinary case management, a broad spectrum of diagnostic imaging facilities and dedicated endovascular radiological treatment options are valuable tools that allow radiology to set up an interdisciplinary center for vascular anomalies. Image-based diagnosis combined with endovascular treatment options is an essential tool for the treatment of patients with highly complex vascular diseases. These vascular anomalies can affect numerous parts of the body so that a multidisciplinary treatment approach is required for optimal patient care. This paper discusses the possibilities and challenges regarding effective and efficient patient management in connection with the formation of an interdisciplinary center for vascular anomalies with strengthening of the clinical role of radiologists. Key points: Vascular anomalies, which include vascular tumors and malformations, are complex to diagnose and treat. There are far more patients with vascular anomalies requiring therapy than interdisciplinary centers for vascular anomalies - there is currently a shortage of dedicated interdisciplinary centers for vascular anomalies in Germany that can provide dedicated care for affected patients. Radiology includes a broad spectrum of diagnostic and minimally invasive therapeutic tools which allow the formation of an interdisciplinary center for vascular anomalies for effective, efficient and comprehensive patient management.

  8. Fracture of an industrial steam turbine horizontal joint nut upon tightening; Bruch der Mutter einer Horizontalteilfugenverschraubung einer Industriedampfturbine beim Anziehen

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Boromir; Giller, Madeleine; Neidel, Andreas; Riesenbeck, Susanne [Siemens AG - Gasturbinenwerk Berlin (Germany). Energy Sector Werkstoffprueflabor

    2017-11-01

    The nut of a horizontal joint fastener cracked upon tightening during assembly in an industrial steam turbine factory. It was previously used in an over-pressure test, but was otherwise not yet used in service. Nut and bolt were made of the nickel-based superalloy Nimonic 80A, a precipitation-hardenable wrought high-strength alloy with excellent creep and corrosion properties. Such alloys usually get a complex heat treatment after hot-rolling, comprising homogenizing and multiple ageing cycles. The subject nut failed due to an extreme case of mixed grain size which detrimentally affected mechanical properties and was attributed to an insufficient degree of deformation during hot rolling.

  9. Ecological aspects to the use of pretreated waste in thermal plants; Oekologische Aspekte beim Einsatz aufbereiteter Abfaelle in thermischen Anlagen

    Energy Technology Data Exchange (ETDEWEB)

    Friedel, M.; Urban, A.I. [Kassel Univ. (Gesamthochschule) (Germany). Fachgebiet Abfalltechnik

    1998-09-01

    The present contribution focuses on the input side of individual process techniques. It shows on the basis of example calculations how two parameters describing the incinerable (residual) waste that are of particular importance for unconventional thermal treatment methods, namely ``pollutant load`` and ``calorific value``, can be influenced by a recycling stage and then further by mechanical-biological pretreatment. [Deutsch] Im folgenden soll das Hauptaugenmerk auf die Inputseite zu den einzelnen thermischen Verfahren gelegt werden und anhand einer Beispielrechnung aufgezeigt werden, wie sich die fuer einen Einsatz in nichtkonventionellen thermischen Verfahren besonders wichtigen Parameter des aufbereiteten (Rest)Abfalls `Schadstoffbelastung` und `Heizwert` zunaechst durch eine Verwertung und weiter durch eine mechanisch-biologische Vorbehandlung veraendern. (orig./SR)

  10. Smart Metering: Learning from telecommunication providers. Innovative customized products; Beim Smart Metering von Telekommunikationsanbietern lernen. Innovative Buendelprodukte

    Energy Technology Data Exchange (ETDEWEB)

    Isbrecht, Volker; Sombrutzki, Ingo [Putz und Partner Unternehmensberatung AG, Hamburg (Germany). Strategie- und Projektmanagement - Energiewirtschaft; Hofer, Kristina [Putz und Partner Unternehmensberatung AG, Hamburg (Germany). CRM- und Telekommunikation

    2010-04-06

    Deregulation in the electricity and gas metering has raised interest in smart meters. Experts estimate that in a four-person household, smart meters may reduce electricity consumption by up to 10 percent, i.e. 50 - 90 Euros, and CO2 emissions by 8.5 million tonnes, which amounts to 4 percent of the total CO2 emissions in Germany. These are ideal conditions for utilities to develop innovative products for the mass market of private consumers and to improve their competitive standing in the market by a clearly communicated advantage to both the customers and the climate. By utilizing the experience gained in the telecommunications industry, they will be able to respond quickly to impending challenges. (orig.)

  11. Bestimmung der fehlenden transversalen Energie auf der ersten Triggerstufe beim ATLAS-Experiment und Optimierung der Triggerselektion von supersymmetrischen Ereignissen

    CERN Document Server

    Rieke, Stefan

    2009-01-01

    The standard model (SM) of particle physics is a theory, describing three out of four fundamental forces. The prediction of the standard model are in good agreement with the results of measurement of the experiments at the CERN, the Fermi lab and other research establishments. Still, not all open questions of the particle physics could be answered with this model. For example, it is not possible to implement the fourth fundamental force, the gravity, into the SM. Another example are candidates for the dark matter, which couldn’t described by the standard model, but cosmological experiments show that the contribution of the dark matter is about 25% of the universe. The supersymmetry, which introduce a symmetry between fermions and bosons, is regarded as one of the most promising solution for these open questions. In this theory, each new particle so-called supersymmetric particles is related to one particle in the standard model. If supersymmetry is realized in nature, one possible model of this symmetry is ...

  12. System integration of CDC attenuation in the new Opel Astra; Systemintegration der CDC-Daempfung beim neuen Opel Astra

    Energy Technology Data Exchange (ETDEWEB)

    Balandat, W.; Kutsche, T. [ZF Sachs AG, Schweinfurt (Germany)

    2004-08-01

    The optional carriage system IDS Plus of the new Opel Astra was developed in close cooperation between opel, ZF Sachs and other suppliers. This networking approach resulted in a high degree of system integration with the electronic attenuation control system CDC as key element. (orig.) [German] Das optionale Fahrwerksystem IDS Plus im neuen Opel Astra entstand in enger Kooperation zwischen Opel, ZF Sachs und weiteren Zulieferern. Die Arbeit im Netzwerk fuehrte zu einer hohen Systemintegration, in deren Kern die elektronische Daempferregelung CDC steht. (orig.)

  13. Ecological improvements in conjunction with the new RADAG hydro power plant; Oekologische Aufwertungsmassnahmen beim Neubau des Wehrkraftwerks der RADAG

    Energy Technology Data Exchange (ETDEWEB)

    Ruess, Beatrice [RUS AG, Baden (Switzerland)

    2010-07-01

    Together the weir power plant and the upgrading measures will create salient ecological improvements of the actual conditions of the residual water route. Of special importance are the increased runoff into the Old Rhine and the additional structuring measures. The natural evasion waters combined with the Collection Gallery and the Vertical Slot fish ladder together with the new fish ladder at the Main Power Station will on one hand greatly improve the longitudinal continuum and on the other hand create habitats for species relying on strong-flowing waters. (orig.)

  14. Vaporization of materials in the operation of high temperature fuel cells (SOFCs); Verdampfung von Werkstoffen beim Betrieb von Hochtemperaturbrennstoffzellen (SOFCs)

    Energy Technology Data Exchange (ETDEWEB)

    Stanislowski, M.

    2006-07-01

    One of the main problems concerning the development of state of the art planar SOFCs are the occurrence of ageing effects in long term application. To a great deal these effects are caused by the release of volatile Cr-species from metallic interconnects which leads to an inhibition of the electrochemical processes at the cathode resulting in a rapid degradation of the cell performance. A goal in further development of SOFC-systems is the reduction of the operation temperature of the cell from currently 800 C to 700 C and below. For this purpose alternative electrolyte materials with higher oxygen ion conductivities have to be developed. Doped lanthanum gallates have been identified as promising materials. However for these materials a depletion of Ga by vaporization has been observed under anodic conditions which may lead to a destruction of their electrolyte properties. The aim of this work is the study of the vaporization processes leading to the mentioned degradation effects. For this purpose an experimental setup according to the transpiration method has been developed. Concerning the vaporization of chromium the Cr release rates of the main ferritic interconnect alloys, namely Crofer 22 APU, ZMG 232, E-Brite, IT-10, IT-11, IT-14 and Ducrolloy as well as a variety of Ni- and Co-base superalloys and stainless steels with different contents of Al, Si, Ti, Mn, W, Ni and Co were measured at 800 C in air and compared to each other. The alloys that form an upper layer of Cr-Mn-spinel on top of the grown chromia scale showed a reduction of the Cr release by 61-75 % compared to pure chromia scales whereas alloys with an outer Co3O4(s) scale had a by more than 90 % reduced Cr release. For the former alloys a significant vaporization of Mn under anodic conditions could be detected. Concerning the vaporization of doped lanthanum gallates the vaporization rates of the elements Ga, Mg, Sr and La were measured as function time, temperature, gas flow rate and stoichiometry for compositions of the type La(1-x)SrxMgy(Fez)Ga(1-y-z)O(3-delta)(s) with x=0,1-0,3, y=0,12-0,32 and z=0-0,08. As a consequence of the depletion of Ga the formation of the impurity phases LaSrGaO4(s) and LaSrGa3O7(s) was observed. Kinetic parameters were obtained by fitting the results to a vaporization model with imposed solid state diffusion. In order to elucidate the quality of thermodynamic calculations equilibrium measurements were performed with pure Cr2O3(s) and Ga2O3(s) in air or Ar/H2 respectively as function of temperature and humidity. For the vaporization of Ga2O3(s) it could be shown that GaOH(g) is the most abundant Ga species in the gas phase. The determined partial pressures for CrO2(OH)2(g) and CrO3(g) or GaOH(g) respectively and the derived enthalpies and entropies of reaction for CrO2(OH)2(g) and GaOH(g) showed significant differences compared to the thermodynamical data in the literature. (orig.)

  15. On the use of hydrate inhibitors for operating natural gas caverns; Zum Einsatz von Hydratinhibitoren beim Betrieb von Erdgasspeichern

    Energy Technology Data Exchange (ETDEWEB)

    Kleinitz, W.; Lissanon, S.J.; Luehn, H.G. [Preussag Energie GmbH, Lingen/Ems (Germany)

    1997-12-31

    One way to prevent gas hydrates in natural gas caverns is to use thermodynamic or kinetic inhibitors in a defined temperature / pressure range. The present contribution describes the temperature conditions prevailing in the tubing string. It also discusses bacterial processes around wells arising in association with methanol digesting bacteria, diethylene glycol digesting bacteria, and kinetic inhibitors. Further topics include inhibitor dosage and absorption drying. (MSK) [Deutsch] Zur Vermeidung von Gashydraten im Erdgasspeicherbereich werden thermodynamische oder kinetische Inhibitoren in einem definierten Temperatur/Druckbereich eingesetzt. Im Folgenden werden die Temperaturbedingungen im Steigrohrsystem erlaeutert. Ebenso werden die bakteriellen Vorgaenge im Bohrlochsbereich in folgenden Einzelheiten: Methanol-verwertenden Bakterien, Diethylenglykol-verwertende Bakterien sowie kinetische Inhibitoren diskutiert. Weitere Themenpunkte sind die Inhibitordosierung und die Adsorptionstrocknung.

  16. Tried and tested automation system helps to reduce air pollution. Ausgereifte Automatisierung hilft beim Reduzieren schaedlicher Emissionen

    Energy Technology Data Exchange (ETDEWEB)

    Haack, R. (Still Otto GmbH, Bochum (Germany, F.R.)); Schreiter, K.D. (Siemens AG, Erlangen (Germany, F.R.). Bereich Anlagentechnik)

    An important step in the coking process is the cooling of the red hot coke. This is mainly done by dowsing with water. The result is the emission of pollutant gases and the waste of heat energy. Disadvantages of this kind can be reduced by the use of a coke drying and cooling plant. This requires, however, because of its complex technology, a tried and tested automation system. A homogeneous solution to the problems faced by the automation system is found in the SIMATIC S5-150U automation unit which was delivered with the coke drying and cooling plant for Pohang (Korea) from the firm Still Otto GmbH in Bochum. This is the largest of its kind. (orig.).

  17. Zur Bedeutung der Pharmakogenetik in der Veterinärmedizin am Beispiel des MDR1-Gendefektes beim Hund

    OpenAIRE

    Geyer, Joachim

    2014-01-01

    Die Pharmakogenetik untersucht, inwieweit Variationen in Genen, welche die pharmakokinetischen und pharmakodynamischen Prozesse eines Arzneistoffes kontrollieren für die interindividuellen Unterschiede in der Arzneistoffwirkung oder dem vermehrten Auftreten unerwünschter Arzneistoffwirkungen verantwortlich sind. Die pharmakogenetische Forschung hat in der Humanmedizin in den vergangenen 10-20 Jahren große Fortschritte erzielt, wobei die auf eine personalisierte Medizin ausgerichtete Berücksic...

  18. ALS Ice Bucket Challenge: Warum die Kampagne über einen „Tsunami Effekt“ beim Spendenverhalten Eisberge versetzen kann

    OpenAIRE

    Decieux, Jean Philippe Pierre

    2015-01-01

    Im Sommer 2014 beherrschte eine Kampagne die sozialen Medien, welche auf originelle Art und Weise auf die Nervenkrankheit Amyotrophe Lateralsklerose (ALS) aufmerksam machen und dadurch Spendengelder für die Erforschung dieser Krankheit generieren wollte. Im Rahmen der sogenannten ALS-Ice-Bucket-Challenge-Kampagne gossen sich die Hauptdarsteller/innen von kleinen Internetclips eiskaltes Wasser über den Kopf und nominierten im Anschluss weitere Personen für die Challenge. Die Herausforderung bz...

  19. Crucible and coil monitoring during melting operation in induction crucible furnaces; Tiegel- und Spulenueberwachung beim Schmelzbetrieb von Induktionstiegeloefen

    Energy Technology Data Exchange (ETDEWEB)

    Doetsch, Erwin; Forsthoevel, Christoph; Rische, Marco [ABP Induction Systems GmbH, Dortmund (Germany)

    2013-03-15

    The immediate proximity of the metal melt, with a temperature of up to above, 1600 C, to the induction coil in inductive melting necessitates highly reliable monitoring systems, in order to prevent dangerous contact between the melt and the cooling-water-conducting copper section. Ground-fault monitoring, in which the electrical resistance between the melt and the coil is continuously measured, is a standard solution for this function. Everyday use of this long-established system has been made more dependable by automating a number of functions, and the system has also been adapted to modern plant technology, including synchronous tandem operation of two crucible furnaces from a common converter power supply, for example. Measurement of frequency and effective power, as a function of wall thickness, is a supplementary monitoring strategy. Processing of the measured data in the melt processor, in combination with visual assessment, permits appraisal of the integral crucible state and reliable estimation of the remaining service-life of the current crucible. (orig.)

  20. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3); Verfahrensanweisung zur Radioiodtherapie (RIT) beim differenzierten Schilddruesenkarzinom (Version 3)

    Energy Technology Data Exchange (ETDEWEB)

    Dietlein, M.; Schicha, H. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Dressler, J. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Nuklearmedizinsiche Klinik der Henriettenstiftung, Hannover (Germany); Eschner, W. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Gruenwald, F. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Frankfurt Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Lassmann, M. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leisner, B. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Allgemeines Krankenhaus St. Georg, Hamburg (Germany); Luster, M.; Reiners, C. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Moser, E. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Radiologische Universitaetsklinik Freiburg (Germany); Schober, O. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Muenster Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2007-07-01

    The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for {sup 131}I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative {sup 131}I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC {<=}1 cm {sup 131}I ablation may be helpful in an individual constellation. Preparation for {sup 131}I ablation requires low iodine diet for two weeks and TSH stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lowerblood activity) and the advantages of endogenous TSH stimulation (necessary for {sup 131}I-therapy in patients with metastases, higher sensitivity of {sup 131}I whole-body scan) are discussed. In most centers standard activities are used for {sup 131}I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of {sup 131}I should not exceed 1-10MBq, alternative tracers are {sup 123}I or {sup 124}I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. (orig.)

  1. Complications following surgery and adjuvant irradiation in rectal carcinoma. Komplikationen nach Operation und nach adjuvanter Bestrahlung beim Rektumkarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Suhr, P.; Limmer, J. (Ulm Univ. (Germany, F.R.). Universitaetsklinikum)

    1991-04-12

    Colorectal cancer is one of the most common human malignancies. Adjuvant irradiation can decrease the risk of recurrence and subsequently the associated morbidity compared with surgery alone. The rate of radiation-induced complications amounts to approximately 10%, which is substantially lower than the frequency of observed local failure. (orig.).

  2. Structural behaviour of pipe umbrellas in tunnel drives in granular soils; Tragverhalten von Rohrschirmdecken beim Tunnelbau im Lockergestein

    Energy Technology Data Exchange (ETDEWEB)

    Eckl, Michael

    2012-11-01

    An increase in the use of pipe umbrellas made of long piles or self drilling injection anchors can be seen in conventional tunnel drives. They are used as reinforcement ahead of the face. This paper consists of investigations concerning the structural and geotechnical behaviour of such umbrellas in granular soils. The research is based on finite element method calculations using a diverse range of essential influencing factors. From the evaluation of the calculations, conclusions can be drawn about the load bearing behaviour of the umbrellas and their interaction with the surrounding ground. A forecasting model is derived in order to predict the internal forces of the umbrella elements and a design methodology is presented. (orig.)

  3. Influence of thyroid metabolism on radioiodine therapy in Graves` disease; Einfluss der Stoffwechsellage auf die Radioiodtherapie beim Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Boerner, A.R. [Forschungszentrum Juelich (Germany). Inst. fuer Medizin; Weckesser, M.; Boy, C.; Schmidt, D.; Langen, K.J.; Mueller-Gaertner, H.W. [Duesseldorf Univ. (Germany). Nuklearmedizinische Klinik]|[Forschungszentrum Juelich (Germany). Inst. fuer Medizin

    1997-12-01

    Radioiodine therapy is one of two definitive methods of treatment in Graves` disease beside near-total thyreoidectomy. Simple strategies like optimization of thyroid metabolism help to improve efficacy in radioiodine therapy thus lowering applied radioiodine doses, radiation exposure to the patient and to the environment and avoiding multiple vain therapeutic efforts. These strategies are likely to reduce costs at the same time. (orig.) [Deutsch] Die Radioiodtherapie ist eine der beiden definitiven Therapiemethoden bei Morbus Basedow neben der nahezu totalen Thyreoidektomie. Ziel ist es, mit einfachen Methoden wie der optimalen Einstellung der Stoffwechsellage die Effizienz der Radioiodtherapie zu optimieren im Hinblick auf eine Reduktion der einzusetzenden Aktivitaet, der Gesamtstrahlenexposition fuer Patient und Umwelt und durch Vermeidung mehrfacher, vergeblicher therapeutischer Ansaetze. Diese Optimierung traegt auch zur Reduktion der Gesamtkrankheitskosten bei. (orig.)

  4. Herausforderungen beim Aufbau und bei der Pflege einer Bilddatenbank – ein Anwendungsbeispiel aus dem Digitalen Forschungsarchiv Byzanz (DiFAB

    Directory of Open Access Journals (Sweden)

    Nina Rannharter

    2017-09-01

    Full Text Available Mit Metadaten versehene, digital archivierte Bilder sind aufgrund ihrer hohen Komplexität eine ständige Herausforderung für den Aufbau von Metadatenstrukturen und für das Beibehalten von adäquaten Metadatenstandards in Bilddatenbanken. Besonders bei Bildern über eine materielle Kultur zeichnet sich diese Komplexität in den diversen Ebenen ab. Zur Verdeutlichung dieser Problematik dient ein einzelnes Monument mit seiner fotographischen Dokumentation als geisteswissenschaftliches Anwendungsbeispiel aus dem Digitalen Forschungsarchiv Byzanz (DiFAB der Universität Wien. Unter der grundsätzlichen Berücksichtigung der künftigen Anforderungen und der einfachen Navigation von Metadaten beinhaltet dieser Beitrag u. a. die Herausforderungen mit den diversen analogen und digitalen Formen der Dokumentation, der historischen Geographie, der kulturspezifischen Terminologie sowie mit der kunsthistorischen Bedeutung einer exakten und unscharfen Datierung für Forschungsarchive.

  5. Thermal management for GDI engine. Ways to reduce warm up; Thermomanagement beim DI Ottomotor. Wege zur Verkuerzung des Warmlaufs

    Energy Technology Data Exchange (ETDEWEB)

    Koch, F.; Haubner, F.; Schwaderlapp, M. [FEV Motorentechnik GmbH und Co KG, Aachen (Germany)

    2001-07-01

    The cooling system of modern engines has to fulfill demands which are for the engine fuel consumption, increase of efficiency, decrease of emissions and for the vehicle warm up characteristic and cabin heater power. Most of the potential to optimize the cooling system is found at low engine loads and during the warm up. For future systems a precise control of the cooling power is required. Parameters are the engine load and the control of coolant and component temperatures. This parameters are necessary to define the strategy of a thermal management system of the engine. Simulation models were developed to describe the thermal behavior and the interactions between cooling system and thermodynamic, thermal load of the components and Tribology. Based on this a concept was worked out which lead to a fuel consumption reduction of 3,8% in NEFZ. (orig.) [German] Das Kuehlsystem heutiger Motoren muss Anforderungen erfuellen, die sich motorseitig aus Verbrauchsreduzierung, Wirkungsgradoptimierung und gleichzeitiger Verschaerfung der Abgasnormen sowie fahrzeugseitig aus der Warmlaufdynamik insbesondere der fuer die Fahrzeugheizung benoetigten Leistung ergeben. Die Potenziale zur Optimierung des Kuehlsystems finden sich vorwiegend fuer den Motorbetrieb bei niedrigen Motorlasten und im Warmlauf. Fuer zukuenftige Systeme erfordert dies eine exaktere Regelung der Kuehlleistung, die sich am tatsaechlichen Bedarf des Motors orientiert. Als wesentliche Parameter sind die staerkere Beruecksichtigung der Motorlast und die gezielte Regelung der Kuehlmittel- sowie der Bauteiltemperaturen zu nennen. Besondere Bedeutung bekommt die Definition der Betriebsweise eines Thermomanagementsystems. Zur Auslegung wurden Simulationsmodelle entwickelt, die das thermische Verhalten und die wesentlichen Interaktionen des Kuehlsystems mit der Thermodynamik, der thermischen Bauteilbelastung und der Tribologie detailliert beschreiben und ein Konzept erarbeitet, das fuer ein Mittelklassefahrzeug 3,8% Verbrauchsverbesserung im NEFZ bringt. (orig.)

  6. Technologische Zukünfte - Was kommt auf uns zu?: Vortrag gehalten beim 2. EUROPEAN INNOVATORS Jahresnetzwerktreffen, 2017, Hannover

    OpenAIRE

    Bantes, René

    2017-01-01

    Technological development is only surprising to the unprepared. The speed of technological development is heavily influenced by non-technological aspects. Societal norming lags profoundly behind the technological advances and turns into a roadblock for technological advances. For the foreseeable future technological disruption is more probable to emerge out of convergence of existing technologies then of revolutionary technological progress.

  7. Early clinical phase of patient's management after polytrauma using 1- and 4-slice helical CT; Fruehes klinisches Management nach Polytrauma mit 1- und 4-Schicht-Spiral-CT

    Energy Technology Data Exchange (ETDEWEB)

    Kloeppel, R.; Kahn, T. [Klinik und Poliklinik fuer Diagnostische Radiologie, Universitaetsklinikum Leipzig (Germany); Schreiter, D. [Chirurgische Intensivtherapieabteilung, Zentrum fuer Chirurgie, Universitaetsklinikum Leipzig (Germany); Dietrich, J. [Abt. Neuroradiologie der Klinik und Poliklinik fuer Diagnostische Radiologie, Universitaetsklinikum Leipzig (Germany); Josten, C. [Klinik und Poliklinik fuer Unfall- und Wiederherstellungschirurgie, Zentrum fuer Chirurgie, Universitaetsklinikum Leipzig (Germany)

    2002-07-01

    In the early clinical phase the comprehensive imaging of patients with multiple trauma using helical CT is already established. Aim of this study was to assess whether MSCT may improve the patient management and the diagnostic results.The procedure is designed as follows: after life-thretening treatment x-ray of chest and ultrasound are carried out in the emergency room. Then the patient is moved to CT. From 1998 to december 2000 241 patients were examined using a single slice helical CT (Somatom plus 4), in 2001 79 patients using a 4-slice helical CT (Somatom VZ, Siemens Med.Sol.). After CT selected radiograms of the extremities were taken.359 of 360 procedures were carried out successfully. Excluding 1 case (death during 1-sl. h CT) all relevant lesions of head, neck, and body were diagnosed. Although the patients had an injury severity score of {approx}30. The change from 1slice-helical CT to 4 slice-helical CT allowed us to reduce the stay in the CT room from 28 to 16 min. The total lethality decreased by {approx}4%.Advantages for the patient arose from the standardized examination protocol using multislice CT. If integrated in an interdisciplinary management concept, it is a good compromise between examination time, comprehensive diagnostic imaging, life-saving therapeutic procedures, and therapy planning. (orig.) [German] Die klinische Erstversorgung Polytraumatisierter schliesst inzwischen in vielen Unfallkliniken den fruehzeitigen Einsatz der Spiral-CT ein. Kann die neuerlich eingefuehrte Mehrschicht-Spiral-CT Ergebnisse und Patientenmanagement weiter verbessern?Nach lebensrettenden Sofortmassnahmen, Thoraxroentgen und Notsonographie im Schockraum erfolgte die CT: Von 1998-2000 wurden 241 Patienten mit einem 1-Schicht-Spiral-CT (Somatom plus 4) und in 2001 79 Patienten mit einem 4-Schicht-Spiral-CT (Somatom VZ, beide Siemens Med. Sol.) untersucht. Klinisch ausgewaehlte Extremitaetenaufnahmen wurden ergaenzt.359 von 360 Untersuchungen verliefen erfolgreich, ein Patient verstarb im 1-Schicht-Spiral-CT. Alle relevanten Verletzungen von Kopf, Hals und Koerperstamm wurden erkannt. Der Injury severity score (ISS) betrug durchschnittlich ueber 30. Mit dem Wechsel vom 1- auf das 4-Schicht-Spiral-CT konnte der Aufenthalt im CT-Raum von durchschnittlich 28 auf 16 min gesenkt werden. Die Gesamtletalitaet sank um ca. 4%.Vorteile fuer polytraumatisierte Patienten resultierten aus einem standardisierten Untersuchungsprotokoll mit Mehrschicht-Spiral-CT. Es stellte einen guten Kompromiss zwischen Untersuchungszeit, Umfang an diagnostischer Information, lebensrettenden Massnahmen und notwendiger Therapieplanung dar. (orig.)

  8. Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report.

    Science.gov (United States)

    Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

    2017-12-01

    Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO). Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs. Unstable pelvic fractures, multiple fractures of bilateral lower limbs with floating knee injury, multiple pelvic and rib fractures and multiple degloving injuries and soft tissue contusion formed the characteristics of the multiple-injury. The algorithm of DCO was determined as the treatment. Early simplified procedures such as wound debridement, pelvis fixation, closed reduction and EF of the right shoulder joint, and chest wall fixation were conducted as soon as possible. After a period of time, internal fixations were applied to the fracture sites. The subsequent functional exercise was also conducted in accordance with this algorithm. This patient got recovery after the treatments which were guided by the criterion of DCO. The restoration of limb functional and the quality of life greatly improved. The DCO plays a decisive role in the first aid and follow-up treatment of this patient. The guidelines of management of complex pelvic ring injuries and floating knee should be established by authorities.

  9. [Polytrauma in children and adolescents. Choice of the primary care clinic and importance of pediatric traumatology competence centers].

    Science.gov (United States)

    Debus, F; Lefering, R; Frink, M; Kühne, C; Mand, C; Ruchholtz, S

    2015-05-01

    The number of (seriously) injured children increased again for the first time in 2011. The aim of this study was to analyse differences compared to multiple injured adults and to show the reality of daily treatment. All cases of the DGU Trauma Registry from the years 1997 to 2010 were examined. The documented cases were divided into different the age groups. The study investigated, e.g. the mechanism of accident, injury pattern, the number of hospital and ICU days, and lethality. At 38.8% the largest percentage of severely injured children and adolescents belongs to the group of 16-17 year olds. The group of 0-5 year olds (15.9%) has the lowest percentage. The most common accident cause was traffic accidents (58.5%). The mechanism of accident and the injury patterns changes with age. Younger patients are often treated in supraregional trauma centers (0-5 year olds: 78.2% vs. 16-17 year olds: 73.1% vs. > 65 years: 63.2%). The average lethality rate was 14.8% (16.3% RISC). The percentage of severely injured children in the overall population is only 7.4%. Because the majority of patients are primarily treated in supraregional trauma centers, trauma centers with specialisation in paediatric traumatology are mandatory.

  10. Berührt sein – Ein Fallbericht zur Rolle von WATSU (WasserShiatsu) in der Rehabilitation nach Polytrauma

    OpenAIRE

    Schitter, Agnes Maria; Fleckenstein, Johannes

    2017-01-01

    Hintergrund: Die herausragende Bedeutung von Körperkontakt für den Menschen ist bekannt und nachgewiesen. Während aber intensiver Körperkontakt in der medizinischen Versorgung von Frühgeborenen etabliert ist, wird Berührung in schulmedizinische Therapiekonzepte für Erwachsene bisher nur marginal integriert. Massnahmen aus der Komplementärmedizin berücksichtigen den individuellen Bedarf an körperlicher Nähe und leisten einen klinischen Mehrwert für den Gesundungsprozess. In besonderer Weise...

  11. Evaluation of Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma

    Science.gov (United States)

    2017-02-01

    long range aero-medical evacuation in hypobaric environments on the physiology and organ function of injured warfighters, thus potentially and...currently ongoing. REPORTABLE OUTCOMES: Steve Chun, MD; Ashraful Haque, MD; Brittany Hazzard, BS; Saha Biswajit, MD, Martin Harssema, MD, Charles Auker...Scultetus MD; Ashraful Haque, MD; Brittany Hazzard, BS; Saha Biswajit, MD; Steve Chun, MD; Martin Harssema, MD; Charles Auker, MD, PhD; Debra Malone

  12. [The 3D-printed dental splint: a valuable tool in the surgical treatment of malocclusion after polytrauma].

    Science.gov (United States)

    van de Velde, W L; Schepers, R H; van Minnen, B

    2016-01-01

    A 22-year old male was referred to the Department of Oral and Maxillofacial Surgery of a university clinic 2 months after he had sustained multiple traumatic injuries abroad because of an anterior malocclusion. The malocclusion was the sequel of an unrecognised, untreated, already consolidated paramedian mandibular fracture on the right and a fracture of the contralateral mandibular angle on the left. Preoperatively, a cobalt-chrome 3D-printed dental splint was prepared. Surgical correction of the malocclusion was carried out by segmental osteotomies of the mandible at the original fracture sites. This involved a vertical paramedian osteotomy on the right side and a unilateral sagittal split osteotomy on the left mandibular angle side. The mandibular segment was mobilised in the correct occlusion with the aid of the 3D-printed dental splint. The splint was fixed to the teeth with dental composite. The custom made 3D-printed dental splint is considered a promising procedural innovation in oral and maxillofacial surgery.

  13. Lung volume reduction in pulmonary emphysema from the radiologist's perspective; Lungenvolumenreduktion beim Lungenemphysem aus der Sicht des Radiologen

    Energy Technology Data Exchange (ETDEWEB)

    Doellinger, F.; Poellinger, A. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Huebner, R.H. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Internal Medicine/Infectious and Respiratory Diseases; Kuhnigk, J.M. [Fraunhofer MEVIS, Bremen (Germany). Inst. for Medical Image Computing

    2015-08-15

    Pulmonary emphysema causes decrease in lung function due to irreversible dilatation of intrapulmonary air spaces, which is linked to high morbidity and mortality. Lung volume reduction (LVR) is an invasive therapeutical option for pulmonary emphysema in order to improve ventilation mechanics. LVR can be carried out by lung resection surgery or different minimally invasive endoscopical procedures. All LVR-options require mandatory preinterventional evaluation to detect hyperinflated dysfunctional lung areas as target structures for treatment. Quantitative computed tomography can determine the volume percentage of emphysematous lung and its topographical distribution based on the lung's radiodensity. Modern techniques allow for lobebased quantification that facilitates treatment planning. Clinical tests still play the most important role in post-interventional therapy monitoring, but CT is crucial in the detection of postoperative complications and foreshadows the method's high potential in sophisticated experimental studies. Within the last ten years, LVR with endobronchial valves has become an extensively researched minimally-invasive treatment option. However, this therapy is considerably complicated by the frequent occurrence of functional interlobar shunts. The presence of ''collateral ventilation'' has to be ruled out prior to valve implantations, as the presence of these extraanatomical connections between different lobes may jeopardize the success of therapy. Recent experimental studies evaluated the automatic detection of incomplete lobar fissures from CT scans, because they are considered to be a predictor for the existence of shunts. To date, these methods are yet to show acceptable results.

  14. Initial experience in the underground use of laser scanners in the monitoring of bulk materials; Erste Erfahrungen beim untertaegigen Einsatz von Laserscannern in der Massengutueberwachung

    Energy Technology Data Exchange (ETDEWEB)

    Voss, H.W. [RAG Aktiengesellschaft, Bottrop (Germany). Bergwerk Prosper-Haniel

    2008-04-17

    The profitability of coal mines is significantly affected by the structural and organisational conditions in the area of bulk material transport. The introduction and implementation of measures to improve logistics constitutes a permanent challenge in the mines. The continuous increase in face outputs in the mines of RAG by the use of increasingly efficient coal-winning equipment also imposes higher demands on the conveyor belts. The capacity of the infrastructure is not high enough in many cases to cope with these quantities. In addition to organisational solutions investigation of the conveyor system to determine optimum or maximum utilisation of capacity is necessary. This has been done at the Prosper-Haniel mine with offline and online simulation systems for several years. The contribution includes further development of mass flow measurement, the newly used volumetric flow measuring system and thus the possibility of direct determination of the dirt content in the material conveyed from the workings. In conjunction with the face data direct determination of the quantity of dirt cut with the coal is possible. (orig.)

  15. Advantages for nitrocarburizing processes with post oxidation in continuous furnaces; Anlagen und verfahrenstechnische Vorteile beim Nitrocarburieren mit Nachoxydieren in kontinuierlichen Ofenanlagen

    Energy Technology Data Exchange (ETDEWEB)

    Irretier, Olaf [Industrieberatung fuer Waermebehandlungstechnik IBW Dr. Irretier, Kleve (Germany); Salerno, David [Safed Suisse, Delemont (Switzerland)

    2011-06-15

    The present contribution shows the possibilities and test results of the new developed nitrocarburizing process called Oxycad NT {sup registered}. It could be shown, that this process is very suitable for bulk materials which have to be heat treated in conveyor belt furnaces for an optimum wear and corrosion resistance. (orig.)

  16. Heat transfer and pressure drop during flow boiling of R407C; Waermeuebergang und Druckverlust beim Stroemungssieden von R407C

    Energy Technology Data Exchange (ETDEWEB)

    Rollmann, Philipp; Spindler, Klaus [Stuttgart Univ. (DE). Inst. fuer Thermodynamik und Waermetechnik (ITW)

    2011-10-15

    The heat transfer and pressure drop during flow boiling of R407C in a horizontal microfin tube have been investigated. The measured heat transfer coefficient is compared with the correlations of Liu and Winterton as well as Cavallini et al. The measured pressure drop is compared with the correlations of Kuo and Wang as well as Mueller-Steinhagen and Heck. (orig.)

  17. On the heat transfer in the pool boiling at tightly finned steel tubes; Zum Waermeuebergang beim Behaeltersieden an eng berippten Stahlrohren

    Energy Technology Data Exchange (ETDEWEB)

    Bujok, Patrick; Wang, Yabai; Luke, Andrea [Kassel Univ. (Germany). Lehrstuhl fuer Technische Thermodynamik

    2012-07-01

    Process-integrated energy efficiency in power plants and process plants can only be achieved with new innovative apparatus concepts. There exist no sufficient reference applications, no data to assist in interpretation a well as no certificates of operational safety for these apparatus concepts. Thus, these concepts are not applied despite of the significant energetic advantages. Under this aspect, industrial companies (plant fabricators, plant operators and engineering offices) and five universities have affiliated to a multi-institutional project in order to explore unused opportunities on the integration of heat. The Department of Technical Thermodynamics at the University of Kassel (Federal Republic of Germany) regards to apparatuses which effectively and securely transfer a heat flow at especially low differences of temperatures between the heat dissipating and heat absorbing side of an evaporator with structured ducts. It has been known for many decades that ribbed structures are one of the most efficient methods to transfer heat. Ribbed ducts in heat exchangers are used in the refrigeration technology as well as in the technology of air conditioning. Nevertheless, plain tubes still are the technical standard in the chemical and process industry. The objective of this research project consists of a presentation of macrostructures and microstructures which can be produced efficiently with regard to the heat transfer, at a relatively low cost as well as in large quantities with a consistent structure. Furthermore, a substantial database for the design of evaporators with such surface textures is set up. Thus, evaporators being produced by the project partner Wieland-Werke AG (Ulm, Federal Republic of Germany) were investigated on a laboratory scale as well as in small tube bundles. Subsequently, selected structures were applied in the technical centre of the project partner Linde AG (Pullach, Federal Republic of Germany) in order to validate the transferability from the laboratory scale (single tube, mini-bundle) to the technical scales. On this occasion, the authors investigate the impact of tightly finned steel tubes with trapezoidal cross-sectional ribs on the heat transfer during the boiling in case of free convection over a wide range of pressures from the beginning up to the fully developed nucleate boiling. Hydrocarbons such as n-pentane and i-octane as a natural refrigerant in the process industry are used as a boiling fluid. The results of the investigations at an electrically heated and horizontally placed test tube consisting of structural steel are compared with correlations from the literature. First results from a mixture of both hydrocarbons show that the heat transfer deteriorates if only a little amount of the heavier boiling component is added.

  18. The effect of bonus/malus systems on the sales of new vehicles; Wirkung von Bonus-Malus-Systemen beim Neuwagenkauf

    Energy Technology Data Exchange (ETDEWEB)

    Haan, P. de

    2008-07-01

    This presentation made at the Swiss 2008 research conference on traffic by Peter de Haan from the Institute for Environmental Decisions at the Swiss Federal Institute of Technology ETH in Zurich takes a look at the effects of bonus/malus systems on the sales of new vehicles. The author notes that in spite of technological progress made, increasing car size, weight and mileage along with increased motor power has eaten up two-thirds of energy-efficiency progress made. The effect of the long lifetime of modern vehicles is commented on. The results of a survey made are presented and discussed, as are the results of simulations. Further aspects discussed include effects on the motor trade and road safety and the indirect effects of bonuses. Finally, trends in the area are noted.

  19. Specifications for refrigerating transport. More rigid temperature specifications for cooling transport; Anforderungen im Transportkaeltebereich. Erhoehte Anforderungen beim Kuehltransport wegen verschaerfter Temperaturvorschriften

    Energy Technology Data Exchange (ETDEWEB)

    Grosskopf, P [Frigoblock Grosskopf GmbH, Essen (Germany)

    2002-09-01

    The recommendations of the Federal Institute of Consumer Health Protection and Veterinary Medicine (Bundesinstitut fuer gesundheitlichen Verbraucherschutz und Veterinaermedizin, BgVV), which sums up all German and European temperature specifications for fresh and refrigerated products, as well as the new Ordinance on Refrigerated food (Verordnung ueber tiefgefrorene Lebensmittel, TLMV) and the new German Ordinance on Food Hygiene (Lebensmittelhygieneverordnjung,LMHV) including temperature monitoring specifications according to HACCP, induced these associations to draw up practical recommendations and guidelines for their members. [German] Die Temperaturempfehlungen des Bundesinstituts fuer gesundheitlichen Verbraucherschutz und Veterinaermedizin (BgVV), die alle deutschen und europaeischen Temperaturvorschriften fuer Frisch- und Tiefkuehlprodukte zusammenfassen sowie die Neufassung der Verordnung ueber tiefgefrorene Lebensmittel (TLMV) und die neue bundeseinheitliche Lebensmittelhygiene-Verordnung (LMHV) inkl. der Temperaturueberwachungsvorschriften gemaess HACCP, haben die betroffenen Verbaende veranlasst, entsprechende Praxisempfehlungen und Leitlinien fuer ihre Mitglieder zu erarbeiten. (orig.)

  20. Transformation behaviour and residual stresses in welding of new LTT filler materials; Umwandlungsverhalten und Eigenspannungen beim Schweissen neuartiger LTT-Zusatzwerkstoffe

    Energy Technology Data Exchange (ETDEWEB)

    Kromm, Arne

    2011-07-06

    It has long been recognized that phase transformation plays a prominent part in the evolution of welding residual stresses in high-strength steel. But thus far, no approaches have been available to practically utilize this effect for welding residual stress control. Innovative Low Transformation Temperature (LTT) alloys featuring a characteristic chemical composition open up the possibility for joining high strength steels on their own strength level. Furthermore, martensitic phase transformation is supposed to permit deliberate adjustment of the welding residual stresses. Even though numerous investigations can be found in the literature on this issue, they provide only little insight into the interaction between phase transformation and resulting welding residual stresses. In order to clarify the problem presented, a matrix of LTT alloys was defined based on evaluated literature. The alloys were characterized with respect to their microstructure, mechanical properties and transformation temperature. Furthermore, it was possible within the scope of this study to realize in-situ experiments during welding using energy-dispersive diffraction methods. The new design and implementation of a welding setup specifically for use at synchrotron beamlines enabled the in-situ diffraction analysis of transformation processes. In the course of these experiments it could be managed to determine the transformation temperatures prevailing in the LTT weld metal. In addition the transformation kinetics of these alloys could be analyzed. The effects of the transformation behavior were analyzed based on the residual stress distributions at the surface of varying specimen geometries. The results illustrate on the one hand that the desired residual stress control by using LTT alloys is actually feasible. This is particularly found in cases with largely free shrinkage of the weld. With increasing shrinkage restraint, however, a shift of the residual stress level into the area of tension is seen to occur. This is observed for the considered alloys to be particularly pronounced in transverse direction of the weld. By contrast, the residual stress level in longitudinal weld direction is nearly independent of the shrinkage conditions. With the help of residual stress depth gradients it could be established that the additional shrinkage restraint manifests itself in a parallel shift of the residual stress level in the weld metal. Application of energy-dispersive diffraction methods additionally allowed it for the first time to determine residual stresses in the austenitic phase of the LTT alloy which is present parallel to martensite. Results gained under laboratory conditions mostly need to be verified under real fabrication conditions. For this purpose, a component weld test was performed in a special large-scale testing facility. Under structural shrinkage restraint, the load relieving effect of a specific LTT welding filler material could be proven by means of a pronounced stress reduction duringwelding. Overall, evidence was furnished that the concept of Low Transformation Temperature (LTT)alloys is successful and that the proven austenite-martensite transformation exerts a significanteffect on the residual stress level. [German] Die Erkenntnis, dass die Phasenumwandlung bei der Schweisseigenspannungsentstehung hochfester Staehle eine bedeutende Rolle spielt, gibt es bereits seit langer Zeit. Bisher existierten jedoch keine Ansaetze, diesen Effekt praktisch zur Schweisseigenspannungskontrolle zu nutzen. Neuartige Low Transformation Temperature (LTT) Legierungen bieten aufgrund ihrer charakteristischen chemischen Zusammensetzung die Moeglichkeit, hochfeste Staehle auf deren Festigkeitsniveau zu fuegen. Die martensitische Phasenumwandlung soll zudem eine gezielte Einstellung der Schweisseigenspannungen erlauben. Die im Schrifttum vorliegenden Untersuchungen zu diesem Thema sind zwar zahlreich, bieten jedoch nur wenige Erkenntnisse zur Wechselwirkung zwischen der Phasenumwandlung und den resultierenden Schweisseigenspannungen. Zur Klaerung dieser Fragestellung wurde basierend auf Literaturauswertungen eine Matrix von LTT-Legierungen verwirklicht, welche hinsichtlich des Gefueges, der mechanischen Eigenschaften und der Umwandlungstemperaturen charakterisiert wurden. Weiterhin konnten im Rahmen dieser Arbeit erstmals In-situ-Beugungsexperimente waehrend des Schweissens unter Anwendung energiedispersiver Methoden realisiert werden. Die Neukonzeption und Verwirklichung einer Schweissvorrichtung speziell fuer den Einsatz an Synchrotronstrahllinien ermoeglichte die bislang einzigartige In-situ-Analyse der Umwandlungsvorgaenge waehrend des Schweissens mit LTT-Legierungen. Im Zuge dieser Experimente konnte neben den im Schweissgut vorherrschenden Umwandlungstemperaturen zusaetzlich die Umwandlungskinetik dieser Legierungen ermittelt werden. Die Auswirkungen des Umwandlungsverhaltens wurden anhand der Eigenspannungsverteilungen in der Oberflaeche variierender Probengeometrien analysiert. Die Ergebnisse verdeutlichen einerseits, dass die mittels der LTT-Legierungen angestrebte Eigenspannungskontrolle tatsaechlich moeglich ist. Dies zeigt sich insbesondere dann, wenn eine weitgehend freie Schrumpfung der Naht vorliegt. Mit zunehmender Schrumpfbehinderung ergibt sich jedoch eine Verschiebung des Eigenspannungsniveaus in den Zugbereich. Dies ist bei den hier betrachteten Legierungen vornehmlich in Nahtquerrichtung ausgepraegt. Dagegen ist das Eigenspannungsniveau in Nahtlaengsrichtung nahezu unabhaengig von den Schrumpfbedingungen. Anhand von Eigenspannungstiefengradienten liess sich feststellen, dass sich die zusaetzliche Schrumpfbehinderung in einer Parallelverschiebung des Eigenspannungsniveaus im Schweissgut aeussert. Die Anwendung energiedispersiver Beugungsmethoden erlaubte zudem erstmals die Eigenspannungsermittlung in der parallel zum Martensit vorliegenden austenitischen Phase der LTT- Legierungen. Ergebnisse, die unter Laborbedingungen gewonnen werden, beduerfen zumeist der Ueberpruefung unter realen Fertigungsbedingungen. Zu diesem Zweck wurde ein Bauteilschweissversuch in einer speziellen Grosspruefanalage durchgefuehrt. Unter konstruktiver Schrumpfbehinderung gelang es, die lastabbauende Wirkung eines spezifischen LTT-Schweisszusatzes anhand einer ausgepraegten Spannungsreduktion waehrend des Schweissens zu belegen. Insgesamt wurde der Nachweis erbracht, dass das Konzept der Low Transformation Temperature (LTT) Legierungen zielfuehrend ist und die nachgewiesene Austenit-Martensitumwandlung einen signifikanten Effekt auf das Eigenspannungsniveau ausuebt.

  1. Ressourceneffizienz durch Digitalisierung: Vortrag gehalten beim Runden Tisch "Nachhaltige Digitalisierung", Digitalisierung als Motor der Nachhaltigkeit, 15. März 2017, Stuttgart

    OpenAIRE

    Sauer, Alexander

    2017-01-01

    Der Vortrag "Ressourceneffizienz durch Digitalisierung" behandelt folgende Themenkomplexe: - DigitalisierungalsInnovationstreiber - Geschäftsmodell-Innovation - Ressourceneffiziente Produktion - Expertensicht auf Unternehmenspotenziale durch Industrie 4.0

  2. [Kombinierte Anwendung von Strahlentherapie und adjuvanter Therapie mit einem Mistelextrakt (Viscum album L.) zur Behandlung des oralen malignen Melanoms beim Hund: Eine retrospektive Studie].

    Science.gov (United States)

    von Bodungen, Uta; Ruess, Katja; Reif, Marcus; Biegel, Ulrike

    2017-01-01

    Hintergrund: Orale maligne Melanome (OMM) des Hundes zeichnen sich durch schnelles Wachstum, lokale Invasion und hohe Metastasierungsraten aus. Extrakte auf Basis von Viscum album L. (VAE) werden zunehmend in der Krebstherapie sowohl in der Human- als auch in der Veterinärmedizin eingesetzt. Ziel unserer Studie war es zu untersuchen, inwieweit die adjuvante Therapie mit VAE eine therapeutische Option zur Behandlung von OMM ist. Besonderes Augenmerk galt dabei der Überlebenszeit und möglichen Nebenwirkungen. Tiere und Methoden: 26 Hunde mit OMM, die in einem der größten veterinäronkologischen Zentren der Schweiz allesamt eine Strahlentherapie erhielten (teilweise nach operativer Tumorresektion) wurden in die retrospektive Studie eingeschlossen: 18 Hunde wurden mit VAE behandelt (1 ml VAE (Iscador®) in ansteigenden Konzentrationen von 0,1 bis 20 mg/ml subkutan 3-mal pro Woche (VAE-Gruppe), 8 erhielten keine adjuvante Behandlung (Vergleichsgruppe). Wir verglichen die Größenentwicklung der OMM sowie die Überlebenszeit. Ergebnisse: Patienten mit Bestrahlung und adjuvanter VAE-Therapie zeigten mit 236 Tagen eine signifikant längere mediane Überlebenszeit im Vergleich zu Patienten mit Bestrahlung, aber ohne adjuvante VAE-Therapie (49 Tage; Log-Rank-Test: p = 0,0047). Die VAE-Therapie verlängerte die Überlebenszeit um mehr als zwei Drittel (Hazard Ratio (HR) = 0,30, 95%-Konfidenzintervall (KI) 0,11-0,86; p = 0,024), während ein höheres Tumorstadium gemäß UICC (Union internationale contre le cancer) einen statistischen Trend zur Verdopplung des Sterberisikos zeigte (UICC-Stadium III/IV vs. I/II: HR = 2,12, 95%-KI 0,88-5,12; p = 0,095). Zwei Patienten zeigten milde Nebenwirkungen während der VAE-Behandlung. Einer der beiden zeigte 1 Tag lang ein selbstlimitiertes Fieber, bei dem anderen Patienten reduzierten wir die Dosis von einem konzentrierteren zu einem weniger konzentrierten VAE (Serie 0) aufgrund von Müdigkeit, die daraufhin verschwand. Schlussfolgerungen: VAE ist eine sichere, nebenwirkungsarme Behandlung und scheint sich positiv auf die Überlebenszeit von Hunden mit OMM auszuwirken. Somit ist dieser therapeutische Ansatz es wert, vermehrt bei der adjuvant zur Strahlentherapie eingesetzten Behandlung des OMM in Betracht gezogen zu werden. Die verglichenen Gruppen waren jedoch klein, divers und nicht konsistent hinsichtlich aller prognostischen Parameter. Eine prospektive Studie mit einer größeren Studienpopulation wäre daher von Interesse. © 2017 S. Karger GmbH, Freiburg.

  3. Thermodynamic potential of the spray-guided combustion system for gasoline engines at Mercedes-Benz; Thermodynamisches Potenzial beim strahlgefuehrten Brennverfahren fuer Ottomotoren bei Mercedes-Benz

    Energy Technology Data Exchange (ETDEWEB)

    Schaupp, U.; Bertsch, D.; Schaub, R.; Schmolla, W.; Winter, H. [DaimlerChrysler AG (Germany)

    2007-07-01

    From the beginning of the nineteen's the development of DI engines for reducing fuel consumption was reinforced. The focus in studies by Mercedes-Benz was located in the development of a robust stratified operation mode (leaner than stoichiometric {lambda}>>1). To reach the targets the spray guided Mercedes-Benz combustion system with Piezo injection technology was developed and went into series production in the CLS 350 CGI in 2006. Main focus of the development was the control of the spray guided combustion system under mass production requirements by keeping-up the consumption- and emission-potentials. The advantage in fuel consumption in the NEDC of the CLS 350 CGI is 10% in comparison to the basic PFI technology. Besides the optimization of the injection system and the combustion chamber geometry a new ignition system offers an additional option for a further increase of the combustion efficiency. This article describes how this new ignition system can be used advantageously, how to get a bigger robustness window and how to open up additional reduction of fuel consumption and better untreated emissions. (orig.)

  4. Multislice helical CT (MSCT) for mid-facial trauma: optimization of parameters for scanning and reconstruction; Mehrschicht-Spiral-CT (MSCT) beim Mittelgesichtstrauma: Optimierung der Aufnahme- und Rekonstruktionsparameter

    Energy Technology Data Exchange (ETDEWEB)

    Dammert, S.; Funke, M.; Obernauer, S.; Grabbe, E. [Abt. Roentgendiagnostik I, Georg-August-Univ. Goettingen (Germany); Merten, H.A. [Abt. fuer Mund-, Kiefer- und Gesichtschirurgie, Georg-August-Univ. Goettingen (Germany)

    2002-07-01

    Purpose: To determine the optimal scan parameters in multislice helical CT (MSCT) of the facial bone complex for both axial scanning and multiplanar reconstructions. Material and Methods: An anthropomorphic skull phantom was examined with a MSCT. Axial scans were performed with continuously increasing collimations (4 x 1.25 - 4 x 2.5 mm), tube current (20 - 200 mA) and table speeds (3.75 mm/rot. and 7.5 mm/rot.). Multiplanar reconstructions in coronal and parasagittal planes with different reconstruction increment and slice thickness were evaluated in terms of image noise, contour artifacts and visualisation of anatomical structures. Results: The best image quality was obtained with a collimation of 4 x 1.25 mm and a - table speed of 3.75 mm/rot. A reconstruction increment of 0.6 mm achieved the best time to image quality relation. With these parameters the bone structures were depicted in an optimal way without artifacts. The tube current could be reduced to 50 mA without significant loss of image quality. The optimized protocol was used for regular routine examinations in patients with facial trauma (n = 66). Conclusions: Low-dose MSCT using thin collimation, low table speed and small reconstruction increments provides excellent data for both axial images and multiplanar reconstructions in patients with facial trauma. An additional examination in coronal orientation is therefore no longer necessary. (orig.) [German] Zielsetzung: Verbesserung der Aufnahme- und Rekonstruktionsparameter in der Mehrschicht Spiral-CT (MSCT) zur Untersuchung des knoechernen Mittelgesichtes in verschiedenen Ebenen. Material und Methode: Ein anthropomorphes Schaedel-Phantom wurde in axialer Schichtfuehrung mit einem MSCT untersucht, wobei die Kollimation (1,25 - 2,5 mm), der Tischvorschubfaktor (Pitch 3 - 6) und der Roehrenstrom (20 - 200 mA) systematisch variiert wurden. Aus den Volumendatensaetzen wurden jeweils koronare und parasagittale Sekundaerreformationen mit unterschiedlichen Rekonstruktionsinkrementen und Schichtdicken erstellt. Anhand einer fuenfstufigen Bewertungsskala wurden die einzelnen Bildsaetze in Hinblick auf die Bildqualitaet und die diagnostische Aussagekraft beurteilt. Ergebnisse: Die beste Bildqualitaet in allen Orientierungen wurde mit einer Kollimation von 1,25 mm und einem Pitch von 3 erzielt. Dabei erwies sich ein Rekonstruktionsinkrement von 0,6 mm als guenstig. Alle knoechernen Strukturen konnten scharf und frei von Stufenartefakten dargestellt werden. Der Roehrenstrom liess sich ohne relevante Einschraenkung der Aussagekraft durch erhoehtes Bildrauschen auf 50 mA reduzieren. Mit diesen Parametern wurde ein Patientenkollektiv mit Mittelgesichtsverletzungen routinemaessig untersucht (n = 66). Schlussfolgerungen: Die MSCT mit multiplanaren Rekonstruktionen erlaubt unter Verwendung einer engen Kollimation, eines relativ niedrigen Pitch und eines drastisch reduzierten Roehrenstroms eine exzellente Darstellung aller knoechernen Mittelgesichtsstrukturen. Eine zweite Untersuchungsserie in koronarer Orientierung ist daher nicht mehr erforderlich. (orig.)

  5. Additive Fertigungsverfahren mit Praxisbeispielen: Vortrag gehalten beim Praxisforum 3D-Druck, 3D-Druck in Produktentwicklung und Fertigung - Anwendungen und Potenziale, 24.03.15, Landshut

    OpenAIRE

    Seidel, Christian

    2015-01-01

    Für die Additive Fertigung von Metallen und Kunststoffen gibt es verschiedenen Methoden und Funktionsprinzipien. Die Potenziale liegen unter anderem in der Formgebungsfreiheit, der Ressourceneffizienz und der Personalisierung. In den nächsten Jahren ist mit einem weiteren Rückgang der Kosten pro hergestelltem Volumen zu rechnen. Mit Hilfe der Bionik wird die Natur als Vorbild abstrahiert und findet Einsatz bei technischen Anwendungen. Als Beispiele für Additive Fertigungsverfahren sind der fu...

  6. Reduction of CO2 emissions during cement clinker burning : Part 2 = Ein Beitrag zur Reduzierung der CO2-Emissionen beim Zementklinkerbrand; Teil 2

    NARCIS (Netherlands)

    Vogel, S.; Kolditz, K.; Beilmann, F.; Finger, F.A.; Ott-Reinhardt, D.; Kralisch, D.

    2013-01-01

    The aim of the research project entitled "New technology in cement production for reducing CO2 emissions" sponsored by the German Federal Environmental Foundation was to lower the CO2 emissions during clinker burning. A possible reduction, relative to an industrial example, of up to 21 % in the

  7. Reduction of CO2 emissions during cement clinker burning; part 1 = Ein Beitrag zur Reduzierung der CO2-Emissionen beim Zementklinkerbrand; Teil 1

    NARCIS (Netherlands)

    Vogel, S.; Kolditz, K.; Bellmann, F.; Ott-Reinhardt, D.; Kralisch, D.

    2013-01-01

    The aim of the research project entitled "New technology in cement production for reducing CO2 emissions" sponsored by the German Federal Environmental Foundation was to lower the CO2 emissions during clinker burning. A possible reduction, relative to an industrial example, of up to 21 % in the

  8. TAMR effect in the tunneling through monocrystalline GaAs barriers; TAMR-Effekt beim Tunneln durch einkristalline GaAs-Barrieren

    Energy Technology Data Exchange (ETDEWEB)

    Lobenhofer, Michael

    2013-01-28

    Within the scope of this thesis the TAMR-effect in magnetic tunnel junctions with a single-crystalline GaAs-barrier was investigated. As ferromagnetic electrodes Fe-, FeCo- and FePt-layers were used. The measured TAMR-effect was investigated with respect to its behaviour towards changes in external Parameters, like the applied voltage, the temperature and the external magnetic field. The physical origin of the effect was attributed to the interaction of Rashba- and Dresselhaus-Spin-Orbit-coupling inside the tunnelling barrier and at the metal/semiconductor-interfaces.

  9. A rare combination of findings revealed by MR imaging in the Marfan syndrome; Seltene Befundkonstellation beim Marfan-Syndrom im MR-Tomogramm

    Energy Technology Data Exchange (ETDEWEB)

    Kleimaker, G [Abt. fuer Nuklearmedizin und Spezielle Biophysik, Medizinische Hochschule Hannover (Germany); Ehrenheim, C [Abt. fuer Nuklearmedizin und Spezielle Biophysik, Medizinische Hochschule Hannover (Germany); Rittierodt, M [Abt. Neurochirurgie, Medizinische Hochschule Hannover (Germany); Jaster, S [Abt. Neurochirurgie, Medizinische Hochschule Hannover (Germany); Hundeshagen, H [Abt. fuer Nuklearmedizin und Spezielle Biophysik, Medizinische Hochschule Hannover (Germany)

    1996-08-01

    We report on the case of a 16-year-old boy known to have suffered form the Marfan syndrome for the past ten years. Even though he could not be regarded as a text-book perfect example, he showed some rare manifestations of the disease. Particular attention is given to the diagnostic possibilities offered by MR imaging. (orig./MG) [Deutsch] Wir berichten ueber den Fall eines 16jaehrigen Jungen mit einem seit etwa 10 Jahren bekannten Marfan-Syndrom, der zwar nicht das typisches Vollbild, jedoch einige seltene Auspraegungen dieses Krankheitsbildes aufweist. Die kernspintomographische Diagnostik findet besondere Beruecksichtung. (orig./MG)

  10. Bone scintigraphy compared to MRI and ultrasound in the early diagnosis of arthritis; Skelettszintigraphie im Vergleich mit MRT und Sonographie beim Fruehnachweis der Arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Sandrock, D. [Klinikum Chemnitz gGmbH, Klinik fuer Nuklearmedizin, Chemnitz (Germany)

    2006-12-15

    Chronic inflammatory arthritis is recognized specifically by bone erosions, caused by characteristic pannus tissue. In the finger joints dynamic low-Tesla MRI is nearly double but not completely sensitive in the detection of erosions than conventional radiography, sonography takes an intermediate position. Less specific signs of synovitis and tenosynovitis are shown with high sensitivity by both 3(2)-phase bone scintigraphy and ultrasound, MRI is less sensitive in this respect. However, standard situation of inflammation in bone scintigraphy - positive finding in early as well as late phase - is of surprisingly low sensitivity, any singular finding in the early or late phase has to be regarded as positive. Specificity of these singular findings is nevertheless sufficiently high, acute inflammatory joint changes and even erosions are also seen with MRI in obviously healthy persons. Only 2-phase bone scintigraphy is easily able to present a simultaneous survey of all joints of the body. For this reason 2-phase bone scintigraphy is most suitable for exclusion but also for primary diagnosis of disease, specification must be done afterwards by other imaging modalities or by laboratory findings. (orig.)

  11. Measures to comply with future particulate number standards with GDI engines; Massnahmen zum Erreichen zukuenftiger Grenzwerte fuer Partikelanzahl beim direkteinspritzenden Ottomotor

    Energy Technology Data Exchange (ETDEWEB)

    Dobes, Thomas; Fraidl, Guenter K.; Hollerer, Peter; Kapus, Paul E.; Ogris, Martin; Riener, Markus [AVL List GmbH, Graz (Austria)

    2011-07-01

    With the ongoing general discussion on fine particulates, also the particulates of Gasoline engines are now a focus of public interest. Compared to conventional Diesel engine, where due to the heterogeneous combustion, a certain amount of particles cannot be avoided; Gasoline engines a substantial reduction of particle number towards a level that does not compromise environmental aspects can be expected even without particle filter, however, with respective high development effort. Certainly the particle number emission is the most complex emission component with Gasoline engines both with regard to measurement technology, conditioning, reproducibility, tolerance sensitivity, long term stability, and OBD as well as development methodology. Thus a comprehensive development methodology - ranging from the detail optimization of individual injection parameters to mastering oil consumption and deposit formation over the whole vehicle lifetime, is most essential for an effective reduction of particle emission. Within this complex subject, the particulate counter itself proves to be uncritical whereas the sufficient conditioning of engine and vehicle and dilution tunnel, comprehensive base investigations have to be performed. All the established know how already generated for gaseous emission components is not sufficient to handle the particulate number issue properly. In spite of the fact, that very low particle numbers can be shown with single prototype vehicles, a reliable transfer into robust production solutions, comprehensive basic investigations especially with regard to tolerance sensitivity and robustness against fuel quality impacts and deposit formation have to be performed. Both for these open issues as well as for robust OBD solutions, actual field experience with a first generation of low particle engines is required. Thus, when introducing enhanced particle limits, the respective increased development durations and significantly enhanced efforts both for the development, calibration and validation have to be considered. (orig.)

  12. Survival advantage by neoadjuvant radiochemotherapy in locally advanced non-inflammatory breast cancer; Ueberlebensvorteil durch praeoperative Radiochemotherapie beim lokal fortgeschrittenen, nicht-inflammatorischen Brustkrebs

    Energy Technology Data Exchange (ETDEWEB)

    Lang, Innokenti

    2011-07-01

    This study compares retrospectively, in terms of pathological complete response (pCR) and ten year survival rate, preoperative radiochemotherapy (RCT) with postoperative RCT for locally advanced or surgically in terms of breast conserving surgery or simple mastectomy unfavourable, non inflammatory breast cancers (LABC).

  13. Multiple utilization of energy in buildings. Utilization of waste heat at the Blood Transfusion Service; Energie im Gebaeude mehrfach nutzen. Abwaermenutzung beim Blutspendedienst Nord

    Energy Technology Data Exchange (ETDEWEB)

    Gaigalat, Jens

    2012-11-01

    For the Blood Transfusion Service North the German Red Cross (Berlin, Federal Republic of Germany) utilizes the waste heat from production facilities and laboratories for heating offices. By doing this, the VRV technology for the realization of this solution was used.

  14. Education and research when dismantling nuclear plants at the Technical University Dresden; Lehre und Forschung beim Rueckbau kerntechnischer Anlagen an der Technischen Universitaet Dresden

    Energy Technology Data Exchange (ETDEWEB)

    Hurtado, A.; Anthofer, A.; Cloppenborg, T.; Schreier, M. [Technische Univ. Dresden (Germany). Inst. fuer Energietechnik

    2013-08-15

    With the decision by the German government in 2011 to revoke the operating permission from 8 of the existing 17 German nuclear power plants, the responsibility of decommissioning and dismantling these plants has moved back into the focus of public awareness. Under the current legal conditions, the last nuclear plant will be disconnected from the grid on 31.12.2022 and this will create an enormous challenge for all the involved approving authorities, expert organisations, as well as companies involved in dismantling the plants. The development of new and efficient dismantling technologies and strategies is required to perform these highly responsible tasks. On the other hand, the nuclear competence and knowhow, as well as the promotion of young talents in the relevant scientific fields must be preserved. Technological and economic solutions are in demand for the various plants due to the different specifics of nuclear power plants. This will still require e.g. in the field of radiation protection highly qualified and well trained staff in future. The training of these skilled employees will require expanding the subject matter taught at universities, colleges and polytechnics to suit the changed parameters. The chair for hydrogen and nuclear energy technology at the TU Dresden will in future offer lectures as part of a new teaching discipline with the focus on dismantling and disposal. The course 'Dismantling nuclear power plants' took place for the first time in the summer semester 2013. It is organised as a three-day block seminar with an excursion to the company NIS Ingenieurgesellschaft mbH in Alzenau. The company NIS is a subsidiary of the Siempelkamp Nukleartechnik GmbH. This article intends to provide an overview of the contents of the courses and the impressions of the participants. In this way the TU Dresden is making a further contribution to preserving nuclear competence and inter-disciplinary dialogue. (orig.)

  15. Pharmacokinetic analysis of Gd-DTPA enhancement in dynamic MR of breast carcinoma. Pharmakokinetische Analyse der Gd-DTPA-Anreicherung in der MRT beim Mammakarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Hess, T. (Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie); Knopp, M.V. (Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie); Hoffmann, U. (Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie); Brix, G. (Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie); Junkermann, H. (Heidelberg Univ. (Germany). Abteilung fuer Gynaekologische Radiologie); Zuna, I. (Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie); Fournier, D. von (Heidelberg Univ. (Germany). Abteilung fuer Gynaekologische Radiologie); Kaick, G. van (Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie)

    1994-06-01

    Dynamic Gd-DTPA enhanced MR of the breast was performed in one single slice in 27 patients with suspicious nodular lesions. The results could be histologically verified in all cases. A rapid spin-echo sequence with a time resolution of 8.75 s was used for the dynamic examination. The signal changes were analysed using a pharmacokinetic model which allowed parametrization of the contrast enhancement and transformation of the data into colour coded parameter images. The parameters allowed reliable distinction of 9 benign from 18 malignant lesions (p<0.05 for ''amplitude'', p<0.001 for ''k[sub 21]''). One fibroadenoma could not be distinguished from the carcinomas. Lymph node metastases and the pharmacokinetic parameter amplitude correlated significantly (p<0.05). (orig.)

  16. Queer worldings in the urban age. Die sub\\urban Journal Lecture beim Deutschen Kongress für Geographie im Oktober 2015 in Berlin

    Directory of Open Access Journals (Sweden)

    Natalie Oswin

    2015-11-01

    Full Text Available Der Beitrag stellt die Frage, in welchem Bezug die vieldiskutierte globale Urbanisierung, die sich in den vergangenen Jahrzehnten besonders im Globalen Süden weiter beschleunigt hat, mit einer ebenfalls zu beobachtenden verstärkten Thematisierung sexueller und geschlechtlicher Identitäten weltweit steht. Denn Kämpfe um Sichtbarkeit, Anerkennung und nicht-normative Lebensweisen artikulieren sich gerade in städtischen Kontexten mit besonderer Virulenz. Ein bislang weitgehend vernachlässigtes Potenzial wird dabei in Überschneidungen von Kritiken tradierter eurozentrischer Stadtkonzepte in den Urban Studies einerseits und der Infragestellung sexueller und geschlechtlicher – und ebenfalls oft an westlichen Standards orientierter – Normen in den Queer Studies andererseits gesehen. Sowohl Urban Studies als auch Queer Studies treiben ein worlding, eine Verweltlichung der untersuchten Probleme voran. Die Fragestellungen, die aus einer Zusammenführung von urban worlding und queer worlding entstehen, ermöglichen neue Blicke auf die Rolle, die gerade marginalisierte Subjekte in Prozessen von Urbanisierung und Globalisierung spielen.

  17. Dynamic MR-mammography in invasive lobular breast cancer; Dynamische MR-Mammographie beim invasiv lobulaeren Mammakarzinom bei 1,0 T

    Energy Technology Data Exchange (ETDEWEB)

    Sittek, H.; Perlet, C.; Kessler, M.; Reiser, M. [Institut fuer Radiologische Diagnostik, Klinikum Grossenhadern, Ludwig-Maximilians-Univ., Muenchen (Germany); Untch, M. [Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Klinikum Grossenhadern, Ludwig-Maximilians-Univ., Muenchen (Germany)

    1998-12-31

    Material and Methods: We carried out 1505 MR mammographoes in 1357 patients. Biopsy was indicated in 413 cases. Among the malignancies, 23/214 (10%) were ILC. MR-M was performed with a 1.0 T whole body MRI system with a dynamic FLASH-3D sequence. Relative signal enhancement within lesions detected and morphologic pattern of contrast enhancement (mep) were determined. Three types of mep were distinguished: type 1 without contrast enhancement, type 2 with focal contrast enhancement, and type 3 with diffuse contrast enhancement of the glandular body. Results: Within MR-M alone, 19/23 (82.6%) of ILC were detected due to a mep type 2. Four ILC were false negative on MR-M (2 cases show mep type 1 or mep type 3). The sensitivity of Mx alone was 86.9% (20/23). When both Mx and MR-M were combined, all 23 ILC were detected. The addition of MR-M to Mx may increase sensitivity to about 100% in the detection of ILC. (orig.) [Deutsch] Material und Methode: Im Zeitraum 05/1993 bis 06/1996 fuehrten wir bei 1357 Patientinnen 1505 MR-Mammographien durch. In 413 Faellen wurde eine Probeexzision indiziert. Die histologische Untersuchung ergab in 214 Faellen einen malignen Tumor. Darunter befanden sich 23 ILC. Die MR-M wurden an einem 1,0 T MRT-System (Impact, Siemens, Erlangen) mit einer dynamischen FLASH 3D Sequenz durchgefuehrt. Neben dem prozentualen Anstieg der Signalintensitaet innerhalb einer Laesion haben wir fuer die Diagnostik folgende morphologische Befundmuster (BM) unterschieden: Typ 1: Keine Aufnahme, Typ 2: Fokale Aufnahme, Typ 3: Diffuse Aufnahme des Druesenkoerpers in der MR-M. Ergebnisse: Mit der MR-M konnten 19/23 (82,6%) der ILC anhand einer fokalen Zunahme der Signalintensitaet richtig positiv erkannt werden (BM Typ 2). Vier der ILC waren in der MR-M falsch negativ. In zwei Faellen (2/23) war keine Zunahme der Signalintensitaet zu verzeichnen (BM Typ 1). In zwei weiteren Faellen (2/23) maskierte eine diffuse Signalintensitaetszunahme des Druesenkoerpers (BM Typ 3) das ILC. Die Sensitivitaet der Mx lag bei 86,9% (20/23). Durch den additiven Einsatz der MR-M konnten alle 23 ILC diagnostiziert werden. (orig.)

  18. Studien zur Messung von Rekonstruktionseffizienz und Untergrund der $\\tau$-Lepton-Identifikation im Zerfall $Z\\to \\tau \\tau$ beim ATLAS-Experiment aus Daten

    CERN Document Server

    Johnert, Sebastian

    2008-01-01

    In dieser Diplomarbeit werden zwei Methoden vorgestellt, mit denen τ -Leptonen in den zuk ̈nf- u tigen Daten des ATLAS-Experiments untersucht werden sollen. Den ersten Teil bildet die Be- stimmung von Missidentifikationsraten von Jets aus QCD-2-Jet-Ereignissen als τ -Leptonen. Der zweite Teil ist die Entwicklung einer Methode zur Bestimmung der τ -Rekonstruktions- und -Identifikationseffizienz relativ zur μ-Effizienz. In diesem Zusammenhang werden invariante Massen aus Z → ll-Ereignissen bestimmt, die Massen aus Z → τ τ -Ereignissen mit denen aus Z → ee und Z → μμ verglichen, τ -Effizienzen gemittelt uber alle Bereiche und in verschiedenen ̈ o η-Bereichen berechnet sowie eine M ̈glichkeit zur Bestimmung von τ -Effizienzen in unterschied- lichen Transversalimpulsbereichen vorgestellt. Des Weiteren wird eine verbesserte Absch ̈tzung a des QCD-Untergrunds vorgenommen und das Verhalten der τ -Effizienz unter Ber ̈cksichtigung u des Triggers untersucht.

  19. Nudge-Ansätze beim nachhaltigen Konsum: Ermittlung und Entwicklung von Maßnahmen zum „Anstoßen“ nachhaltiger Konsummuster

    NARCIS (Netherlands)

    Thorun, Christian; Diels, Jana; Vetter, Max; Reisch, Lucia A.; Bernauer, Manueala; Micklitz, Hans-Wolfgang; Purnhagen, K.; Rosenow, Jan; Forster, Daniel

    2016-01-01

    This research project analyses the potential of nudges in the area of sustainable consumption focusing on ecological consumption. Nudges are regulatory instruments based on insights from psychology and behavioral economics and are applied to achieve behavior change. In the present report, the

  20. Spectroscopical plasma diagnostics for the procedure optimization in laser-beam high-speed cutting; Spektroskopische Plasmadiagnostik zur Verfahrensoptimierung beim Laserstrahl-Hochgeschwindigkeitsschneiden

    Energy Technology Data Exchange (ETDEWEB)

    Nate, M.

    2001-07-01

    In the present thesis the laser-induced plasma typical for the high- speed cutting process was studied in the region of the interaction zone. For this especially the absorption properties of the plasma for the incident laser radiation and their correlation with the maximally reachable cutting speeds. For this with methods of the spectroscopic plasma diagnostics the influence of different process parameters on the quantities characterizing the plasma, electron density and temperature, was determined. On the base of these values in the framework of an equilibrium model the densities of all particles contained in the plasma were determined. With these values the plasma absorption coefficient was subsequently calculated and the laser radiation absorbed in the plasma estimated.

  1. Investigation on working quality of laser beam cutting of composite materials. Final report. Untersuchung der Bearbeitungsgenauigkeit und Prozessfuehrung beim Laserstrahlschneiden von Verbundwerkstoffen und Werkstoffverbunden. Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Geiger, M.; Mueller, R.

    1992-01-01

    Expanded use of composite materials often requires a cutting process to reach the desired shape of the work piece. In conventional mechanical cutting technologies like milling remarcable tool wear has to be considered due to the containing glass fibers which have a tremendous abrasive effect on the tool teeth. Here the laser beam is an alternative 'tool'. With this investigations the knowledge about the parameters of laser beam cutting of composites which determine working quality was increased. Requirements for an optimal cutting process and fundamental correlations between process parameters and working quality are presented. In absence of suitable criterions to estimate the working quality of laser beam cut composite materials, a suggestion of a DIN 2310, Part 7, 'Thermal Cutting, Laser Beam Cutting of Composites' is presented. (orig.) With 69 refs., 125 figs.

  2. Using CAD/CAM-systems for process optimization during laser beam cutting and surface treatment. CAD/CAM-gestuetzte Prozessauslegung beim Laserstrahlschneiden und -oberflaechenveredeln

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, W.; Trasser, F.J.; Wetzels, W. (Fraunhofer-Inst. fuer Produktionstechnologie, IPT, Aachen (Germany))

    1991-02-01

    Using technological modules in modern CAD/CAM-systems provides an efficient use of the available know-how. On the one hand, companies can save their know-how, on the other hand they can improve manufacturing quality as well as increase the productivity. Especially laser beam cutting allows an automatic process control - orientated on geometry aspects. Similar results can be shown for laser surface treatment as well, although up to now reducing of the programming time is the main task of technological modules for this application, including special algorithms for CNC-controlled rotation/swiveling of powder-nozzles and adjustment of the powder flow rate.

  3. The bypass solution as a capacity enhancing measure in connecting biogas plants to the grid; Die Bypass-Loesung als kapazitaetserhoehende Massnahme beim Netzanschluss von Biogasanlagen

    Energy Technology Data Exchange (ETDEWEB)

    Grassmann, Nils [PwC Legal AG, Frankfurt am Main (Germany). Bereich Energierecht in der Region Sued; Reinhardt, Anja [PwC Legal AG, Muenchen (Germany)

    2012-07-01

    In spite of repeated amendments to the laws governing the connection of biogas plants to the grid there still remain unresolved disputes in practice. A significant issue in this regard concerns what is referred to as the bypass solution, where a connection to the general supply grid of the receiving grid operator is created and at the same time technical equipment is installed which provides a connection to an upstream grid to which biogas can be backfed in times of low grid load. The Upper Regional Court of Duesseldorf classifies constellations of this kind as a combined grid connection to two different grids. It argues that since the legislature has provided no regulations on this constellation there can be no legitimate right to obtaining a connection of this configuration. However, this line of argumentation does not appear compelling. The meaning and purpose of Articles 31 ff. of the Gas Network Access Ordinance and the wording of the relevant norms both speak in favour of considering bypass solutions as capacity-enhancing measures. The receiving (downstream) grid operator would then be obliged, under the general requirements, to create a grid connection and to draw the bypass solution into consideration as a special means of backfeeding. This would provide legal certainty for all involved and allow technically meaningful solutions to be implemented.

  4. CO{sub 2}-potential by usage of light materials in passenger cars; CO{sub 2}-Potenzial durch Leichtbau beim PKW

    Energy Technology Data Exchange (ETDEWEB)

    Rohde-Brandenburger, Klaus [Volkswagen AG, Wolfsburg (Germany). Abt. Fahrzeugtechnik; Obernolte, Jens [Volkswagen AG, Wolfsburg (Germany). Gesamtfahrzeug-Entwicklung fuer Fahrleistung, Verbrauch und Getriebeauslegung

    2009-07-01

    The question 'what is the effect of a weight change of 100 kg on fuel consumption in the european driving cycle NEDC?' will be answered for vehicles with gasoline and diesel engines. Therefore the mechanical energy for moving 100 kg through the NEDC is calculated. Considering the fact, that combustion engines have an almost constant efficiency for delivering difference loads in the lower speed/loadrange that are used for the NEDC, the mechanical energy is converted into fuel consumption and CO{sub 2}-emission. The maximum fuel consumption difference of 0,15 l/100 km per 100 kg can increase up to 0,4 l/100 km per 100 kg, if the transmission ratio or the engine size is adapted to constant acceleration performance. Values of about 1 l/100 km per 100 kg, that you can find in magazines or brochures of NGO's, are exposed as unrealistic. (orig.)

  5. Heat and mass transfer during the inductive skull melting process of glasses and oxides; Waerme- und Stofftransport beim induktiven Skull-Schmelzen von Glaesern und Oxiden

    Energy Technology Data Exchange (ETDEWEB)

    Nacke, Bernard; Niemann, Benjamin [Leibniz Univ. Hannover (Germany). Inst. fuer Elektroprozesstechnik; Schlesselmann, Dirk [Auer Lighting GmbH, Bad Gandersheim (Germany)

    2013-03-15

    The skull melting technology is a melting process for innovative materials in the range of glasses. A hitherto unknown problem under glass melting by means of this technology is the fact that the processes in the interior of the molten mass are still unknown. Under this aspect, the authors of the contribution under consideration present an overview of the inductive melting process for glasses in an inductor crucible developed at the Institute for Electrotechnology (Hanover, Federal Republic of Germany). A newly developed numerical model is presented in order to simulate the heat and mass transfer in a molten glass. This simulation enables a future optimization of the design of the inductor crucible and the melting process. The transient three-dimensional melting flow during the melting of glasses and oxides by means of the skull meeting process also can be simulated by the newly developed numerical model.

  6. The legal framework for data privacy and protection in smart metering and smart grids; Der Rechtsrahmen beim Datenschutz fuer Smart Metering und Smart Grids

    Energy Technology Data Exchange (ETDEWEB)

    Stamm, Markus [Alcatel-Lucent Deutschland AG, Nuernberg (Germany)

    2011-07-01

    The legal framework for data privacy and protection in Smart Meter and Smart Grid applications has been substantially changed through modifications of the German law on the supply of electricity and gas (Energiewirtschaftsgesetz - EnWG), especially through its sections 21c et seq. Nonetheless, these modifications have on partially attained the goal of the reform, to create a secure legal framework for the use of Smart Meters and Smart Grids, and some of the newly introduced regulations actually decrease the security of the framework through the use of systematically incorrect terminology. This article gives an overview of the content of the key regulations and the issues to be resolved which result from them. (orig.)

  7. Load-vs.-time functions resulting from the impact of missiles filled with a liquid; Last-Zeit-Funkionen beim Aufprall fluessigkeitsgefuellter Projektile

    Energy Technology Data Exchange (ETDEWEB)

    Bernhart, D. [Materialpruefungs- und Forschungsanstalt Karlsruhe (Germany)

    2007-10-15

    Considerations of possible external impacts on nuclear power plants require verification of the safety precautions in place. Especially the impact of large masses, such as a passenger aircraft, is a factor of major importance because of the damage potential it involves. The load impact resulting from an airplane crash was estimated already back in the 1960s. That approach, which was based on the conservation of momentum, was developed further in a modified form over the next few years. Recalculations of impact tests of a Phantom F-4 plane showed excellent agreement. The transferability to large passenger aircraft of this method of calculation has not been investigated so far. For this reason, the Institute for Solid Construction and Building Materials Technology of the University of Karlsruhe carried out small-scale tests with aluminium missiles. The geometry of the missiles and their stiffness distribution along the longitudinal axis were matched to those of a passenger aircraft. In addition, the influence of the speed of the aircraft on the force-vs.-time function, and the influence of various tank filling levels were studied. Another question to be answered is that of the influence of different angles of impact of the missiles. (orig.)

  8. Surface settlements during the tunnel drivage in loose rock. Prognosis, measurement and impact; Oberflaechensetzungen beim Tunnelvortrieb im Lockergestein. Prognose, Messung und Beeinflussung

    Energy Technology Data Exchange (ETDEWEB)

    Fillibeck, Jochen [Technische Univ. Muenchen (Germany). Zentrum fuer Geotechnik

    2012-11-01

    The realistic prediction of supplement in tunnel construction is essential to secure the acceptance of the construction measure in the population. In addition to numerical calculations particularly empirical processes are suitable whose input variables are derived from previous experiences. Empirical methods use the Gaussian function for the description of the settlement trough arising from the tunnelling at the surface. The contribution under consideration describes the method of Fillibeck allowing the determination of the input parameters for shotcrete drivages and shield drivages. This empirical method was derived from a large number of carefully selected and inspected measuring cross-sections.

  9. Localization and analysis of error sources for the numerical SIL proof; Lokalisierung und Analyse von Fehlerquellen beim numerischen SIL-Nachweis

    Energy Technology Data Exchange (ETDEWEB)

    Duepont, D.; Litz, L. [Technische Univ. Kaiserslautern (Germany). Lehrstuhl fuer Automatisierungstechnik; Netter, P. [Infraserv GmbH und Co. Hoechst KG, Frankfurt am Main (Germany)

    2008-07-01

    According to the standard IEC 61511 each safety-related loop is assigned to one of the four Safety Integrity Levels (SILs). For every safety-related loop a SIL-specific Probability of Failure on Demand (PFD) must be proven. Usually, the PFD calculation is performed based upon the failure rates of each loop component aided by commercial software tools. However, this bottom-up approach suffers from many uncertainties. Especially, a lack of reliable failure rate data causes many problems. Reference data collected in different environments are available to solve this situation. However, this pragmatism leads to a PFD bandwidth, not to a single PFD value as desired. In order to make a decision for a numerical value appropriate for the chemical and pharmaceutical process industry a data ascertainment has been initiated by the European NAMUR. Its results display large deficiencies for the bottom-up approach. The error sources leading to this situation are located and analyzed. (orig.)

  10. Clearance of radioactive materials during reactor dismantling. Permanent enclosure instead of demolition and renaturation?; Freigabe radioaktiven Materials beim AKW-Abriss. Dauerhafter Einschluss statt Rueckbau?

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-07-01

    During reactor dismantling besides high-level radioactive wastes a large amount of low-level contaminated steel and concrete has to be disposed. In case that radioactivity falls below defined dose limits (10 micro Sv/person and year) these materials may be disposed in domestic waste landfill or in municipal incineration facilities. The issue is discussed in detail including the fact that many power plants are dismantled at the same time so that the contaminated materials might accumulate. Another issue is the occupational safety of contract workers during dismantling. The permanent enclosure could avoid this environmental contamination of decommissioned power plants might also be less expensive.

  11. Retrospective study on radiotherapy efficacy in case of painful heel spur; Retrospektive Studie ueber die Wirksamkeit der Strahlentherapie beim schmerzhaftem Fersensporn

    Energy Technology Data Exchange (ETDEWEB)

    Klossok-Niethammer, Ruth Giuliana

    2011-07-01

    Objective: The effect of radiotherapy in context of a plantar fasciitis in order to reduce pain was evaluated in this retrospective study. Patients and methods: The data of 188 patients who suffered of heel spur pain and who were irradiated in the period from 1994 to 2009 were evaluated in this study. All of them had at least one follow up examination after radiatiotherapy. The mean age amounted to 57 years. 76.5% of the patients were female. All patients described a local pain which was the basis for the indication. 74.4 % of the patients described pain especially under stress. The duration of anamnesis was averaged as follows: 15 % of the patients had pain for some weeks to 3 months, 43 % for 4 to 6 months, 28% even for 7 to 12 months. The period of medical history was longer than 12 months for 12 % of the patients in this study. 122 of 188 patients received orthopedic arch support (shoe inlays) as first therapy method. Most of the patients were irradiated using regular lateral opposing fields with photons of the energy 4 MV and 6 MV of a linear accelerator, applying a total dose of 6Gy in 6 fractions to 1,0Gy twice weekly. Only one patient was irradiated using a Co{sup 60} machine. The acquisition of data regarding the effect was performed on the last day of the radiotherapy and in 3 to 6 monthly follow ups. Additionally the doctors who attended the patients beyond the radiotherapy received a special questionnaire about the pain reduction, so that the follow up data could be completed. Results: On the last day of radiotherapy 120/188 patients (63,8%)reported an improvement of pain reduction, 7/188 patients (3,7%) absence of pain. For 52/188 patients (27.6 %) pain remained constant. At the second follow up examination after in the median 100 days the effect of radiotherapy of 165 patients could be evaluated, 43/165 patients (26 %) were pain free, 79/165 patients (47,8 %) reported an obvious pain reduction, and for 33/165 patients there was no pain improvement. At the third follow up examination after in median 503 days there were data of 94 patients that could be used for our study, 22/94 patients (23,4 %) felt a pain reduction and 56/94 patients (59,5 %) were completely painless. At the fourth follow up examination after in median of 1170 days patient database included 37 statements about pain. For 4/37 patients (10,8%) there was a pain reduction and for 32/37 patients (86,4 %) an absence of pain. After in median of 1590 days the fifth follow up took place, this showed statements of 84 patients about their pain. For 72/84 patients (85,7 %) radiotherapy achieved a complete absence of pain, an obvious improvement with 9/84 patients (10,7 %). Only 3/84 patients (3,5 %) described a steady pain symptomatology. All these results for pain reduction of 182 patients were achieved nearly without side effects, only 5 patients reported a light flush in the irradiated area. Conclusion: The radiotherapy of the painful heel spur appears highly effective, long-lasting and side-effect-free regarding to pain relief. The effect occurs often several months after radiotherapy, as far as it can be evaluated in this retrospective setting based on partially incomplete follow up data. We could not identify any prognostic factors.

  12. Sentinel lymph node mapping and biopsy in breast cancer - facts and unanswered questions; Waechterlymphknotendetektion und -Biopsie beim Mammakarzinom - Fakten und unbeantwortete Fragen

    Energy Technology Data Exchange (ETDEWEB)

    Czech, N. [Klinik fuer Nuklearmedizin, Universitaetsklinikum Schleswig-Holstein, Campus Kiel (Germany)

    2006-06-15

    The concept of sentinel lymph node (SLN) biopsy in breast cancer patients is rapidly becoming the standard of care [1]. The fast assent of this technique in clinical practise is the result of multiple factors, including accuracy of the technique, decreased morbidity, and supplying the pathologist with only few nodes which allows a more focused and sensitive histopathologic evaluation. The sentinel nodes are those most likely to contain tumour cells that have spread from the tumour. Histopathological evaluation of these nodes therefore can be an accurate predictor for metastases in the respective lymph node basin and can guide regional and systemic treatment. The SLN-biopsy concerns the identification and subsequent resection of the initial lymph nodes (SLN) which are draining the primary tumour. These nodes can be identified by radioguided lymphatic mapping and/or by visualisation of the nodes with vital blue dyes. Axillary lymph node dissection (ALND) and its morbidity can be avoided in patients with negative SLN. Despite the success and acceptance of lymphatic mapping, some controversies and questions remain unanswered. In this review, some of the most relevant clinical issues will be discussed. (orig.)

  13. Emotionen und Kontrollüberzeugungen beim komplexen Problemlösen : eine experimentelle Untersuchung anhand des computersimulierten Problemlöseszenarios FSYS 2.0

    OpenAIRE

    Spering, Miriam

    2001-01-01

    Diese Studie untersucht den Einfluss positiver und negativer Emotionen auf komplexes Problemlösen unter Berücksichtigung der Kompetenz- und Kontrollüberzeugungen als Traits. 74 studentische männliche und weibliche Probanden bearbeiteten das computersimulierte Szenario FSYS 2.0 (Wagener & Conrad, 1997), anhand dessen sich Aussagen sowohl über die Problemlösegüte als auch das Problemlöseverhalten (z.B. Informationsmanagement) treffen lassen. Emotionen wurden vor Beginn des Szenarios und nach de...

  14. Ecological comparison between hydrated lime and sodium bicarbonate when used for dry flue gas purification; Oekologischer Vergleich von Kalkhydrat und Natriumbicarbonat beim Einsatz in der trockenen Rauchgasreinigung

    Energy Technology Data Exchange (ETDEWEB)

    Wecker, Andreas [Federal German Association of the Lime Industry, Koeln (Germany)

    2009-07-01

    Lime plays an important role in environmental protection. Not only due to its properties but also due to its natural occurrence, it is suitable and accepted for universal application in the environment sector. Lime and its refined products can be used in various processes to remove the acid gases, the gaseous metal compounds and organic trace constituents from the flue gas of waste incineration plants. The choice of the suitable process depends on the raw gas load, the separation efficiency to be achieved and the way of recovery of the reaction product obtained as a result of flue gas cleaning. The dry sorption processes have been established for many years and have been continuously further developed, in which lime is injected into the flue gas flow and the reaction product is retained via a filtering separator. As an alternative to lime products, it is also possible, under certain boundary conditions, to use sodium hydrogen-carbonate NaHCO{sub 3} (below called sodium bicarbonate) as a basic reaction component in the dry sorption process. As opposed to calcium hydroxide, there are differences, for example as regards the reaction temperature required and the necessary amount of sorbent to achieve the desired purification effect. (orig.)

  15. Klimaänderung und die Vorverlegung des Brutbeginns beim Kiebitz (Vanellus vanellus) : 33-jährige phänologische Beobachtungen (1976-2008)

    OpenAIRE

    Kooiker, Gerhard

    2011-01-01

    Zwischen 1976 und 2008 stieg die Jahresdurchschnittstemperatur in Osnabrück um 1,3 °C dramatisch an. Die Erwärmung beschränkte sich im Wesentlichen auf das Winterhalbjahr. In den für Kiebitze relevanten Monaten der Ankunft, Vorbrut- und Brutphase (Februar, März, April) stiegen die über diesen Zeitraum gemittelten Temperaturen sogar um 2,0 °C an (1976 = 4,4 °C, 2008 = 6,4 °C). Das bedeutet eine jährliche Steigerung um 0,06 °C! In dem zugrundeliegenden 33-jährigen Zeitraum hat sich die Brutperi...

  16. 77 FR 27863 - Privacy Act of 1974; System of Records

    Science.gov (United States)

    2012-05-11

    ... from each facility within the Polytrauma System of Care and the Physical Medicine and Rehabilitation..., Dallas, TX 75216. VA Polytrauma Rehabilitation Center/ Craig Hospital, 3425 S. Traumatic Brain Injury...

  17. Rehabilitation and Prosthetic Services

    Science.gov (United States)

    ... Review Resources AT Education Blind Rehab Chiropractic Service Polytrauma/TBI Prosthetics & Sensory Aids Recreation Therapy More Health ... Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues ...

  18. History and practice of material research on the examples of Material Testing and Materialpruefungsanstalt (MPA) Stuttgart, liquid crystals and screen technology as well as superconductivity. An interdisciplinary teaching project of the University of Stuttgart; Geschichte und Praxis der Materialforschung an den Beispielen Materialpruefung und Materialpruefungsanstalt (MPA) Stuttgart, Fluessigkristalle und Bildschirmtechnik sowie Supraleitung. Ein interdisziplinaeres Lehrprojekt der Universitaet Stuttgart

    Energy Technology Data Exchange (ETDEWEB)

    Hentschel, Klaus; Webel, Josef (eds.)

    2016-07-01

    The knowledge of material research and its history is not very common among scientists and engineers alike. Within the scope of an interdisciplinary teaching project carried out for the first time in the summer semester 2014 and ever since then every summer semester at the University of Stuttgart, an attempt is made to approach material research both from a scientific, technical and historical perspective. The Material Testing and Materials Testing Institute in Stuttgart (MPA), the liquid crystals and the screen technology as well as the superconductivity were selected as topics, which have a long tradition in research and teaching in Stuttgart. In this anthology the materials of the teaching project are summarized. [German] Das Wissen um die Materialforschung und ihre Geschichte ist selbst unter Naturwissenschaftlern und Ingenieuren wenig verbreitet. Im Rahmen eines erstmals im Sommersemester 2014 und seither dann jedes Sommersemester an der Universitaet Stuttgart durchgefuehrten interdisziplinaeren Lehrprojektes wird deshalb der Versuch unternommen, sich der Materialforschung sowohl aus naturwissenschaftlicher und technischer als auch aus historischer Perspektive anzunaehern. Als Themenbereiche wurden dafuer die Materialpruefung und Materialpruefungsanstalt (MPA) Stuttgart, die Fluessigkristalle und die Bildschirmtechnik sowie die Supraleitung ausgewaehlt, die in Stuttgart auf eine lange Tradition in Forschung und Lehre zurueckblicken. Im vorliegenden Sammelband sind die Materialien des Lehrprojektes zusammengefasst.

  19. Complex carotid cavernous sinus fistulas Barrow type D: endovascular treatment via the ophthalmic vein, imaging control with standardized MRI, long-term results; Interdisziplinaere Embolisation spontaner Karotis-Cavernosus-Fisteln Typ D nach Barrow ueber die Vena ophthalmica: klinische Langzeitergebnisse und kernspintomografische Befunde

    Energy Technology Data Exchange (ETDEWEB)

    Struffert, T.; Grunwald, I.Q.; Reith, W. [Abteilung fuer Diagnostische und Interventionelle Neuroradiologie, Universitaetsklinikum des Saarlandes (Germany); Muecke, I. [Klinik fuer Augenheilkunde, Universitaetsklinikum des Saarlandes (Germany)

    2007-04-15

    Purpose: Since feeding arteries from both the internal and external carotid artery are common, cavernous fistulas of Barrow type D are difficult to treat. Embolization using the transarterial approach is considered to be the standard therapy. However, it is often impossible to embolize feeders from the internal carotid artery. The transorbital approach after anterior orbitotomy through the ophthalmic vein is an alternative in this complex situation. The following reports our experience with three female patients who underwent transvenous embolization. Procedural success was documented using standardized MRI and clinical reevaluation. Materials and Methods: Three female patients between 57 and 78 years of age were diagnosed with carotid cavernous fistulas by conventional angiogram. All patients were suffering from exophthalmus and visual impairment. Two patients showed secondary glaucoma and diplopia. In one patient we performed a technically successful transarterial embolization using particles, but no relevant improvement of the patient's condition was seen. Transfemoral transvenous access via the sinus petrosus was not possible in any patient. All patients were then embolized via the ophthalmic vein using GDC detachable coils. All patients were clinically reevaluated by an ophthalmologist. Also a standardized MRI was performed for documentation. Follow-up was performed for the first patient for 32 months, for the second patient for 34 months and for the third patient for 50 months. Results: Transvenous embolization was technically successful in all three cases. Clinical symptoms disappeared rapidly. Postprocedural MRI showed a symmetric diameter of the ophthalmic vein. Venous congestion of the orbit caused by fatty tissue edema regressed completely. Contrast-enhanced magnetic resonance angiography showed normal arterial vessels without evidence of fistula. (orig.)

  20. Pathological changes (developmental/growth disturbances) of the spine after radiation therapy of nephroblastomas during early childhood. A retrospective long-term follow-up study in 82 children. Wirbelsaeulenveraenderungen nach Bestrahlung wegen Wilmstumor im Kleinkindesalter. Retrospektive interdisziplinaere Langzeitstudie an 82 Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Willich, E; Kuttig, H; Pfeil, G; Scheibel, P [Heidelberg Univ. (Germany, F.R.). Universitaets-Kinderklinik Heidelberg Univ. (Germany, F.R.). Universitaets-Strahlenklinik Heidelberg Univ. (Germany, F.R.). Orthopaedische Klinik und Poliklinik

    1990-12-01

    82 children with nephroblastomas, who had therapy between 1960 and 1983, underwent continuous follow-up examinations until 1988. 79 children who survived had been treated with nephrectomy followed by radiation therapy (n=72) and chemotherapy (n=72). 64 of these patients had a combination of both post-surgical treatments. Radiotherapy was performed with cobalt-60 until 1977, followed by high-energy photon and electron beam therapy since 1978. In the beginning the dose applied in each patient within five to seven weeks was 46.5 Gy. Since 1972 it was reduced to 42.8 Gy and after 1978 to 32.3 Gy. The overall survival rate between 1960 and 1988 was 65% and rising to 91% since 1980. 47 children had spinal X-ray examinations at regular intervals for more than two years and 28 of these patients could be followed up to 20 years after radiotherapy. 39 children who had been irradiated before the age of 2 1/2 years developed a more pronounced degree of scoliosis and lumbar kyphosis with a higher incidence. 1500 spinal radiograms were evaluated. Measurements of the second lumbar vertebra, which was constantly situated within the target volume, were compared with those of the eight thoracic vertebral body outside the radiation field, and the curvature of the spine was analysed. Late radiation injuries of the spine could be reduced by involving the whole vertebral diameter into the radiation beam, by the use of high-energy radiation techniques and by excluding children under the age of one year from radiotherapy. However, disturbances of spinal growth cannot always be prevented. (orig.).

  1. Endovascular Perfusion Augmentation for Critical Care (EPACC) as a Resuscitative Adjunct in a Swine (Sus scrofa) Polytrauma Model of Ischemia Reperfusion Injury

    Science.gov (United States)

    2017-11-29

    been any personnel/staffing changes (PI/CI/ AI /TC/lnstructor) since the last IACUC approval ofprotocol, or annual review? _X_ Yes No If yes, complete...Protocol function - PI/CI/ AI /TC/lnstructor, IACUC approval - Yes/No) I NAME I PROTOCOL FUNCTION 1|IACUC APPROVAL 1 1 Robert Faulconer Al Yes Jeremy...Cannon Al Yes Steven Chu Al Yes DELETIONS: (Include Name, Protocol function - PI/CI/ AI /TC/lnstructor, Effective date of deletion) None. 8. PROBLEMS

  2. Major influence of interobserver reliability on polytrauma identification with the Injury Severity Score (ISS): Time for a centralised coding in trauma registries?

    Science.gov (United States)

    Maduz, Roman; Kugelmeier, Patrick; Meili, Severin; Döring, Robert; Meier, Christoph; Wahl, Peter

    2017-04-01

    The Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) find increasingly widespread use to assess trauma burden and to perform interhospital benchmarking through trauma registries. Since 2015, public resource allocation in Switzerland shall even be derived from such data. As every trauma centre is responsible for its own coding and data input, this study aims at evaluating interobserver reliability of AIS and ISS coding. Interobserver reliability of the AIS and ISS is analysed from a cohort of 50 consecutive severely injured patients treated in 2012 at our institution, coded retrospectively by 3 independent and specifically trained observers. Considering a cutoff ISS≥16, only 38/50 patients (76%) were uniformly identified as polytraumatised or not. Increasing the cut off to ≥20, this increased to 41/50 patients (82%). A difference in the AIS of ≥ 1 was present in 261 (16%) of possible codes. Excluding the vast majority of uninjured body regions, uniformly identical AIS severity values were attributed in 67/193 (35%) body regions, or 318/579 (55%) possible observer pairings. Injury severity all too often is neither identified correctly nor consistently when using the AIS. This leads to wrong identification of severely injured patients using the ISS. Improving consistency of coding through centralisation is recommended before scores based on the AIS are to be used for interhospital benchmarking and resource allocation in the treatment of severely injured patients. Copyright © 2017. Published by Elsevier Ltd.

  3. Whole-body CT in polytrauma patients: the effect of arm position on abdominal image quality when using a human phantom

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Pil-Hyun [Yonsei University, Wonju (Korea, Republic of); Wonju Christian Hospital, Wonju (Korea, Republic of); Kim, Hee-Joung; Lee, Chang-Lae; Kim, Dae-Hong [Yonsei University, Wonju (Korea, Republic of); Lee, Won-Hyung; Jeon, Sung-Su [Wonju Christian Hospital, Wonju (Korea, Republic of)

    2012-06-15

    For a considerable number of emergency computed tomography (CT) scans, patients are unable to position their arms above their head due to traumatic injuries. The arms-down position has been shown to reduce image quality with beam-hardening artifacts in the dorsal regions of the liver, spleen, and kidneys, rendering these images non-diagnostic. The purpose of this study was to evaluate the effect of arm position on the image quality in patients undergoing whole-body CT. We acquired CT scans with various acquisition parameters at voltages of 80, 120, and 140 kVp and an increasing tube current from 200 to 400 mAs in 50 mAs increments. The image noise and the contrast assessment were considered for quantitative analyses of the CT images. The image noise (IN), the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), and the coefficient of variation (COV) were evaluated. Quantitative analyses of the experiments were performed with CT scans representative of five different arm positions. Results of the CT scans acquired at 120 kVp and 250 mAs showed high image quality in patients with both arms raised above the head (SNR: 12.4, CNR: 10.9, and COV: 8.1) and both arms flexed at the elbows on the chest (SNR: 11.5, CNR: 10.2, and COV: 8.8) while the image quality significantly decreased with both arms in the down position (SNR: 9.1, CNR: 7.6, and COV: 11). Both arms raised, one arm raised, and both arms flexed improved the image quality compared to arms in the down position by reducing beam-hardening and streak artifacts caused by the arms being at the side of body. This study provides optimal methods for achieving higher image quality and lower noise in abdominal CT for trauma patients.

  4. Whole-body CT in polytrauma patients: The effect of arm position on abdominal image quality when using a human phantom

    Science.gov (United States)

    Jeon, Pil-Hyun; Kim, Hee-Joung; Lee, Chang-Lae; Kim, Dae-Hong; Lee, Won-Hyung; Jeon, Sung-Su

    2012-06-01

    For a considerable number of emergency computed tomography (CT) scans, patients are unable to position their arms above their head due to traumatic injuries. The arms-down position has been shown to reduce image quality with beam-hardening artifacts in the dorsal regions of the liver, spleen, and kidneys, rendering these images non-diagnostic. The purpose of this study was to evaluate the effect of arm position on the image quality in patients undergoing whole-body CT. We acquired CT scans with various acquisition parameters at voltages of 80, 120, and 140 kVp and an increasing tube current from 200 to 400 mAs in 50 mAs increments. The image noise and the contrast assessment were considered for quantitative analyses of the CT images. The image noise (IN), the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), and the coefficient of variation (COV) were evaluated. Quantitative analyses of the experiments were performed with CT scans representative of five different arm positions. Results of the CT scans acquired at 120 kVp and 250 mAs showed high image quality in patients with both arms raised above the head (SNR: 12.4, CNR: 10.9, and COV: 8.1) and both arms flexed at the elbows on the chest (SNR: 11.5, CNR: 10.2, and COV: 8.8) while the image quality significantly decreased with both arms in the down position (SNR: 9.1, CNR: 7.6, and COV: 11). Both arms raised, one arm raised, and both arms flexed improved the image quality compared to arms in the down position by reducing beam-hardening and streak artifacts caused by the arms being at the side of body. This study provides optimal methods for achieving higher image quality and lower noise in abdominal CT for trauma patients.

  5. The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period.

    Science.gov (United States)

    Naidoo, Natasha; Muckart, David J J

    2015-09-19

    Injury in childhood is a major cause of potentially preventable morbidity and mortality. In order to implement effective preventive strategies, epidemiological data on mechanisms of injury and outcome are essential. To assess the causation, severity of injury, morbidity and mortality of paediatric trauma admitted to a level 1 trauma intensive care unit (TICU). Children were defined as being 25 in 98 patients (54.1%), 16-25 in 51 (28.2%), 9-15 in 9 (4.9%) and 25. Of the 26 patients who died, 88.4% had a head injury, 46.2% an extremity injury, 38.5% an external injury, 34.6% abdominal or chest injuries, 19.2% neck injury and 11.5% facial injury. Motor vehicle-related injuries, especially PMVCs, dominate severe paediatric trauma and there is an urgent need for more road traffic education and stringent measures to decrease the incidence and associated morbidity and mortality.

  6. Whole-body CT in polytrauma patients: the effect of arm position on abdominal image quality when using a human phantom

    International Nuclear Information System (INIS)

    Jeon, Pil-Hyun; Kim, Hee-Joung; Lee, Chang-Lae; Kim, Dae-Hong; Lee, Won-Hyung; Jeon, Sung-Su

    2012-01-01

    For a considerable number of emergency computed tomography (CT) scans, patients are unable to position their arms above their head due to traumatic injuries. The arms-down position has been shown to reduce image quality with beam-hardening artifacts in the dorsal regions of the liver, spleen, and kidneys, rendering these images non-diagnostic. The purpose of this study was to evaluate the effect of arm position on the image quality in patients undergoing whole-body CT. We acquired CT scans with various acquisition parameters at voltages of 80, 120, and 140 kVp and an increasing tube current from 200 to 400 mAs in 50 mAs increments. The image noise and the contrast assessment were considered for quantitative analyses of the CT images. The image noise (IN), the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), and the coefficient of variation (COV) were evaluated. Quantitative analyses of the experiments were performed with CT scans representative of five different arm positions. Results of the CT scans acquired at 120 kVp and 250 mAs showed high image quality in patients with both arms raised above the head (SNR: 12.4, CNR: 10.9, and COV: 8.1) and both arms flexed at the elbows on the chest (SNR: 11.5, CNR: 10.2, and COV: 8.8) while the image quality significantly decreased with both arms in the down position (SNR: 9.1, CNR: 7.6, and COV: 11). Both arms raised, one arm raised, and both arms flexed improved the image quality compared to arms in the down position by reducing beam-hardening and streak artifacts caused by the arms being at the side of body. This study provides optimal methods for achieving higher image quality and lower noise in abdominal CT for trauma patients.

  7. Politik der Mikroentscheidungen: Edward Snowden, Netzneutralität und die Architekturen des Internets

    OpenAIRE

    Sprenger, Florian

    2015-01-01

    Ob beim Aufrufen einer Webseite, beim Versenden einer E-Mail oder beim Hochfrequenzhandel an der Börse: Auf ihrem Weg durch die Weiten digitaler Netze durchqueren Bits zahlreiche Knoten, an denen eine Reihe von Mikroentscheidungen getroffen werden. Diese Entscheidungen betreffen den besten Pfad zum Ziel, die Verarbeitungsgeschwindigkeit oder die Priorität zwischen den ankommenden Paketen. In ihrer vielschichtigen Gestalt bilden solche Mikroentscheidungen eine bislang nur marginal beachtete Di...

  8. Lymph scintigraphy and pre- and intraoperative gamma probe measurements for localization of sentinel lymph nodes (SLN) in breast cancer; Lymphszintigraphie sowie prae- und intraoperative Sondenmessung zur Darstellung des Sentinel Lymph Node (SLN) beim Mammakarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Brenner, W.; Czech, N.; Felde, U. zum; Kampen, W.U.; Henze, E. [Kiel Univ. (Germany). Klinik fuer Nuklearmedizin; Ostertag, H. [Kiel Univ. (Germany). Klinik fuer Gynaekologie und Geburtshilfe; Klutmann, S.; Bohuslavizki, K.H. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin; Luettges, J.; Sprenger, A. [Kiel Univ. (Germany). Inst. fuer Allgemeine und Pathologische Anatomie

    2000-05-01

    Aim of this study was to prove the clinical value of nuclear medicine procedures to detect the sentinel lymph node (SLN) for SLN biopsy. Methods: In 132 patients with breast cancer we performed lymph scintigraphy of the breast as well as both pre- and intraoperative gamma probe measurements correlating the results with the findings of histopathology. Results: SLN were detectable in 62 of 110 patients according to a sensitivity of 56% when scanning was performed only at 1-2 h p.i. while the sensitivity increased to 86% (19 of 22 pts.) if sequential images were acquired up to 2 h p.i. One or more SLN were identified by a handheld gamma probe transcutaneously prior to surgery in 96% (113 of 118 pts.) of the patients who showed up with no clinically suspected lymph node metastases. Intraoperatively, in additionally 2 patients the SLN could be found resulting in a sensitivity of 97% (115 of 118 pts.). In only 3 patients with clinically no tumor spread to axillary lymph nodes no SLN could be identified by the probe. Skip lesions, i.e. lymph node metastases in patients with tumorfree SLN, occurred in 2 cases: Due to SLN biopsy in these patients lymph node staging was false negative compared to conventional staging by means of axillary lymph node dissection. Conclusion: The results demonstrate a high preoperative detection rate of SLN in patients with breast cancer using lymph scintigraphy and gamma probe measurements. Thus, nuclear medicine is capable of providing the basic requirements for SLN biopsy in the daily routine. (orig.) [German] Ziel der vorliegenden Arbeit im Vorfeld einer geplanten Multicenterstudie zur Wertigkeit der Sentinel-Lymphknoten (SLN) Biopsie war, die Zuverlaessigkeit der SLN-Detektion mit nuklearmedizinischen Methoden im klinischen Routinebetrieb zu ueberpruefen. Methoden: Bei 132 Patientinnen mit stanzbioptisch gesichertem Mammakarzinom fuehrten wir eine Lymphszintigraphie der Brust sowie eine prae- und intraoperative Gammasondenmessung durch und korrelierten die Befunde mit den histopathologischen Ergebnissen. Ergebnisse: Die Lymphszintigraphie konnte unter Verwendung von statischen Einzelaufnahmen 1-2 h p.i. nur bei 62 von 110 so untersuchten Patientinnen einen SLN nachweisen entsprechend einer Sensitivitaet von 56%. Mittels Lymphsequenzszintigraphie lag die Sensitivitaet dagegen bei 86% (19 von 22 Pat.). Die praeoperative Gammasondenmessung detektierte mindestens einen SLN bei Patientinnen mit klinisch unauffaelliger Axilla in 96% (113 von 118 Pat.), intraoperativ fand sich bei 2 weiteren Patientinnen des SLN und die Sensitivitaet lag bei 97% (115 von 118 Pat.). Nur bei 3 Patientinnen mit klinisch unauffaelligen axillaeren Lymphknoten konnte mit der Sondentechnik kein SLN detektiert werden. Die histologische Aufarbeitung ergab bei 2 Patientinnen sogenannte skip lesions, d.h. Lymphknotenmetastasen bei tumorfreiem SLN, mit entsprechend alasch negativem Lymphknotenstaging durch die SLN-Biopsie. Schlussfolgerung: Mit der Lymphsequenzszintigraphie und der praeoperativen Gammasondenmessung lassen sich bei Mammakarzinompatientinnen der Lymphabstrom aus der Brust und SLN zuverlaessig darstellen. Die Nuklearmedizin kann somit die fuer die SLN-Biopsie erforderliche Methodik routinemaessig zur Verfuegung stellen. (orig.)

  9. Metastases in patients with malignant melanoma despite of negative sentinel lymph node: has the concept to be changed?; Metastasierung beim malignen Melanom trotz histologisch negativem Sentinel Lymph Node: muss das Konzept in Frage gestellt werden?

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, M.; Dresel, S.; Tatsch, K.; Hahn, K. [Muenchen Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Konz, B.; Schmid-Wendtner, M.H.; Sander, C.; Volkenandt, M. [Muenchen Univ. (Germany). Dermatologische Klinik und Poliklinik

    2000-11-01

    The aim of the present study was to prove the prognostic value of the SLN-concept in these patients. Methods: So far the clinical follow-up of 162 patients with histologically proven malignant melanoma and metastatically uninvolved (negative) SLN was investigated. Histological examination included standard methods (HE-Test) and special histochemical techniques (S-100, HMB-45). All patients underwent clinical examination, ultrasonic diagnosis of the regional lymph nodes, and X-ray of the chest every 3 months. Results: Despite of negative SLN-findings in 8/162 patients metastases of the malignant melanoma were found after a time period of 5-27 months. Three patients presented with recurrence in the previously mapped (negative) SLN-basin. In another case the scintigraphically visualized SLN could not be identified intraoperatively by means of the hand-held gamma probe. One patient showed intransit-metastases or skin-metastases, respectively; another patient recurred in the scar area. One patient showed hematogenic dissemination (liver) which is not detectable by lymphoscintigraphy; in another patient metastases were found outside the primary lymphatic basin (cervical). Conclusion: In our patient group 4,9% presented with metastases despite negative SLN while published data report up to 11% (observation period 35 months), among them only 3 patients (1,9%) being real concept failures. Our results underline that there is no evidence to change this concept in patients with clinically early stage. (orig.) [German] Ziel dieser klinischen Verlaufsuntersuchung war es, die prognostische Aussage dieses Konzeptes zu pruefen. Methoden: Es wurde der Verlauf von 162 Patienten mit gesichertem malignen Melanom und histologisch unauffaelliger SLN-Biopsie verfolgt. Die histologische Aufarbeitung umfasste Standardmethoden (HE-Faerbung) und spezielle immunhistochemische Techniken (S-100, HMB-45, Stufenschnitte). Die Nachsorge (klinische Untersuchung, Sonographie regionaler Lymphknoten und des Abdomens, Roentgen-Thorax) erfolgte vierteljaehrlich. Ergebnisse: Trotz negativem SLN zeigten 8/162 Patienten nach einer Beobachtungszeit von 5/27 Monaten eine Metastasierung. Bei drei Patienten konnte eine Lymphknotenmetastasierung in der SLN-Region gesichert werden, bei einem Patienten liess sich der praeoperativ szintigraphisch markierte SLN intraoperativ nicht sicher mittels Sonde lokalisieren. Ein Patient zeigte Intransit- bzw. Hautmetastasen, bei einem weiteren zeigte sich ein Narbenrezidiv. In einem anderen Fall ist von einer mit dieser Methode nicht erfassbaren haematogenen Streuung (Leber) auszugehen. Bei einem weiteren Patienten lag die Metastasierung ausserhalb des durch diese Lokalisationsmethode erfassten lymphogenen Abflussgebietes (zervikal). Schlussfolgerung: In unserem Kollektiv zeigten 4,9% der Patienten trotz negativem SLN eine Metastasierung; demgegenueber finden sich in der Literatur Angaben bis zu 11% (Beobachtungszeitraum bis 35 Monate). Davon kam es lediglich bei 3 Patienten (1,9%) zu einer Melanomprogression in der SLN-Region. Unsere Daten unterstreichen, dass derzeit keine Notwendigkeit besteht das SLN-Konzept bei Patienten im klinischen Stadium I und II zu aendern. (orig.)

  10. Silizium-Kohlenstoff-Hohlraumstrukturen als Anodenmaterial in Lithium-Ionen- und Lithium-Schwefel-Batterien: Paper präsentiert beim 15. Mitteldeutschen Anorganiker-Nachwuchssymposium, Leipzig, 31.8.2017

    OpenAIRE

    Baasner, Anne; Dörfler, Susanne; Althues, Holger; Kaskel, Stefan

    2017-01-01

    Die Nachfrage nach günstigen Batterien mit hohen Energiedichten hat in den letzten Jahren stark zugenommen. Silizium wird für die nächste Generation von Anodenmaterialien für Lithium-Ionen-Batterien hoch gehandelt. So hat es eine fast zehnmal höhere gravimetrische Kapazität (3590 Ah kg-1 Li15Si4) als die bisher eingesetzten Graphitanoden (370 Ah kg-1) [1]. Mit Lithium-Schwefel-Batterien ist theoretisch eine weitaus höhere Steigerung der Energiedichten möglich. Allerdings haben gegenwärtige Li...

  11. Implementation of a seawater cooling system in Eemshaven power plant (NL). A challenge of constructional and hydrological engineering; Umsetzung einer Meerwasserkuehlung beim Kraftwerk Eemshaven (NL). Eine bautechnische Herausforderung im Bereich Tief- und Wasserbau

    Energy Technology Data Exchange (ETDEWEB)

    Ulke, Bernd [RWE Technology GmbH, Eemshaven (Netherlands). Bauleitung STKW; Boerg, Bernd [Tiefbau GmbH Unterweser (TAGU), Oldenburg (Germany)

    2011-04-15

    RWE Eemshaven Holding B.V. is currently constructing a coal power plant with seawater cooling at Eemshaven (NL). The main coolant line will go under the dam and necessitates construction of a cooling water outlet structure, which is described in the article. The work done until December 2009, including construction of the first underwater concrete floor, was described in an earlier article (Bautechnik 87 (2010), pp. 294-297). (orig.)

  12. Effects of sunshades and daylighting systems on room climate in the new building of the Baden-Wuerttemberg office for listed buildings in Esslingen; Auswirkungen von Sonnenschutz/Tageslichtsystemen auf das Raumklima beim Neubau Landesdenkmalamt Esslingen

    Energy Technology Data Exchange (ETDEWEB)

    Buehler, H.J. [GN Bauphysik, Ingenieurgesellschaft mbH, Stuttgart (Germany)

    2003-07-01

    Visual and thermal comfort have a crucial influence on the well-being of the users. With conventional sun protective systems the simultaneous implementation of both requirements is hardly to be carried out. By means of retroflecting sun protective systems type RETROLux Therm can be achieved an optimal daylight illuminating and at the same time a minimization of the summer energy entry. There is for the angles of incidence conditions in the summer months total energy transmission factors (g-value) of 0.10 to expect with simultaneous visual communication with the environment. The sun protective effect is therefore comparable with a conventional external blind system, which exhibits however a substantially limited external outlook. Newest test certificates of the RetroLux Therm lamellas show that in connection with highly reflecting lamella surfaces total energy transmission factors under g=0.10 can be achieved. By thermal simulation calculations it could be proved that with the planned facade conception on basis of the retroreflection no disadvantages are to be expected regarding room climate and operating cost in relation to a conventional facade system with external blinds. The planned facade conception forms thereby together with the building-technical conception of the construction unit activation and the multi-functionally used edge strip a conclusive primary energetically favorable energy concept. (orig.)

  13. Radiation exposure to personnel involved in bone scans for horses with technetium 99m-diphosphonat; Strahlenexposition des Personals bei der Skelettszintigrafie mit Technetium-99m-Diphosphonat beim Pferd

    Energy Technology Data Exchange (ETDEWEB)

    Sommerfeld, Theresa Christine

    2016-07-01

    Key objective of this study has been the evaluation of radiation exposure of veterinarian personnel wearing dosimeters which were involved in equine scintigraphy. A survey, which was developed in parallel to this study, showed that personnel in equine horse clinics have often knowledge gaps about scintigraphy and the related radiation doses. The survey showed skepticism of the involved personnel towards the methods of bone scintigraphy as the impacts of expositions are barely known in common. The scintigraphic investigations and measurements were done at the horse clinic (department of surgery) in Giessen and were part of the routinely bone scanning of horses. A total of 33 bone scans were taken, covering either full- or half-body scintigraphies. Additional 10 bone scans covered measurements with and without the protection of a 0,5 mm lead-shield. The activity of involved personnel was monitored at four different positions: MP1 was associated with the position of the person preparing the radiopharmaceutical for injection, MP2 with the position at holding the horse during the bone scan, MP3 with the position at holding the horse's legs and to make sure that the horse was standing in the right position, MP4 with the position for the camera operator. Some more dose measurements were made from the horse body (MP5 and MP6) as well as in the control area (MP7). In order to analyze the patient's constitution, additional data like weight, size, body extent and length of the torso were additionally captured. The body data were collected to investigate exposure differences of rather big and heavy or small and thin horses. These data and the dosimeter at the horse body (MP5) enabled the correlation analysis between the horse body composition and the received dose rate of the personnel (MP2). MP1 received a mean dose of 11 μSv and a dose rate of 123 μSv/h, MP2 received 31 μSv for a whole-body and 23 μSv for a half-body bone scan. The dose rate of MP2 was 22 μSv/h. MP3 was measured with an averaged dose of 28 μSv for a whole- and 19 μSv for a half-body bone scan. The dose-rate for MP3 was 19 μSv/h. MP4 received 5 μSv for the whole-body scintigraphy and approximately 3 μSv for the incomplete body scintigraphy. The dose rate for MP4 was 3 μSv/h. The highest dose was recorded at MP2 and was caused by the close distance to the headbones of the horses. These bones have only a thin absorption layer which leads to a higher dose-rate in this area. A slightly correlation between the dose rate at MP2 and the body composition data of the horses was recognized. The dose rates went up when performing bone scans of horses with a heavy caliber and a higher bodyweight in general. The measurements at MP3 showed more variations than the ones at MP2, due to the different in soft tissue mass depending on body weight of the horses at this measuring point. The bladder as a big radiation source is covered well enough by surrounding soft-tissue which explains why MP3 did not reach a higher dose-rate standing next to this area. The comparison of the difference between the dose-rates of MP2 and MP3 has proven to be statistically significant with a p-value of 0.008. Through the enlarged distance between the radiation source and MP4, the camera operator received approximately factor 6 less of the dose received by the horse handler. MP1, MP2 and MP4 were selected for the series of comparative measurements with and without lead shield protection because the positions were limited in moving as well as the wearing of lead shields has been less hindering to the personnel. The results of the comparative measurement demonstrate up to 70 % dose reduction at all points if lead shields were used. Especially within the context of smaller doses radiation protection is in controversy discussion. The mandatory use of lead shield in nuclear-medical diagnostics is not regulated by law although the reduction of dose is evident by its use. Within the community of radiation experts the impact of the so called ''beam hardening effect'' under the lead shield appears in opposed discussions. Therefore each medical center handles the use of lead shields individually, a matter of fact which was also mirrored by the survey of this dissertation. With regards to lower radiation doses the ''Hypothesis of Hormesis'' is contradictory to the ICRP rules, which cover the ''Linear-No-Threshold-Model'' and the ''ALARA-Principle''. As of today none of the before mentioned principles are confirmed by scientific investigations. Hence, veterinarian personnel shall reduce the dose consumption by obeying the three main principles for radiation protection: ''Distance'', ''Shielding'' and ''Time of Exposure''.

  14. SPECT/CT for staging and treatment monitoring in oncology. Applications in differentiated thyroid cancer and liver tumors; SPECT/CT zum initialen Staging und Therapiemonitoring in der Onkologie. Indikationen beim differenzierten Schilddruesenkarzinom und bei Lebertumoren

    Energy Technology Data Exchange (ETDEWEB)

    Weber, K.; Berger, F.; Reiser, M.F. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Innenstadt, Institut fuer Klinische Radiologie, Muenchen (Germany); Mustafa, M.; Bartenstein, P.; Haug, A. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Klinik und Poliklinik fuer Nuklearmedizin, Muenchen (Germany)

    2012-07-15

    Hybrid imaging of function and morphology has gained significant importance for lesion detection and treatment monitoring in oncology. In patients with differentiated thyroid carcinoma (DTC) a planar whole body scan is carried out after radioiodine therapy (RIT) for staging. However, due to limited spatial resolution the diagnostic accuracy of this scintigraphy method is impaired. Radioembolization utilizing {sup 90}Yttrium loaded micro-spheres by selective internal radiotherapy (SIRT) allows a minor invasive therapy of primary and secondary liver tumors. In order to avoid side effects of the micro-spheres caused by an outflow into intestines, stomach or lungs, imaging the arteries supplying the liver has to be performed by means of technetium-99m macroaggregated albumin ({sup 99m}Tc-MAA) and scintigraphy. The limited morphological information supplied by scintigraphy is again a challenge in treatment monitoring. {sup 131}Iodine whole body scanning is used for staging in patients with DTC 3-4 days after ablation. Monitoring of the tumor marker thyroglobulin and selective radioiodine whole body scans are available for patients with a high risk profile in the further follow-up with imaging of the arteries supplying the liver by means of {sup 99m}Tc-MAA scintigraphy in preparation of SIRT. Single photon emission computed tomography/computed tomography (SPECT/CT) of the neck and thorax with a therapeutic activity of radioiodine for staging after ablation. Techniques include imaging of arteries supplying the liver by means of {sup 99m}Tc-MAA SPECT/CT before SIRT and evaluation and quantification of the uptake of liver tumors, especially in comparison to the uptake of liver parenchyma by means of SPECT/CT. Due to the integration of combined functional and morphological information SPECT/CT can be used to characterize the morphology and iodine uptake of lesions more accurately, resulting in optimized staging in patients with DTC in comparison to whole body iodine scans and SPECT/CT provides more accurate imaging of the arterial supply of the liver and of potential outflows of micro-spheres into other organs. SPECT/CT allows evaluation and quantification of the uptake of liver tumors. Improved postablative staging in patients with differentiated thyroid cancer by SPECT/CT in comparison to radioiodine whole body scans can be achieved. Improved planning and monitoring of SIRT therapies utilizing SPECT/CT leads to optimized therapeutic doses within liver lesions. Integration of SPECT/CT into the clinical standard for postablative staging in patients with DTC is recommended as well as utilization of SPECT/CT during the planning process, for dose calculation and treatment monitoring of SIRT therapies. (orig.) [German] In den letzten Jahren hat die Hybridbildgebung mit Verbindung von funktioneller und morphologischer Information zur Diagnostik zahlreicher Erkrankungen zunehmend an Bedeutung gewonnen. Bei Patienten mit differenziertem Schilddruesenkarzinom (DTC) wird nach erfolgter Radiojodtherapie (RJT) ein planares Ganzkoerperszintigramm zum Staging durchgefuehrt. Die diagnostische Genauigkeit dieser szintigraphischen Methode ist jedoch aufgrund limitierter raeumlicher Aufloesung begrenzt. Die Radioembolisation von mit {sup 90}Yttrium beladenen Mikrosphaeren (selektive interne Radiotherapie, SIRT) ermoeglicht eine wenig invasive Therapie primaerer und sekundaerer Lebertumoren. Zur Vermeidung von Nebenwirkungen der Mikrosphaeren durch einen Abstrom in Darm, Magen und Lunge muss vor Therapiebeginn eine Darstellung des durch die leberversorgenden Arterien versorgten Gebiets mittels {sup 99m}Tc-MAA ({sup 99m}Technetium-makroaggregiertes Albumin) und einer Szintigraphie erfolgen. Auch hier limitiert die begrenzte morphologische Information der Szintigraphie das Therapiemonitoring. {sup 131}Jod-Ganzkoerperszintigramm zum Nachweis einer erfolgreichen Ablation und Staging ca. 3-4 Tage postablativ bei Patienten mit DTC. Ueberwachung des Tumormarkers Thyreoglobulin, ergaenzt durch Radiojodganzkoerperszintigraphien im weiteren Follow-up bei besonderem Risikoprofil. Darstellung des durch die leberversorgenden Arterien versorgten Gebiets durch eine {sup 99m}Tc-MAA-Szintigraphie als Vorbereitung auf eine SIRT. ''Single photon emission computed tomography''/CT (SPECT/CT) der Hals- und Thoraxregion mit einer therapeutischen Aktivitaetsmenge Radiojod im Rahmen des postablativen Stagings. Darstellung der leberversorgenden Arterien mittels {sup 99m}Tc-MAA-SPECT/CT vor Beginn einer SIRT. Analyse und Quantifizierung des Speicherverhaltens der Lebertumoren, insbesondere im Vergleich zum Leberparenchym durch die SPECT/CT. Aufgrund der Kombination von funktioneller und morphologischer Information ist die SPECT/CT in der Lage, radiojodpositive Herde exakter morphologisch zu korrelieren, damit optimiertes Staging im Vergleich zur Ganzkoerperszintigraphie. Durch die zusaetzliche, von der SPECT/CT gebotene anatomische Information gelingt eine genauere Darstellung der arteriellen Versorgung der Leber sowie potenzieller Abstroeme der Mikrosphaeren in andere Organe. Darueber hinaus ermoeglicht die SPECT/CT eine Analyse und Quantifizierung des Speicherverhaltens der Lebertumoren. Verbessertes postablatives Staging bei Patienten mit differenziertem Schilddruesenkarzinom, insbesondere in Bezug auf das Auffinden von Lymphknotenmetastasen (LKM) im Vergleich zur ueblichen Radiojodganzkoerperszintigraphie. Verbesserte Planung und Durchfuehrung einer SIRT-Therapie bei Leberlaesionen; Optimierung der applizierten Dosis durch Einsatz der SPECT/CT. Integration der SPECT/CT in den klinischen Standard im Rahmen des postablativen Stagings bei Patienten mit DTC. Anwendung der SPECT/CT im Planungsprozess einer SIRT-Therapie sowie bei der Dosisberechnung. (orig.)

  15. Chronic intersticial lung disease in the horse- Findings in arterial bloodgas analysis, tracheobronchial mucus cytology and radiological examination of the thorax; Chronisch interstitielle Lungenerkrankung beim Pferd - Blutgasanalytische, sekretzytolytische und röntgenologische Befunde

    Energy Technology Data Exchange (ETDEWEB)

    Dieckmann, M. [Klinik fuer Pferde, Tieraerztliche Hochschule Hannover (Germany); Klein, H. J.; Deegen, E.

    1990-07-01

    In 12 horses chronic interstitial lung disease was diagnosed. All horses were referrred because of unexplained loss of performance. In general there was no history of respiratory problems; 4 horses showed nasal discharge and 2 horses coughed. Results of arterial bloodgas analysis, tracheobronchial mucus cytology and radiological examination of the lungs were found in a typical combination, and they were different from results found generally in horses suffering from chronic obstructive pulmonary disease. Mean value of arterial partial pressure of oxygen was 100,6 mm Hg, arterial partial pressure of carbon dioxide was 45,1 mm Hg and alveolo-arterial difference in oxygen 5,1 mm Hg, respectively. In tracheobronchial aspirates pulmonary alveolar macrophages and neutrophil granulocytes were found in a relation of 2,6 : 1. Chest radiographs of all horses showed diffuse interstitial pattern throughout the lung.

  16. Steering levies on the purchase of new cars for the reduction of CO{sub 2} emissions; Lenkungsabgaben zur Senkung des CO{sub 2}-Ausstosses beim Neuwagenkauf. Hintergrund, Mechanismen, Prognosen

    Energy Technology Data Exchange (ETDEWEB)

    Haan, P. de; Mueller, M.; Peters, A.; Hauser, A.

    2007-12-15

    This comprehensive final report for the Swiss Federal Office of Energy (SFOE) takes a look at the background, mechanisms and prognoses for the reduction of CO{sub 2} emissions of new cars. This report focuses on policy measures - specifically the collection of budget-neutral so-called 'feebates' - that aim to influence the behaviour of buyers of new cars as a means of enhancing energy efficiency and reducing CO{sub 2} emissions. Both the European Union and Switzerland are pursuing a three-pillar strategy in which agreements with manufacturers and importers (pillar 1) are supplemented by the provision of more detailed information for customers in the form of energy labels for new vehicles as well as catalogues listing levels of fuel consumption (pillar 2). Pillar 3 concerns measures aimed at influencing car buying behaviour, generally based on the use of the energy label for new vehicles in order to realise the existing potentials for reducing CO{sub 2} emissions. The report takes a look at Switzerland's car market, buying behaviour, information on efficient vehicles, acceptance factors and incentive schemes. The findings of the study are presented and commented on.

  17. Vergleich verschiedener Beurteilungsverfahren an Röntgenbildern des Ellbogengelenkes beim Deutschen Schäferhund und Rottweiler unter Berücksichtigung des Einflusses der Lagerung als Basis einer züchterischen Selektion gegen die Ellbogengelenksdysplasie

    OpenAIRE

    Klein, Sandra

    2010-01-01

    Ziel dieser Untersuchung war es, drei Bewertungsverfahren zur Beurteilung der Ellbogengelenksdysplasie bei Hunden der Rasse Deutscher Schäferhund und Rottweiler miteinander zu vergleichen. Hierbei sollte insbesondere ein Einfluss der Lagerung während der Röntgenaufnahme überprüft werden. Bewertet wurden Röntgenaufnahmen von 19.798 Deutschen Schäferhunden und 2.430 Rottweiler, von denen bereits ein offizieller ED – Befund vorlag. Es erfolgte eine Beurteilung entsprechend der zwei Punktesch...

  18. Visualization of the dissipation of energy during the cutting process. Presentation of energy value flows by means of dual energy signatures; Energieverschwendung beim Zerspanungsprozess sichtbar machen. Darstellung von Energiewertstroemen mittels dualer Energiesignaturen

    Energy Technology Data Exchange (ETDEWEB)

    Schillig, Rainer [Hochschule Aalen (Germany). Professur Fertigungsorganisation und Prozessmanagement; Kalhoefer, Eckehard [Hochschule Aalen (Germany). Stiftungslehrstuhl Spanende Fertigung; Stock, Timo [Hochschule Aalen (Germany). Studiengang Maschinenbau/Produktion und Management

    2012-09-15

    Lean production systems are the minimization of wastage. Therefore, process steps are divided in value-added and non-value-added process steps. Using the value stream analysis non-value-adding process shares can be identified easily.The main aim usually are the two factors processing time and inventory. By means of a cutting process, the authors of the paper under consideration report on a method which divides the process-related utilization of energy in value-adding and non-value-adding energy use. Due to the dual consideration of energy use, the energy consumption can be easily integrated in the value stream analysis.

  19. Development of a system for detection and diagnosis of errors in the operation of space HVAC systems; Entwicklung eines Systems zur Erkennung und Diagnose von Fehlern beim Betrieb von HLK-Anlagen

    Energy Technology Data Exchange (ETDEWEB)

    Bach, H.; Bauer, M.; Grob, R.F. [Stuttgart Univ. (Germany). Lehrstuhl fuer Heiz- und Raumlufttechnik

    1997-12-31

    Buildings with heating and space HVAC systems require considerable automatic control effort to ensure engergy-efficient operation. Faults are only to be avoided by the use of automatic fault detection systems. The contribution describes the procedure adopted in operation monitoring, the IKE system for fault detection and diagnosis, and the evaluation of the FDD system. (MSK) [Deutsch] Gebaeude mit heiz-und raumlufttechnischen Anlagen erfordern bei energetisch rationellem Bertrieb einen grossen Aufwand an Steuerungs-und Regelungstechnik. Um ohne Fehler zu arbeiten erfordert diese Steuerungs-und Regelungstechnik den Einsatz von automatischen Fehlererkennungssystemen. Im Folgenden werden die Vorgehensweise bei der Betriebsueberwachung, das IKE-System zur Fehlererkennung und Diagnose sowie die Evaluierung des FDD-Systems (Fault Detection and Diagnosis System) erlaeutert.

  20. Interferenz von Muttersprache und Zweitsprache auf eine dritte Sprache beim freien Sprechen -- ein Vergleich (Interference by the Native Language and a Second Language on a Third Language in Free Conversation -- A Comparison)

    Science.gov (United States)

    Stedje, Astrid

    1976-01-01

    Tests given at the German Institute of the University of Stockholm to 32 Finnish students studying German revealed that both their native language and their Swedish interfered with their learning German, in about equal degree overall. The mother tongue, Finnish, caused more interference errors in pronunciation. (Text is in German.) (IFS/WGA)

  1. Fast Expansion oder doch 4-Gate-Push? - Kompetenzerwerb und Transfer beim Spielen von Echtzeit-Strategiespielen im Mehrspielermodus am Beispiel von StarCraft II – Wings of Liberty.

    Directory of Open Access Journals (Sweden)

    Andreas Steininger

    2013-03-01

    Full Text Available Derzeit ist unklar, inwiefern in Computerspielen erworbene Kompetenzen in andere Kontexte transferiert werden. In der vorliegenden Arbeit wird der subjektiv wahrgenommene Wissenstransfer von 444 SpielerInnen und eines Online-Echtzeitstrategiespieles untersucht. Etwas weniger als die Hälfte der Befragten sehen einen Wissenstransfer im Bereich der sozialen Kompetenz, der Medienkompetenz, der persönlichkeitsorientierten Kompetenz und der kognitiven Kompetenz. Mehr als 50% der Befragten nehmen subjektiv einen Wissenstransfer im Bereich der sensomotorischen Kompetenzen und der Fremdsprachkenntnisse wahr.The transfer of competencies acquired in video games into other contexts is hardly researched yet. For this paper, the transfer of competencies is researched from players point of view. 444 players of a real time strategy game have been interviewed. Slightly less than 50% perceived a knowledge transfer for media competencies, personality, social competences and cognitive competencies. More than 50% perceived a transfer for sensomotor skills and foreign language competence.

  2. Constructing in the monument. Respecting the Old and mark the New. Cost-reliable planning during building upon existing structures; Bauen im Denkmal. Altes achten und Neues kenntlich machen. Kostensicher planen beim Bauen im Bestand

    Energy Technology Data Exchange (ETDEWEB)

    Schneider-Sorger, Roswitha [ORCA Software GmbH, Rosenheim (Germany)

    2011-07-01

    The revitalization of historically protected real estate is a passion of the owners - the family Werndl (Rosenheim, Federal Republic of Germany). In the case of the Old spinning mill in the Kolbenmotor near Rosenheim a whole district was arranged new. The highest premise of the planning team Quest Architekten GBR (Rosenheim, Federal Republic of Germany) was to respect and receive the rough charm of the building stock. This also becomes clear considering the two-storey Batteur building of 1862 being a component of the energy centre of the spinning mill. Once cotton was cleaned, now shops and gastronomy are in the ground floor as well as practices and office units in the upper floor.

  3. Changes of structure and properties in the heat-affected zone during the welding of high-strength aluminium alloys. Gefuege- und Eigenschaftsaenderungen in der Waermeeinflusszone beim Schweissen hochfester Aluminiumlegierungen

    Energy Technology Data Exchange (ETDEWEB)

    Umgeher, A. (Tyrolitschleifmittelwerke Swarovski KG, Schwaz (Austria)); Cerjak, H. (Technische Univ., Graz (Austria))

    High strength aluminium alloys like AlZnMgCu 1.5 are usually classified as 'non-weldable' alloys. If welding technologies such as TIG-plasma keyhole welding are used, it is possible to weld these alloys successfully. However, the heat input during welding affects the base material adjacent to the fusion zone. The main objective of this investigation was to study the change of microstructure and properties in this heat affected zone (HAZ) of high strength aluminium alloys. The base material was a high strength wrought aluminium alloy AlZnMgCu 1.5 (7075) in the T6 condition. The specimens were welded by TIG-plasma keyhole welding. Additionally, Gleeble welding simulation techniques were used. The specimens were investigated in the 'as welded' condition, 'naturally aged', 'artificially aged', and after a complete post weld heat treatment. The microstructure was investigated using light and electron microscopy. Hardness and electric resistivity measurements and DSC-analysis were made. (orig.)

  4. Rail travel with water and wind. Alternatives for more renewable energies with Germany's largest electricity consumer; Bahn fahren mit Wasser und Wind. Wege fuer mehr regenerative Energien beim groessten Stromverbraucher Deutschlands

    Energy Technology Data Exchange (ETDEWEB)

    Horenburg, Peter

    2012-07-01

    It is a core problem of the energy revolution: the fluctuating yields from renewable energy sources have to be integrated into the electricity supply without endangering its safety and economic feasibility. Here the Deutsche Bahn railway company provides a prime example: by 2020, the company intends to draw more than one third of the 12 billion kilowatthours it consumes each year from green electricity. Researchers have calculated that doubling the green electricity used today will increase the electricity costs by around five per cent. The German railway power grid is distinguished, however, by many unique features. (orig.)

  5. Effects of active influencing of drivers on passenger car safety in road traffic; Untersuchungen zur Auswirkung einer aktiven Fahrerbeeinflussung auf die Fahrsicherheit beim Pkw-Fahren im realen Strassenverkehr

    Energy Technology Data Exchange (ETDEWEB)

    Bielaczek, C.

    1998-09-01

    The behaviour of car drivers in road traffic was investigated both in the `normal`, uninfluenced state and with supporting alarm systems informing the driver on critical situations. Systems of this kind may get more important as traffic density increases and increasingly comfortable cars cut the driver off from immediate feedback to recognize critical situations. The tests were carried out with fixted and with driver-adaptive alarm thresholds. Information was transmitted to the driver in the form of haptic/kinesthetic signals on the control elements for vehicle control, i.e. the steering wheel and the gas pedal. It is important to take account of the driver`s recognition of alarm signals under natural driving conditions as in road traffic. The best results were achieved with driver-adaptive alarm thresholds combined with the alarm signal `variable steering wheel control` which also met with high acceptance by the drivers. (orig.) [Deutsch] Die vorliegende Arbeit befasst sich mit der Untersuchung des Verhaltens von Pkw-Fahrern waehrend Fahrten im oeffentlichen Strassenverkehr im unbeeinflussten und durch Fahrer-Assistenz-Systeme beeinflussten Zustand des Fahrers, um die Auswirkung einer aktiven Fahrerunterstuetzung durch eine gezielte Warn-Signaluebermittlung an den Fahrer in kritischen Fahrsituationen zu untersuchen. Die Notwendigkeit einer solchen Untersuchung liegt einerseits in der staendig wachsenden Verkehrsdichte begruendet, die den Fahrer staerker belastet, andererseits aber auch in der durch verbesserten Komfort zunehmenden Entkopplung des Fahrers von der Umgebung, die sich im fehlenden Feedback zur Erkennung kritischer Fahrzustaende aeussert. - Es wurden, hinsichtlich des querdynamisch orientierten Kraftschlusspotentials, sowohl feste als auch fahreradaptive Warngrenzen definiert und ueberprueft. Die Informationsuebermittlung an den Fahrer wurde in Form von haptisch/kinaesthetischen Signalen (variable Betaetigungskraefte) an den Stellgliedern zur Fahrzeugfuehrung, dem Fahrpedal und der Lenkung, durchgefuehrt. - Ein sehr wichtiger Aspekt der Arbeit ist die Einbeziehung der Fahrerwahrnehmung von Warnsignalen unter natuerlichen Fahrerbelastungsbedingungen, wie sie in Feldversuchen im oeffentlichen Strassenverkehr gegeben sind. Dabei zeigten fahreradaptive Warngrenzen in Kombination mit den Warnsignalen `variable Lenkkraefte` den besten Erfolg hinsichtlich einer aktiven Fahrerbeeinflussung bei gleichzeitig hoher Akzeptanz dieses Systemansatzes. (orig.)

  6. Support of the Ukrainean Supervisory Authority during the extension of the improved operational NCP monitoring. Final report part III; Unterstuetzung der ukrainischen Aufsichtsbehoerde beim Ausbau der verbesserten betrieblichen KKW-Ueberwachung. Abschlussbericht Teil III

    Energy Technology Data Exchange (ETDEWEB)

    Beyer, M.; Carl, H.

    2005-05-01

    Technical systems to improve the operational monitoring for the three units of the South Ukraine NPP and for the 1{sup st} unit of the Chmelnitzky NPP were put up by analogy with the systems for the Zaporoshye NPP and the Rovno NPP. For that up to 51 safety-relevant technological and 16 radiological parameters from every unit are available to the supervisory authority on-site and in the crisis centre in Kiev for collection and assessment. These parameters are transferred on-line by modern technical equipment once a minute. The developed evaluation software enables the visualisation of the monitoring results in form of diagrams, charts and graphs. By means of an archive modus the trends of all parameters can be analysed. With the integration of the technical equipment delivered for the sheltered room of the Zaporoshye NPP into the on-site existing remote monitoring system is it now possible to record and to evaluate essential safety-relevant parameters of the whole NPP also during severe accidents by means of modern technical equipment. (orig.)

  7. Phase transformation and local mechanical properties of TRIP steel in a simulated and real resistance spot weld process; Phasenumwandlung und lokale mechanische Eigenschaften von TRIP Stahl beim simulierten und realen Widerstandspunktschweissprozess

    Energy Technology Data Exchange (ETDEWEB)

    Brauser, Stephan

    2013-06-01

    TRIP steels give high strength along with good ductility owing to metastable austenite to martensite phase transformation (TRIP effect) caused by mechanical load. Under the extreme process-specific heating and cooling rates of resistance spot welding, these materials may undergo modifications in their austenite portion resulting in changed mechano- technological performance locally. The prime objective of this study was therefore to carry out microstructure analyses of the spot weld area in order to identify the modified portion of austenite and the resulting changes in local mechanical performance with special consideration of the TRIP effect. First, the metastable austenite portion in the unprocessed parent metal was quantified by in-situ diffraction using high energy synchrotron radiation. Next, the basic aspects of temperature dependent austenite transformation in the heating and cooling process were investigated in furnace experiments under defined temperature profiles. Continuative Gleeble tests and furnace experiments were conducted using various temperature profiles with different peaks occurring locally in the spot welding process in order to enable systematic assessment of the influence of temperature and of heating and cooling conditions on the austenite content under real conditions. Correlation experiments between the mechanical characteristics of thermally prepared tensile specimens and the metallographically and roentgenographically determined austenite contents allowed it to ascertain the metastable, i.e. transformable austenite portions. Finally, the results were evaluated concerning their transferability to real resistance spot welds. It was demonstrated that the austenite to martensite phase transformation can come into action only in a strongly localized material area in the transition zone between heat-affected zone and base metal. Consequently, the TRIP effect does not significantly affect the strength and ductility performance in the joining area of spot welded TRIP steels. The established mechanical characteristics were used as input data for numerical simulation of the spot weld ductility and strength performance. Here, the attention was focused on the necessity of implementing mechanical characteristics of the heat-affected zone for realistic tensile shear test modelling. [German] TRIP Staehle realisieren durch eine unter mechanischer Beanspruchung hervorgerufene Phasenumwandlung von metastabilen Austenit in Martensit (TRIP-Effekt) hohe Festigkeiten bei gleichzeitig guten Verformungseigenschaften. Waehrend der Verarbeitung dieser Werkstoffe mittels Widerstandspunktschweissen koennen unter den prozessspezifischen extremen Aufheiz- und Abkuehlraten Modifikationen des Austenitanteils hervorgerufen werden die als Folge lokal zu einer Aenderung der mechanisch-technologischen Eigenschaften fuehren. Wesentliche Zielsetzung der vorliegenden Arbeit war daher die Analyse der Gefuegestruktur im Bereich einer Punktschweissverbindung hinsichtlich der Aenderung des Austenitanteils und den daraus resultierenden Aenderungen der lokalen mechanischen Eigenschaften unter besonderer Beruecksichtigung des TRIP-Effekts. Durch in-situ Beugungsuntersuchungen mittels hochenergetischer Synchrotronstrahlung erfolgte zunaechst die Quantifizierung des metastabilen Austenitanteils im unbehandelten Grundwerkstoff. Darauf aufbauend wurden unter definierten Temperaturprofilen in Ofenversuchen die grundlegenden Aspekte der thermisch bedingten Austenitumwandlung im Aufheiz- und Abkuehlprozess untersucht. Durch Gleeble-Versuche und Ofenexperimente wurden weiterfuehrend verschiedene Temperaturprofile mit unterschiedlichen im Punktschweissprozess lokal vorliegende Spitzentemperaturen genutzt um eine systematische Bewertung des Einflusses der Temperatur und der Aufheiz- sowie der Abkuehlbedingungen auf den Austenitgehalt unter realen Bedingungen zu ermoeglichen. Durch Korrelationsuntersuchungen zwischen den mechanischen Kennwerten thermisch praeparierter Zugproben und den mittels Metallographisch wie auch roentgenographisch ermittelten Austenitgehalten konnten die metastabilen, d.h. umwandlungsfaehigen Austenitanteile bestimmt werden. Schliesslich erfolgte eine Bewertung hinschlich der Uebertragbarkeit der Ergebnisse auf reale Widerstandspunktschweissverbindungen. Es wurde dabei der Nachweis erbracht, dass die Austenit-Martensit-Phasenumwandlung lediglich in einem lokal eng begrenzen Werkstoffbereich am Uebergang WEZ/Grundwerkstoff wirksam werden kann. Demzufolge fuehrt der TRIP-Effekt zu keiner signifikanten Beeinflussung von Festigkeits- und Verformungseigenschaften im Fuegebereich von widerstandspunktgeschweissten TRIP Staehlen. Die ermittelten mechanischen Kennwerte wurden abschliessend als Eingangsdaten fuer die numerische Simulation des Verformungs- und Festigkeitsverhaltens von Punkschweissverbindungen genutzt. Dabei wurde insbesondere die Notwendigkeit der Implementierung von mechanischen Kenndaten der Waermeeinflusszone fuer eine realitaetsnahe Modellierung von Scherzugversuchen untersucht.

  8. Komplexe Normierungen – widerspenstige Effekte. Zur Rolle des Rechts beim Wandel der Geschlechterverhältnisse Complex Standardization—Unruly Effects. On the Role of Law in Changing Gender Relations

    Directory of Open Access Journals (Sweden)

    Ulrike Lembke

    2008-11-01

    Full Text Available Diese Dokumentation einer internationalen Tagung wartet mit sehr differenzierten Antworten zu der Frage auf, ob (auch mit den Mitteln des Rechts jener Wandel initiiert werden kann, der notwendig ist, um die Geschlechterverhältnisse gerecht(er zu gestalten. In den vielgestaltigen Beiträgen zu den Themenfeldern Arbeitswelt, Familie, Biopolitik und Einwanderungsgesellschaft wird deutlich, dass die Frage nach dem emanzipatorischen Potential von Recht zwar nur jeweils konkret beantwortet werden kann, der Austausch von Erfahrungen und Reflektionen jedoch unerlässlich ist für erfolgreiche feministische Rechtspolitiken.This documentation of an international conference provides varying answers to the question whether change, which is essential in forming gender relations in a more equitable fashion, can (also be initiated through the instruments of law. The varied contributions on the themes of work, family, biopolitics, and immigrant society make clear that while the question of the emancipatory potential of law can only partially be answered, the exchange of experiences and reflections is essential for successful feminist legal politics.

  9. Rubber friction and force transmission during the shearing process of actively-driven vacuum grippers on rough surfaces; Elastomerreibung und Kraftuebertragung beim Abscheren von aktiv betriebenen Vakuumgreifern auf rauen Oberflaechen

    Energy Technology Data Exchange (ETDEWEB)

    Kern, Patrick

    2016-12-21

    Nowadays, vacuum grippers come in many different shapes and sizes. Their stability is guaranteed through specially manufactured metal fittings. These fittings are non-positively and positively connected to the elastic part of the vacuum gripper. The design of the elastic part may vary, though. Elastomer components are used to ensure tightness for the negative pressure in the active cave chamber of the vacuum gripper, as well as for the transfer of shearing forces, which acting parallel to the surface. Some vacuum grippers feature one elastomer for both the sealing function and the transfer of shear forces; other gripper types are equipped with various elastomers for those applications. The vacuum grippers described in this work are equipped with structured rubber friction pads, their tightness being ensured by sealing lips made of a flexible foam rubber. A restraint system consisting of one or several vacuum grippers must be sized prior to its actual practical use. For the transmission of shearing forces, which acting parallel to the surface, it is necessary to take the tribological system, consisting of the suction element's elastomer and the base material, into account since these loads put shearing stress on the vacuum gripper. In practice, however, a standardized value is given for the coefficient of friction μ; i.e. the ratio of transmissible frictional force to the normal force. This does neither include a detailed description of the elastomer used nor of the roughness of the base material. The standardized friction coefficients cannot be applied to the practical design of restraint systems. The present work includes the analysis of the load transmission and the modeling of the friction coefficients μ on rough surfaces during the shearing process of actively-driven vacuum grippers. Based on current theories, the phenomenon of elastomeric friction can be attributed to the two main components of hysteresis and adhesion friction. Both components are presented and modeled at length in this work. In addition, the positive locking, which is not considered in rubber friction theories but allows an increase of the transferable shear forces and thus further contributes to the overall friction coefficient, is also examined here. With the help of a test program, all factors relevant to the shearing process of a vacuum gripper on a given surface and their effect on the tribological system will be analyzed in detail. These include essential influencing factors, i.e. operating temperature, shear speed, mixture composition of the elastomer, and the surface roughness. Moreover, the important factor of the structure of the rubber friction pads must also be considered. In this work, the overall friction coefficient model is based on existing rubber friction theories which describe the contributions of hysteresis and adhesive friction, and on a new approach of how positive locking also contributes to the result. Since the model of the overall friction coefficient is a theoretic one and not all required parameters can directly be measured, the friction model is related to the experimental results. Thus, the missing model parameters can be derived. As a result, it is possible to calculate the expected friction coefficient μ for any structure of rubber friction pads in compliance with the method presented in this work. Unlike the generalized friction coefficient μ data provided by the manufacturers, this friction model allows to realistically calculate friction coefficients and therefore to optimize the design of restraint systems for vacuum grippers.

  10. Experiences with the use of conservative tracers as an aid in transferring lysimeter results to the open field; Erfahrungen beim Einsatz von konservativen Tracern als Hilfsmittel zur Uebertragung von Lysimeterergebnissen auf Freilandflaechen

    Energy Technology Data Exchange (ETDEWEB)

    Seeger, J.; Meissner, R.; Rupp, H. [UFZ - Umweltforschungszentrum Leipzig-Halle GmbH, Falkenberg (Germany). Lysimeterstation; Mueller, L.; Eulenstein, F. [Zentrum fuer Agrarlandschafts- und Landnutzungsforschung e.V. (ZALF), Muencheberg (Germany)

    1999-02-01

    Four lysimeter trials performed on an IS-type soil yielded an almost constant range of displacement of a tracer front (NO{sub 3} front) of 4.0 to 4.5 mm / l of seepage water (referred to a surface area of 1 m-2 and a depth of 1 m). This was experimental confirmation of a tentatively formulated simplified relationship between seepage water volume, vertical tracer displacement, and field capacity. The results were also in very good agreement with those of a control study in the open field carried out under similar hydrological, pedological, and agrotechnical conditions using lysimeters and Cl tracers for determining quantities of seepage water formation. As the present lysimeter trials mirror soil hydrological processes in the open field with sufficient accuracy, they appear well suited to take the place of the so often lacking territorial data as a means of validating mathematical models describing seepage-water-bound material export. [Deutsch] Auf der Basis von 4 Lysimeterversuchen konnte fuer die Bodenart IS ein nahezu konstanter Wertebereich fuer die Verlagerung einer Tracerfront (NO{sub 3}-Front) in Hoehe von 4,0 bis 4,5 mm/l Sickerwasser (bezogen auf eine Oberflaeche von 1 m{sup 2} und eine Tiefe von 1 m) ermittelt werden. Damit konnte die vereinfachte Beziehung zwischen Sickerwassermenge, Tracerverlagerungstiefe und Feldkapazitaet experimentell bestaetigt werden. Ein Vergleich zur Bestimmung der Sickerwassermengenbildung mit Hilfe von Lysimetern und durch Einsatz von Cl-Tracern unter aehnlich hydrologischen, pedologischen und agrotechnischen Bedingungen im Freiland wies eine hohe Uebereinstimmung auf. Da die hier durchgefuehrten Lysimeteruntersuchungen bodenhydrologische Prozesse von Freilandflaechen mit ausreichender Genauigkeit widerspieglen, erscheinen sie anstelle oft fehlender Gebietskenndaten zur Validierung von mathematischen Modellen zur Beschreibung sickerwassergebundener Stoffaustraege gut geeignet. (orig.)

  11. Ecological and economic assessment and optimisation of measures for in-house recycling in hot galvanizing plants; Oekologische und oekonomische Beurteilung und Optimierung von Massnahmen zur innerbetrieblichen Stoffkreislaufschliessung beim Feuerverzinken von Stahl

    Energy Technology Data Exchange (ETDEWEB)

    Ackermann, R.; Fleischer, G. [TU Berlin, Inst. fuer Technischen Umweltschutz, Lehrstuhl Abfallvermeidung und Sekundaerrohstoffwirtschaft, Berlin (Germany)

    2003-07-01

    Exemplary strategies for materials use and recycling in a plant for hot galvanizing of steel are reviewed from an ecological and economic viewpoint and optimized. The changes resulting from the optimization measures are assessed in terms of cost and potential ecological effects. The results of this assessment, which is based on the methodology published in DIN EN ISO 14040 ff, illustrate the potential contained in the recycling option. (orig.) [German] Fuer das Feuerverzinken von Stahlbauteilen werden beispielhaft Strategien zur innerbetrieblichen Stoffkreislaufschliessung oekologisch und oekonomisch beurteilt und optimiert. Die sich hinsichtlich der betrieblichen Stoff- und Energiefluesse durch Optimierungsmassnahmen ergebenden Veraenderungen werden in Bezug auf die Kostensituation des Unternehmens und die oekologischen potentiellen Auswirkungen beurteilt. Die Ergebnisse der Oekologischen Betriebsoptimierung, die unter Nutzung methodischer Elemente der Oekobilanzierung (DIN EN ISO 14040 ff) erzielt werden, verdeutlichen, welche Potentiale in einer weitgehenden Schliessung des Stoffkreislaufs liegen. (orig.)

  12. About the influence of the topography of the steel surface on faults during hot galvanizing of part loads; Zum Einfluss der Topographie der Stahloberflaeche auf Fehler beim Stueckgut-Feuerverzinken

    Energy Technology Data Exchange (ETDEWEB)

    Schulz, W.D. [Institut fuer Korrosionsschutz GmbH, Dresden (Germany); Schubert, P.

    2002-03-01

    The topography of the steel surface can influence the formation of layers during hot galvanizing in many ways. Information is given on galvanizing faults caused by impressions in the steel surface (rolling and drawing ridges). Flux remainders accumulated in these impressions can be encapsulated in the zinc coating during hot galvanizing. This leads to cavities and pores in the coating or to sponge-like zinc raisings at its surface. The flux remainders from the zinc coating can boil during powder coating and lead to blisters and pimple-like rises in the coating. Therefore, steel surfaces designed for galvanizing should be even or only have flat impressions. (orig.)

  13. Inhibitor efficiency in long-time protection of steel tanks for the chemical surface preparation against local corrosion by process solutions containing hydrochloric acid; Inhibitorwirksamkeit beim Langzeitschutz von Stahlbehaeltern fuer die chemische Oberflaechenvorbereitung gegen oertliche Korrosion durch salzsaeurehaltige Prozessloesungen

    Energy Technology Data Exchange (ETDEWEB)

    Stieglitz, U.; Schulz, W.D. [Institut fuer Korrosionsschutz Dresden GmbH, Gostritzer Str. 61-63, D-01217 Dresden (Germany)

    2004-02-01

    The efficiency of prevailing acid inhibitors is examined by age hardening heavy tank-steel plates in technically usual hot-galvanizing solutions for 1000 hours. With acid inhibitors local corrosion emerged as shallow pit formation first and foremost in hydrochlorid acid pickles (20 g/l HCl) at ambient temperature as well as in cleaners containing hydrochloric acid (10-30 g/l HCl) at 40 C when other conditions also applied. Above all, local corrosion was produced if the inhibitor concentration became too low (0.2 g/l) in connection with a minimum hydrochloric acid concentration (10-30 g/l). However, oxidizing agents like iron(III)-ions (5-10 g/l), atmospheric oxygen and free chlorine (100-1000 mg/l) lead to local corrosion, too. Local corrosion did not emerge in rinse baths (2-10 g/l HCl) and fluxing material solutions of zinc chloride and ammonium chloride (pH value: 2.0-5.5). Here uniform corrosion developed. Acid inhibitors turned out to be very effective against uniform corrosion in the examined long-time period (inhibiting values up to 99%). (Abstract Copyright [2004], Wiley Periodicals, Inc.) [German] Die Wirksamkeit handelsueblicher Saeureinhibitoren wird durch eine Auslagerung von Grobblechen aus Behaelterstahl ueber 1000 Stunden in technisch gebraeuchlichen Loesungen der Feuerverzinkung untersucht. Oertliche Korrosion ist als Muldenkorrosion in Gegenwart von Saeureinhibitoren vor allem in Salzsaeurebeizen (20 g/l HCl) bei Raumtemperatur und in salzsaeurehaltigen Reinigern (10-30 g/l HCl) bei 40 C aufgetreten, wenn Zusatzbedingungen erfuellt sind. Oertliche Korrosion wird vorwiegend durch eine Unterschreitung der Inhibitorkonzentration (0,2 g/l) in Verbindung mit einer minimalen Salzsaeurekonzentration (10-30 g/l) ausgeloest. Aber auch Oxidationsmittel wie Eisen(III)-Ionen (5-10 g/l), Luftsauerstoff und freies Chlor (100-1000 mg/l) fuehren zu oertlicher Korrosion. In Spuelbaedern (2-10 g/l HCl) und Flussmittelloesungen aus Zinkchlorid und Ammoniumchlorid (pH-Wert: 2,0-5,5) ist keine oertliche Korrosion entstanden, sondern Flaechenkorrosion. Im untersuchten Langzeitbereich sind Saeureinhibitoren gegen Flaechenkorrosion sehr gut wirksam (Hemmwerte bis 99%). (Abstract Copyright [2004], Wiley Periodicals, Inc.)

  14. Experiments on the Haeffner effect i. e. isotope enrichment on passage of high current densities through metallic melts. [Lithium]. Versuche zum Haeffner-Effekt (Isotopenanreicherung beim Durchgang von Gleichstrom hoher Stromdichte durch Metallschmelzen)

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, G

    1962-01-01

    The Haeffner effect (E. Haeffner 1953) found first with mercury and later confirmed with several other metals consists in an enrichment of the lighter isotopes at the anode end, and of the heavier isotopes at the cathode end. In the present work measurements were made on molten lithium. To keep current intenisities within reasonable limits the experiments were done in steel capillaries of 0.6 mm inner diameter and lengths 22-43 cm. Current densities were 6000-7400 A/cm/sup 2/ and the duration 150 h. Neutron activation was used as isotope analysis method. Surprisingly and in contrast to previous measurements an enrichment of Li/sub 6/ of about 1% was found at the ends of the capillary relative to its middle. This was independent of the current direction. No explanation of the effect is given.

  15. Progress in biogas. Biogas production from agricultural biomass and organic residues. Pt. 1 and 2. Proceedings (oral presentations and poster presentations); Fortschritt beim Biogas. Biogas aus landwirtschaftlicher Biomasse and organischen Reststoffen. T. 1 und 2. Tagungsband. Vortraege and Poster

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    Within the International Conference ''Progress in Biogas - Biogas production from agricultural biomass and organic residues'' at the University Hohenheim (Stuttgart, Federal Republic of Germany) from 18th to 21st September, 2007, the following lectures were held: (1) Global relevance and potential of bioenergy for regional development; (2) Biogas electricity for France feed-in tariff and some other things to know before entering French market; (3) Policy drivers and future prospects for on-farm anaerobic digestion in Northern Ireland; (4) Biogas in Belgium, a swot analysis; (5) Status and prospects of biogas energy use in Ukraine; (6) Recent developments in Chinese agricultural biogas production; (7) Opportunities for agricultural based biogas systems in the province of Ontario, Canada; (8) Pre-treatment and digestion of separated collected household waste in Sweden; (9) To the problem of monitoring measures and prophylaxis measures with the utilization of organic residual substances in biological gas facilities from hygienic view; (10) Fermenting residues from biological gas facilities - nutrients and pollutants, possibilities of application in the agriculture; (11) Treatment and utilization of fermentation residues; (12) Potential of residual gas of NaWaRo feeded biogas plants in Baden-Wuerttemberg; (13) Operating analytics of biogas plants to improve efficiency and to ensure process stability; (14) The potential of biogas and electric power production from subproducts in the sugar and alcohol industries by the application of anaerobic digestion; (15) Co-digestion plant in dairy cattle farm in Emilia Romagna region (Italy); (16) Facing operational problems in a biodigeser in Yuvientsa - Amazonian Region of Ecuador; (17) Biogas plant instead of milk cow - payment and occupation with the use of grassilage; (18) Biogas in ecologic agriculture - experiences from 3 years of fermentation of grass-clover ley; (19) Combined solar-biogas basis for the population social level raising; (20) Production of biogas with grassilage - when is this profitable?; (21) Biogas: Opportunity or threat for the agriculture; (22) Country report Cameroon; (23) Fruit wastes bioconversion for anaerobic co-digestion with pig manure. Process development for the recycling in decentralised farm scale plants; (24) A parameter estimation protocol for anaerobic digestion; (25) BABIU - a new process for production of biomethane from biogas; (26) Dry fermentation of organic wastes; (27) Biological production of hydrogen from agricultural raw materials and residual materials with subsequent methane step; (28) Two phase continuous digestion of solid manure on-farm; (29) Investigation and development of an optimal process of fermenentation of grassilage by a two-phase process operation; (30) Technical weak points at biogas plants - occasions, effects and measures; (31) Plant safety - a substantial component according to permission and availability of biogas plants; (32) Analysis and evaluation of alternative concepts of the energetic use of biogas and other biogenous gases; (33) Gas-side bundling of some biogas plants, gas processing and gas feeding; (34) Technical and economical demands to biogas production for feeding into the HD grid; (35) Thinking about the use of biogas from the view of heat utilization - development of concepts for bioenergy villages; (36) Biogas cogeneration plant in the practice: Behaviour of emission and performance; (37) The future of biogas in Europe: Visions and targets until 2020; (38) Two-stage dry-wet-fermentation - optimization of the hydrolysis for a short space-time-yields; (39) Manure-free fermentation of renewable raw materials; (40) Quantification of different microbial population in termophilic-dry anaerobic digestion; (41) The use of hydrolytic enzymes in agricultural biogas production; (42) A contribution to mobile online gas diagnostics according to the efficiency of biogas plants; (43) Genetic 'fingerprints' to characterize microbial communities during organic overloading and in large-scale biogas plants; (44) Codigestion of olive mill wastewater and swine manure using UASB bioreactors for biogas production; (45) Addition of fibre cracking enzymes according to the enhancement of yield of biogas of energy plants; (46) On-site consulting of operators of biogas plants; (47) Cooperation between energy economy and agriculture at Erdgas Suedwest (Concept of biogas upgrading as a cooperation perspective for gas utilities and agriculture); (48) Cooperative operator models for biogas plants with utilization of heat in municipal sites - a common community of agriculturists and an experienced contractor; (49) Risk and insurance management for biogas plants; (50) Experiences in the german-chinese market of biogas and utilization of CDM projects.

  16. Hemangiosarcoma after breast-conserving therapy of breast cancer. Report of four cases with molecular genetic diagnosis and literature review; Haemangiosarkom nach brusterhaltender Therapie beim Mammakarzinom. Vier Fallbeispiele mit molekulargenetischer Diagnostik und Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Nestle-Kraemling, Carolin [Universitaetsklinikum, Duesseldorf (Germany). Frauenklinik; Boelke, Edwin; Budach, Wilfried [Universitaetsklinikum Duesseldorf (DE). Klinik und Poliklinik fuer Strahlentherapie und radiologische Onkologie] (and others)

    2011-10-15

    Hemangiosarcomas of the breast represent a rare disease of the breast mainly occurring as secondary neoplasias with a latency of 5-10 years after primary treatment of breast cancer and are associated with an unfavourable prognosis. Radiation therapy, which is integrated within the concept of breast conserving therapy ranks as the main risk factor. In this report we describe the clinical course of 4 patients including their molecular genetic pattern and give a summary of the actual literature. Hemangiosarcomas occur as a secondary neoplasm with a latency of 5-10 years after primary treatment of breast cancer and have an unfavorable prognosis. A genetic predisposition is assumed, but we could not find a significant role of tumor suppressor genes BRCA1, BRCA2 or p53 in our patients. Due to limited data available for these tumors, recommendations for therapy include radical tumor resection achieving wide free margins and inconsistent regimens of chemo- and/or immunetherapy modalities. In the majority these are based on systemic therapy regimens for other cutaneous sarcomas, such as Kaposi's sarcoma. Efforts should be taken for a nation-wide systematic registration of all cases of post-irradiation hemangiosarcomas.

  17. Synopsis on selected hazard reports from Germany, Europe and international; Synopse zu ausgewaehlten Gefahrenberichten aus Deutschland, Europa und international. Eine Analyse im Rahmen des 4. Gefahrenberichts der Schutzkommission beim Bundesministerium des Innern

    Energy Technology Data Exchange (ETDEWEB)

    Atzl, Andreas [Karlsruher Institut fuer Technologie (KIT) (DE). Inst. fuer Regionalwissenschaft/Inst. fuer Staedtebau und Landesplanung (IfR/ISL); Lerch, Jennifer [Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ), Regionales Zentrum Saarland, Saarbruecken (Germany); Luxen, Johannes; Urban, Bert; Lackner, C.K. [Klinikum der Univ. Muenchen (DE). Inst. fuer Notfallmedizin und Medizinmanagement (INM)

    2012-07-01

    The Report covers the following issues in 6 sections (1) Introduction. (2) Procedures and methodology: selection of documents, qualitative pre-evaluation, quantitative analysis. (3) Results from the medical point of view: rush of patients in case of asymmetric threads; rush of casualties in case of natural disasters, medical care impairment in case of destroyed infrastructure; epidemics and pandemics; attacks or accidents in nuclear facilities; disturbance of the drinking water supply; CBRN (chemical, biological, radiation, nuclear) attacks. (4) Results from the point of view of environmental and engineering science: overview, asymmetric threat, climatic change, D (information and communication technologies) hazards; public supply in case of emergency. (5) Results from the point of view of social science: overview on the matrix; vulnerabilities, institutional challenges, self-protection, information and warning of the public. (6) Conclusions: dominance of asymmetric threat and need of systemic approaches in civil defense; supply of the public and critical infrastructures, transformation processes and challenges in civil defense; quality of documents and need of additional research on emergency protection.

  18. Percutaneous, radiology-assisted stent implantation by means of a novel prosthesis of the bile duct in cases of inoperable cholangioma. Perkutane radiologische Stentimplantation beim inoperablen Gallengangskarzinom mittels einer neuen Gallengangsprothese

    Energy Technology Data Exchange (ETDEWEB)

    Beck, A; Nanko, N [Freiburg Univ. (Germany, F.R.). Abt. Roentgendiagnostik; Milic, S [Consiglio Nazionale delle Ricerche, Rome (Italy); Volk, B [Freiburg Univ. (Germany, F.R.). Abt. Innere Medizin 1 (Haematologie und Onkologie)

    1989-07-01

    In case of malignant growth causing biliary obstruction, biliary decompression can be achieved by surgery, or by means of external/internal drainage. A novel stent with an F7 outer diameter can be percutaneously introduced and positioned through an F8 sluice, assisted by radiologic and cholangioscopic control, and can be dilated to the required diameter by means of a balloon catheter. The implentation can entirely be done through the sluice.

  19. The extrusion of AZ-series magnesium alloys - extending the processing limits by hydrostatic extrusion; Erweiterung der Prozessgrenzen beim Strangpressen von Magnesiumknetlegierungen der AZ-Reihe durch das hydrostatische Strangpressverfahren

    Energy Technology Data Exchange (ETDEWEB)

    Swiostek, J. [GKSS-Forschungszentrum Geesthacht GmbH (Germany). Inst. fuer Werkstofforschung

    2008-12-04

    The present study is concerned with the analysis of the influence of hydrostatic extrusion on the microstructural development and mechanical properties of extruded profiles of the AZ-series magnesium alloys. This work also deals with the correlation between the microstructure and resulting mechanical properties for the case extruded profiles. (orig.)

  20. Adsorption, regeneration and reuse of activated carbon for elimination of COD from municipal waste water. Final report. Untersuchungen zur Aktivkohle-Adsorption, -Regeneration und Wiederverwendung beim Einsatz zur Elimination des CSB aus kommunalem Abwasser. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Sekoulov, I.; Holst, H.J.

    1994-02-01

    One practicability to reduce COD-loadings of secondary effluents is the activated carbon fixed bed-process. In this project activated carbons (GAC) of different raw products (peat, wood, coal) were loaded with filtrated municipal waste water (mean COD-concentration: 60 mg CSB/L). After the break-through of adsorption-colums, the carbon was regenerated by means of superheated steam (optimal conditions: [theta]=300 C, pressure=2 bar, thermal energie=10 KW). Regeneration experiments demonstrated, that the results of steam-treatment of GAC is independent in respects to the preloading of activated carbons and the raw products. The mass of COD, detected in the condensed (liquid) steam-phase, always was in quantity about 10% of the further COD adsorbed to the GAC. Gaseous reaction products could not evaluated by means of the experimental design. But former perculation cycles of steam-treated carbons and measurments of the specific area (BET-method) indicated, that the adsorption-capacity of regenerated GAC seams to be in the same quantity, than unloaded carbons. Measurements (GC/MS) of single organic components showed, that humic-substances are catalysed at steam temperatures about 300 C. It seams, that chlorinated hydrocarbons could formed by means of this regeneration method. BOD experiments demonstrated, that substances of the steam-treatment could be biological degraded about 50% to 60%. (orig.)

  1. Industrie 4.0. Standort Deutschland im internationalen Kontext: Vortrag gehalten beim 70. Deutschen Betriebswirtschafter-Tag, Digitalisierung, Vernetzung und disruptive Geschäftsmodelle - Betriebswirtschaftliche Implikationen des wirtschaftlichen Wandels, 28./29. September 2016, Düsseldorf

    OpenAIRE

    Bauernhansl, Thomas

    2016-01-01

    Der Vortrag "Industrie 4.0: Standort Deutschland im internationalen Kontext" behandelt folgende Themenkomplexe: - Internationaler Vergleich - Der Wettlauf um die Wertschöpfunghat begonnen - Digitale Transformation - Wo steht Deutschland international?

  2. Influence of the spray characteristics of a piezo-A-nozzle on the inflammation at spray guided combustion processes; Einfluss der Spraycharakteristik einer Piezo-A-Duese auf die Entflammung beim strahlgefuehrten Brennverfahren

    Energy Technology Data Exchange (ETDEWEB)

    Breuninger, Tobias; Schmidt, Juergen [Magdeburg Univ. (DE). Inst. fuer Stroemungstechnik und Thermodynamik (ISUT); Hese, Martin; Tschoeke, Helmut [Magdeburg Univ. (DE). Inst. fuer Mobile Systeme (IMS); Kufferath, Andreas [Robert Bosch GmbH, Schwieberdingen (Germany); Altenschmidt, Frank [Daimler AG, Stuttgart (Germany)

    2011-07-01

    The spray-guided combustion process offers a significant potential for improvement on the fuel consumption in partial-load engine operation. Due to the very close positioning of the injector to the spark plug, there is only very little time for the fuel mixture generation which leads to the presence of still liquid fuel particles next to already evaporized one. Furthermore the fuel-mixture generation is primarily driven by the dynamics of the fuel spray. In this article the spray characteristics of a Piezo-A-injector under pressure-chamber conditions as well as the combustion behavior on a one-cylinder test motor are analyzed. The global spray dispersion is analyzed using high-speed visualization while laser-optical measurements are used to observe the ignition-area. The mean diameter as well as the velocity of fuel droplets are determined using the phase-doppler-anemometry (PDA). An extinction-measuring methodology is used to quantify the liquid fuel particles. Analyzing the evaluated misfire-rate as a function of the spray-attributes allows for rating the spray-sections according to their ignition behavior. (orig.)

  3. Accident or maltreatment? Radiographic X-ray patterns in non-accidental trauma. The concept of sentinel injuries; Unfall oder Misshandlung? Radiologische Befunde beim nichtakzidentiellen Trauma. Das Konzept der ''sentinel injuries''

    Energy Technology Data Exchange (ETDEWEB)

    Hirsch, F.W.; Sorge, I.; Roth, C. [Uniklinikum Leipzig AoeR, Abteilung fuer Kinderradiologie, Leipzig (Germany); Gosemann, J.H. [Universitaetsklinikum Leipzig, Uniklinikum Leipzig AoeR, Klinik und Poliklinik fuer Kinderchirurgie, Leipzig (Germany)

    2016-05-15

    The focus of this review article is on child abuse and the radiographic pattern of X-ray findings. The radiologist should be able to recognize typical injuries resulting from child abuse. In some cases the findings are highly specific for abuse and these include metaphyseal corner fractures of the long bones in children aged up to 24 months. In other cases the fractures are not specific but highly indicative of child abuse: rib fractures, for example can be associated with child abuse in more than 50 % of the cases; however, maltreatment is difficult to diagnose without taking the entire pattern of skeletal findings into consideration so that a radiological screening of the entire skeleton is often necessary. The concept of sentinel injuries might be helpful for deciding in which cases a complete skeletal screening should be performed. In the age group up to 24 months old a complete skeletal status (with some exceptions) is recommended if one of the three sentinel injuries of rib fractures, intracranial bleeding and abdominal trauma is present. (orig.) [German] Die Kindesmisshandlung und ihre radiologischen Befundmuster sind Gegenstand dieser Uebersicht. Der Radiologe sollte in der Lage sein, typische Verletzungen als Misshandlungsfolge zu erkennen. In Einzelfaellen ist der Befund hochspezifisch fuer eine Misshandlung. Hierzu zaehlen z. B. metaphysaere Kantenabsprengungen an den langen Roehrenknochen bei bis 24 Monate alten Kindern. In anderen Faellen sind die Frakturen nicht spezifisch, aber hochsensitiv fuer das Vorliegen einer Misshandlung, z. B. bei Rippenfrakturen, die in ueber 50 % der Faelle mit einer Misshandlung assoziiert sein koennen. Die Misshandlung kann allerdings oft nur aus der Zusammenschau der unterschiedlichen Befunde, also nach Beurteilung des gesamten Skelettstatus, diagnostiziert werden. Fuer die Entscheidung, in welchen Faellen ein kompletter Skelettstatus angefertigt werden sollte, stellt sich das Konzept der ''sentinel injuries'' als hilfreiches Tool heraus. In der Altersgruppe bis 24 Monate wird hierbei (mit Ausnahmen) ein kompletter Skelettstatus bei den 3 ''sentinel injuries'' Rippenfrakturen, intrakranielle Blutung und Abdominaltrauma empfohlen. (orig.)

  4. Combined intraoperative and external irradiation of the celiac artery in the rabbit: Effects on gastric mucosal blood flow; Kombinierte intraoperative und externe Bestrahlung der Arteria coeliaca beim Kaninchen: Auswirkungen auf die Durchblutung der Magenschleimhaut

    Energy Technology Data Exchange (ETDEWEB)

    Doerr, W. [Universitaetsklinikum Carl Gustav Carus, Dresden (Germany). Klinik und Poliklinik fuer Strahlentherapie]|[GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Kallfass, E. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Berg, D. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Kummermehr, J. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany)

    1996-12-01

    Aim: To demonstrate changes in gastric mucosal blood flow caused by intraoperative radiotherapy of the celiac artery combined with external radiotherapy of the upper abdomen in a rabbit model. The study was designed to identify a possible correlation between a radiation-induced reduction in mucosal blood flow and the induction of gastric ulcer. Material and Method: Intraoperative radiation doses of 0 or 30 Gy were given to the celiac artery in rabbits. After a delay of 14 days external radiotherapy of the upper abdomen with 3x4 Gy/week to a maximum total dose of 40 Gy was initiated. Gastric mucosal blood flow was assessed by intraventricular injection of radioactively-labelled microspheres (15 {mu}m) followed by measurement of radioactivity in the mucosa. The injections were performed at various time intervals between 2 and 63 days after intraoperative radiation. Results: Intraoperative radiotherapy, including sham-intraoperative radiation, resulted in a transitory reduction of mucosal blood flow by about 50% of the control value on day 7. After a temporary recovery by day 14, a marked and permanent reduction in blood flow was assessed after week 6. This time corresponds to the time of development of gastric ulcer. Conclusions: A relationship between the time of ulcer development and of reduced gastric mucosal blood flow was observed after combined intraoperative and external radiotherapy. The mechanical component of intraoperative treatment has to be emphasized. Reduced blood flow was also seen after intraoperative radiotherapy alone, without an induction of ulcer by this treatment. Hence additional mucosal damage by external radiation must be present for the induction of gastric ulcer. (orig.) [Deutsch] Ziel: Untersuchung der Veraenderungen der Magenschleimhautdurchblutung am Kaninchen als Folge einer kombinierten intraoperativen Bestrahlung der Arteria coeliaca und externen Bestrahlung des Oberbauchs. Durch diesen Ansatz sollte ein moeglicher Zusammenhang zwischen einer strahleninduzierten Minderdurchblutung und der Genese von Magenulzerationen dargestellt werden. Material und Methode: Die intraoperative Bestrahlung der Arteria coeliaca erfolgte mit 0 bzw. 30 Gy. Nach einer Pause von 14 Tagen wurde eine externe Bestrahlung des Oberbauches mit 3x4 Gy/Woche bis zu einer Gesamtdosis von 40 Gy angeschlossen. Die Messung der Durchblutung der Magenschleimhaut wurde mittels intraventrikulaerer Injektion radioaktiv markierter Mikrophaeren (15 {mu}m) und Bestimmung der Aktivitaet in der Magenschleimhaut durchgefuehrt. Diese Messungen erfolgten zu verschiedenen Zeitpunkten zwei bis 63 Tage nach intraoperativer Bestrahlung. Ergebnisse: Die intraoperative Bestrahlung, auch die Scheinbestrahlung, fuehrt zu einer transienten Verminderung der Schleimhautdurchblutung bis zu etwa 50% des Normalwertes an Tag 7. Nach einer voruebergehenden Erholung bis zu Tag 14 tritt ab der sechsten Woche eine deutliche und anhaltende Minderdurchblutung ein. Dieser Zeitraum deckt sich mit dem Termin der Ulkusentstehung. Schlussfolgerungen: Es besteht ein zeitlicher Zusammenhang zwischen der Ausloesung von Magenulzerationen und eine Reduktion der Schleimhautdurchblutung durch kombinierte intraoperative und externe Strahlentherapie. Hierbei ist die mechanische Komponente der intraoperativen Radiotherapie besonders hervorzuheben. Die reduzierte Durchblutung laesst sich auch nach alleiniger intraoperativer Radiotherapie nachweisen, ohne dass hier jedoch Ulzera auszuloesen sind. Eine zusaetzliche direkte Schleimhautschaedigung durch die externe Bestrahlung ist somit fuer die Ausloesung von Magenulzerationen von Bedeutung. (orig.)

  5. Maximizing the CO{sub 2} separation in the Oxyfuel coal-fired process with cryogenic air separation plant; Maximierung der CO{sub 2}-Abtrennung beim kohlebefeuerten Oxyfuel-Prozess mit kryogener Luftzerlegungsanlage

    Energy Technology Data Exchange (ETDEWEB)

    Dickmeis, Jens

    2015-07-01

    In this work the influence of a maximised carbon capture rate on the overall process of an Oxyfuel coal-fired power plant is evaluated. The capture rate is increased by implementing an additional capture process as a complement to the partial condensation process. This additional process can either be a membrane process or a pressure swing adsorption. The processes are evaluated with commercial modelling tools.

  6. MRI, CT, and sonography in the preoperative evaluation of primary tumor extension in malignant pleural mesothelioma; MRT, CT und Sonographie in der praeoperativen Beurteilung der Primaertumorausdehnung beim malignen Pleuramesotheliom

    Energy Technology Data Exchange (ETDEWEB)

    Layer, G.; Steudel, A.; Schild, H.H. [Radiologische Universitaetsklinik Bonn (Germany); Schmitteckert, H.; Tuengerthal, S.; Schirren, J. [Thoraxklinik Heidelberg-Rohrbach (Germany); Kaick, G. van [Deutsches Krebsforschungszentrum Heidelberg (Germany). Schwerpunkt fuer Onkologische Diagnostik und Therapie

    1999-04-01

    Purpose: Evaluation of the diagnostic value of the imaging modalities computed tomography (CT), magnetic resonance imaging (MRI), and thoracic sonography in the preoperative staging of malignant pleural mesothelioma. Results: The accuracy rates for CT were 85%, 98%, 83%, 73%, 71%, and 83%. MRI had an accuracy of 71%, 92%, 71%, 83%, 71%, and 96%, the thoracic ultrasound examinations of 76%, 63%, 51%, 60%, 71% and 89%. Conclusions: According to these results CT remains the method of choice in the preoperative assessment of T-stage of malignant pleural mesothelioma. MRI is of nearly the same value, but is not a must. Sonography may be supplementary method for operation planning. (orig./AJ) [Deutsch] Ziel: Evaluation der diagnostischen Wertigkeit der Schnittbildverfahren MRT, CT und Sonographie in der praeoperativen Diagnostik des Pleuramesothelioms. Ergebisse: Die Treffsicherheiten betrugen fuer die genannten anatomischen Regionen im CT 85%, 98%, 83%, 73%, 71%, und 83%, im MRT 71%, 92%, 71%, 83%, 71% bzw. 96%, waehrend sich fuer die thorakale Ultraschalluntersuchung Treffsicherheiten von 76%, 63%, 51%, 60%, 71% und 89% errechneten. Schlussfolgerungen: Die CT bleibt damit das Verfahren erster Wahl in der praeoperativen Diagnostik des malignen Pleuramesothelioms. Eine unbedingte Forderung nach praeoperativer Durchfuehrung einer MRT-Untersuchung ergibt sich nach der vorliegenden Studie nicht. Die Sonographie des Thorax und oberen Abdomens liefert einen wichtigen ergaenzenden Beitrag bei der Planung der Operation des malignen Pleuramesothelioms. (orig./AJ)

  7. Progress in biogas. Biogas production from agricultural biomass and organic residues. Pt. 1 and 2. Proceedings (oral presentations and poster presentations); Fortschritt beim Biogas. Biogas aus landwirtschaftlicher Biomasse and organischen Reststoffen. T. 1 und 2. Tagungsband. Vortraege and Poster

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    Within the International Conference ''Progress in Biogas - Biogas production from agricultural biomass and organic residues'' at the University Hohenheim (Stuttgart, Federal Republic of Germany) from 18th to 21st September, 2007, the following lectures were held: (1) Global relevance and potential of bioenergy for regional development; (2) Biogas electricity for France feed-in tariff and some other things to know before entering French market; (3) Policy drivers and future prospects for on-farm anaerobic digestion in Northern Ireland; (4) Biogas in Belgium, a swot analysis; (5) Status and prospects of biogas energy use in Ukraine; (6) Recent developments in Chinese agricultural biogas production; (7) Opportunities for agricultural based biogas systems in the province of Ontario, Canada; (8) Pre-treatment and digestion of separated collected household waste in Sweden; (9) To the problem of monitoring measures and prophylaxis measures with the utilization of organic residual substances in biological gas facilities from hygienic view; (10) Fermenting residues from biological gas facilities - nutrients and pollutants, possibilities of application in the agriculture; (11) Treatment and utilization of fermentation residues; (12) Potential of residual gas of NaWaRo feeded biogas plants in Baden-Wuerttemberg; (13) Operating analytics of biogas plants to improve efficiency and to ensure process stability; (14) The potential of biogas and electric power production from subproducts in the sugar and alcohol industries by the application of anaerobic digestion; (15) Co-digestion plant in dairy cattle farm in Emilia Romagna region (Italy); (16) Facing operational problems in a biodigeser in Yuvientsa - Amazonian Region of Ecuador; (17) Biogas plant instead of milk cow - payment and occupation with the use of grassilage; (18) Biogas in ecologic agriculture - experiences from 3 years of fermentation of grass-clover ley; (19) Combined solar-biogas basis for the population social level raising; (20) Production of biogas with grassilage - when is this profitable?; (21) Biogas: Opportunity or threat for the agriculture; (22) Country report Cameroon; (23) Fruit wastes bioconversion for anaerobic co-digestion with pig manure. Process development for the recycling in decentralised farm scale plants; (24) A parameter estimation protocol for anaerobic digestion; (25) BABIU - a new process for production of biomethane from biogas; (26) Dry fermentation of organic wastes; (27) Biological production of hydrogen from agricultural raw materials and residual materials with subsequent methane step; (28) Two phase continuous digestion of solid manure on-farm; (29) Investigation and development of an optimal process of fermenentation of grassilage by a two-phase process operation; (30) Technical weak points at biogas plants - occasions, effects and measures; (31) Plant safety - a substantial component according to permission and availability of biogas plants; (32) Analysis and evaluation of alternative concepts of the energetic use of biogas and other biogenous gases; (33) Gas-side bundling of some biogas plants, gas processing and gas feeding; (34) Technical and economical demands to biogas production for feeding into the HD grid; (35) Thinking about the use of biogas from the view of heat utilization - development of concepts for bioenergy villages; (36) Biogas cogeneration plant in the practice: Behaviour of emission and performance; (37) The future of biogas in Europe: Visions and targets until 2020; (38) Two-stage dry-wet-fermentation - optimization of the hydrolysis for a short space-time-yields; (39) Manure-free fermentation of renewable raw materials; (40) Quantification of different microbial population in termophilic-dry anaerobic digestion; (41) The use of hydrolytic enzymes in agricultural biogas production; (42) A contribution to mobile online gas diagnostics according to the efficiency of biogas plants; (43) Genetic 'fingerprints' to characterize microbial communities during organic overloading and in large-scale biogas plants; (44) Codigestion of olive mill wastewater and swine manure using UASB bioreactors for biogas production; (45) Addition of fibre cracking enzymes according to the enhancement of yield of biogas of energy plants; (46) On-site consulting of operators of biogas plants; (47) Cooperation between energy economy and agriculture at Erdgas Suedwest (Concept of biogas upgrading as a cooperation perspective for gas utilities and agriculture); (48) Cooperative operator models for biogas plants with utilization of heat in municipal sites - a common community of agriculturists and an experienced contractor; (49) Risk and insurance management for biogas plants; (50) Experiences in the german-chinese market of biogas and utilization of CDM projects.

  8. Interdisciplinary analysis of the chances of implementation of an energy conservation and air pollution abatement policy. Adverse and favourable conditions for rational energy use in private households and their responsible decision-makers from an economic and social psychological perspective; Interdisziplinaere Analyse der Umsetzungschancen einer Energiespar- und Klimaschutzpolitik. Hemmende und foerdernde Bedingungen der rationellen Energienutzung fuer private Haushalte und ihr Akteursumfeld aus oekonomischer und sozialpsychologischer Perspektive

    Energy Technology Data Exchange (ETDEWEB)

    Hennicke, P.; Jochem, E.; Prose, F.

    1997-08-01

    The investigation attempted an analysis of the causes and remedies of the gap between ecological and climate-relevant requirements on the one hand and public and political action on the other hand. It presents a theoretical concept for an ecologically oriented social restructuring process which will support rational energy use and the appropriate research and development measures more strongly than it does now. While the Federal government intends a 25 % reduction of carbon dioxide emissions by 2005, an 80 % reduction is required on a long-term basis (e.g. by 2050). In view of this, the contribution of the German government is interpreted as a necessary but still insufficient contribution to sustainability. [German] Diese Studie erarbeitet einen Beitrag zur Analyse der Ursachen und Loesungsmoeglichkeiten fuer den Widerspruch zwischen umwelt- und klimarelevanten Handlungsnotwendigkeiten einerseits und den gesellschaftlichen Handlungsdefiziten andererseits. Weitergehend erbringt sie einen theoretisch-konzeptionellen Ansatz zum oekologischen Umbau der Industriegesellschaft. Dadurch wird konkret dazu beigetragen, die Politik zur rationellen Energieanwendung einschliesslich der Forschungs- und Entwicklungspolitik besser als bisher zu unterstuetzen. Ausgegangen wird von dem energie- und klimapolitischen Ziel der Bundesregierung, bis zum Jahr 2005 die CO{sub 2}-Emissionen gegenueber dem Referenzjahr 1990 um 25% zu reduzieren. Langfristig, bis etwa zum Jahr 2050, ist nach der Empfehlung der Klima-Enquete-Kommission eine CO{sub 2}-Reduktion um 80% erforderlich. Dieser Beitrag der Bundesrepublik zum internationalen Klimaschutz kann als notwendige, wenn auch noch nicht hinreichende Voraussetzung fuer eine 'zukunftsfaehige Entwicklung' (sustainability) in der Bundesrepublik interpretiert werden. (orig.)

  9. Efficient radiologic diagnosis of pelvic and acetabular trauma; Rationelle bildgebende Diagnostik von Becken- und Azetabulumverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, K.F.; Mildenberger, P.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Rommens, P.M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Unfallchirurgie

    2000-01-01

    In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury. (orig.) [German] Bei der Klaerung einer Verletzung des Beckens oder des Azetabulums stellen konventionelle Uebersichtsaufnahmen weiterhin die Basis der bildgebenden Diagnostik dar. Art und Umfang werden bestimmt von lokalen Gegebenheiten (z.B. Verfuegbarkeit von CT-Geraeten) sowie vom klinischen Zustand des Patienten. Aufgrund der diagnostischen Ungenauigkeit der konventionellen Roentgendiagnostik gerade im Bereich des stabilitaetsbedeutsamen dorsalen Beckenringes und des Azetabulums schliesst sich beim klinisch stabilen

  10. Biomarkers Prognostic for Elevated Intracranial Pressure

    Science.gov (United States)

    2016-03-01

    Orthopedic injury (n=20) iii) Exclusion of patients with polytrauma . It has been reported that serum ceruloplasmin (as well as copper) levels...inclusion of polytrauma patients in our results. We therefore identified the TBI patients with isolated head trauma, and compared the recorded...ceruloplasmin values between those with elevated ICP and those without. Figure 13 shows that when the patients with polytrauma were excluded from the

  11. Preclinical Evaluation of the Effects of Aeromedical Evacuation on Military-Relevant Casualties

    Science.gov (United States)

    2017-10-01

    Evaluation of the timing of aeromedical evacuation in rat and swine models of TBI and polytrauma ” will investigate whether early vs delayed aeromedical...injury. Instrumented swine with polytrauma [TBI, hemorrhagic shock (HS), and acute respiratory distress syndrome (ARDS)] will be resuscitated and...2). WRAIR/NMRC IACUC protocol 17-OUMD-29LS “Evaluation of the Timing of Aeromedical Evacuation in Rat and Swine Models of TBI and Polytrauma

  12. Characterization and Comparison of Combat Related Injuries in Women During OIF and OEF

    Science.gov (United States)

    2016-01-05

    military women have sustained in recent conflicts, with specific attention to polytrauma incidence in this population. In addition to studying physical...multi- ple body regions because of polytrauma . *p ≤ 0.05; **p < 0.01; ***p < 0.001. TABLE I. Demographic and Injury Characteristics by Mission 2003...that were involved in explosive events.18 Polytrauma was evident in the majority of women injured in these conflicts; findings showed that almost 65

  13. Evaluation of SOCOM Wireless Monitor in Trauma Patients

    Science.gov (United States)

    2016-02-01

    justified in polytrauma patients? Presented at 2014 American College of Surgeons Florida Committee on Trauma Paper Competition Jacksonville, FL Oct...Model of Polytrauma , Hemorrhage and Traumatic Brain Injury” J Trauma Acute Care Surg 2013 Dec 75(6):974-975 4) Thorson CM, Dubose JJ, Rhee P, Knuth TE...injury increase the risk for venous thromboembolism in polytrauma patients? J Trauma Acute Care Surg 2014 Aug;77(2):243-50. 26) Ryan ML, Van Haren RM

  14. A SOF Damage Control Resuscitation Cocktail

    Science.gov (United States)

    2015-05-01

    resuscitation (DCR) cocktail for use by SOF’s that is capable of improving survival from polytrauma in austere settings. The cocktail components...components are tested in a combat-relevant swine polytrauma model of hemorrhagic shock with traumatic brain injury, free internal bleeding from an aortic...from polytrauma in austere settings. The cocktail components include Hextend for volume resuscitation and tissue perfusion, fibrinogen concentrate

  15. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Treatments (A-Z) Hepatitis HIV Mental Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation ...

  16. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Military Exposures Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations ...

  17. Clostridium perfringens challenge and dietary fat type modifies performance, microbiota composition and histomorphology of the broiler chicken gastrointestinal tract

    DEFF Research Database (Denmark)

    Josefiak, Damian; Swiatkiewicz, S; Kieronczyk, B

    2016-01-01

    Belastung mit Clostridium perfringens und Futterfettquelle modifizieren die Leistung, die Zusammensetzung der Microbiota und die Histomorphologie des Verdauungstraktes beim Broiler......Belastung mit Clostridium perfringens und Futterfettquelle modifizieren die Leistung, die Zusammensetzung der Microbiota und die Histomorphologie des Verdauungstraktes beim Broiler...

  18. Evaluation of radiation dose in 64-row whole-body CT of multiple injured patients compared to 4-row CT; Evaluation der Strahlendosis bei Polytrauma-CT-Untersuchungen eines 64-Zeilen-CT im Vergleich zur 4-Zeilen-CT

    Energy Technology Data Exchange (ETDEWEB)

    Harrieder, A.; Geyer, L.L.; Koerner, M.; Deak, Z.; Wirth, S.; Reiser, M.; Linsenmaier, U. [Ludwig-Maximilians-Univ. Muenchen (Germany). Inst. fuer Klinische Radiologie

    2012-05-15

    Purpose: To evaluate radiation exposure in whole-body CT (WBCT) of multiple injured patients comparing 4-row multidetector computed tomography (MDCT) to 64-row MDCT. Materials and Methods: 200 WBCT studies were retrospectively evaluated: 92 4-row MDCT scans and 108 64-row MDCT scans. Each CT protocol was optimized for the particular CT system. The scan length, CT dose index (CTDI), and dose length product (DLP) were recorded and analyzed for radiation exposure. The mean effective dose was estimated based on conversion factors. Student's t-test was used for statistical analysis. Results: The mean CTDI{sub vol} values (mGy) of the thorax and abdomen were significantly reduced with 64-row MDCT (10.2 {+-} 2.5 vs. 11.4 {+-} 1.4, p < 0.001; 14.2 {+-} 3.7 vs. 16.1 {+-} 1.7, p < 0.001). The DLP values (mGy x cm) of the head and thorax were significantly increased with 64-row MDCT (1305.9 {+-} 201.1 vs. 849.8 {+-} 90.9, p < 0,001; 504.4 {+-} 134.4 vs. 471.5 {+-} 74.1, p = 0.030). The scan lengths (mm) were significantly increased with 64-row MDCT: head 223.6 {+-} 35.8 vs. 155.5 {+-} 12.3 (p < 0.001), thorax 427.4 {+-} 44.5 vs. 388.3 {+-} 57.5 (p < 0.001), abdomen 520.3 {+-} 50.2 vs. 490.8 {+-} 51.6 (p < 0.001). The estimated mean effective doses (mSv) were 22.4 {+-} 2.6 (4-row MDCT) and 24.1 {+-} 4.6 (64-row MDCT; p = 0.001), resulting in a percentage increase of 8 %. Conclusion: The radiation dose per slice of the thorax and abdomen can be significantly decreased by using 64-row MDCT. Due to the technical advances of modern 64-row MDCT systems, the scan field can be adapted to the clinical demands and, if necessary, enlarged without time loss. As a result, the estimated mean effective dose might be increased in WBCT. (orig.)

  19. Harnessing Neuroplasticity to Promote Rehabilitation: CI Therapy for TBI

    Science.gov (United States)

    2015-10-01

    the Tampa VAMC and San Antonio VAMC, which both host Polytrauma Rehabilitation Centers. In addition, we plan to work with the Alabama Brain Injury...sites with those funds, e.g., the Tampa VAMC and San Antonio VAMC, which both host Polytrauma Rehabilitation Centers. In addition, we are seeking

  20. Medical Surveillance Monthly Report (MSMR). Volume 22, Number 12, December 2015

    Science.gov (United States)

    2015-12-01

    injury. In fact, PTSD, chronic pain, and persis- tent post-concussive symptoms have been termed the “ polytrauma clinical triad.”7–10 However, whether...SK, Clark ME, Morasco BJ, Freeman M, Campbell R, Helfand M. Systematic review of the literature on pain in patients with polytrauma including

  1. Inflammatory bowel diseases (IBD) - critical discussion of etiology, pathogenesis, diagnostics, and therapy; Chronisch entzuendliche Darmerkrankungen - Kritische Diskussion von Aetiologie, Pathogenese, Diagnostik und Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Ochsenkuehn, T.; Sackmann, M.; Goeke, B. [Medizinische Klinik II, Klinikum der Universitaet Muenchen-Grosshadern (Germany)

    2003-01-01

    rather be adapted to the patient's individual inflammatory pattern than be oriented to schematic treatment rules.New endoscopic and radiologic techniques provide the necessary diagnostic tools. (orig.) [German] Zielsetzung Die chronisch entzuendlichen Darmerkrankungen (CED) Morbus Crohn und Colitis ulcerosa befallen ca. jeden 500.Menschen. Obwohl sich, angetrieben durch therapeutische Erfolge der Zytokinforschung, immer mehr medizinische Einrichtungen mit Fragestellungen rund um die CED beschaeftigen, stellen diese Erkrankungen fuer Patient und Arzt immer noch eine lebenslange Herausforderung dar.Die enge interdisziplinaere Zusammenarbeit zwischen Gastroenterologie, Radiologie und Chirurgie ist entscheidend fuer ein effizientes Diagnose- und Therapiekonzept, dessen Grundlagen wir in unserer Uebersichtsarbeit erlaeutern wollen.Methodik Aus der Sicht des den Patienten betreuenden Gastroenterologen werden, basierend auf aktuellen Publikationen und Erfahrungswerten einer CED-Klinik, Aspekte aus Aetiologie,Pathogenese,Diagnostik und Therapie der CED dargestellt.Ergebnisse Eine genetisch beeinflusste, ueberschiessende und anhaltende Immunreaktion gegen die eigene Darmflora scheint eine der wichtigsten Ursachen dieser Erkrankungen zu sein.Auch Umwelteinfluesse sind von Belang.So wurde z.B.lange Zeit der Einfluss des Zigarettenrauchens beim Morbus Crohn als unguenstig eingeschaetzt, nun zeigt sich sogar, dass Rauchen einen eindeutigen Risikofaktor in Genese und Unterhaltung dieser Erkrankung darstellt.Da die CED und insbesondere der Morbus Crohn als systemische Erkrankungen betrachtet werden muessen, setzen therapeutische Ueberlegungen eine genaue Kenntnis des Organbefalls voraus.So kann z.B.durch den Einsatz der MRT-Enteroklysmatechnik eine strahlungsarme Untersuchung derjenigen Teile des Verdauungstrakts erreicht werden, die bisher einer routinemaessigen Inspektion nicht zugaenglich waren,wie z.B.das untere Jejunum und das obere Ileum. Therapeutisch scheint es zu einem

  2. Netzformen und VDE-Bestimmungen

    Science.gov (United States)

    Bernstein, Herbert

    Der Verband Deutscher Elektrotechniker (VDE) hat eine Reihe von Vorschriften ausgearbeitet, die dem Schutz von Leben und Sachen beim Umgang mit elektrischer Energie dienen. Besonders wichtig sind die in den VDE-Bestimmungen 0100 und 0411 festgelegten Vorschriften.

  3. Gender-Pay-Gap

    OpenAIRE

    Eicker, Jannis

    2017-01-01

    Der Gender-Pay-Gap ist eine statistische Kennzahl zur Messung der Ungleichheit zwischen Männern* und Frauen* beim Verdienst. Es gibt zwei Versionen: einen "unbereinigten" und einen "bereinigten". Der "unbereinigte" Gender-Pay-Gap berechnet den geschlechtsspezifischen Verdienstunterschied auf Basis der Bruttostundenlöhne aller Männer* und Frauen* der Grundgesamtheit. Beim "bereinigten" Wert hingegen werden je nach Studie verschiedene Faktoren wie Branche, Position und Berufserfahrung herausger...

  4. Phylogenetische und funktionelle Analysen zur Kapsel O-Acetyltransferase NeuO von Escherichia coli K1

    OpenAIRE

    Mordhorst, Ines Louise

    2010-01-01

    Escherichia coli ist ein Kommensale des menschlichen und tierischen Gastrointestinaltraktes. Einige E. coli-Stämme sind in der Lage, extraintestinale Erkrankungen beim Menschen wie Harnwegsinfekte, Neugeborenen-Meningitis und Sepsis, sowie beim Tier aviäre Coliseptikämien, hervorzurufen. Ein wichtiger Virulenzfaktor des Bakteriums ist dabei die aus α-2,8-verknüpften Sialinsäuremonomeren aufgebaute K1-Kapsel, die phasenvariabel mit einer hohen Frequenz O-acetyliert werden kann. Im Jahr 20...

  5. Driving systems: trends - innovations - mechatronics; Antriebssysteme: Trends - Innovationen - Mechatronik

    Energy Technology Data Exchange (ETDEWEB)

    Binder, A. [Technische Univ. Darmstadt (Germany). Inst. fuer Elektrische Energiewandlung; Wick, A. [Siemens A und D (Germany); Gold, P.W. [RWTH Aachen (Germany)

    2005-04-01

    Short overview on this special meeting with interdisciplinary topics of connection between mechanical and electrical engineering: mechatronics. The main topics are covered by the fields motion control, simulation of drives, monitoring, gears, motors engineering/-design, converter systems, industrial applications and drives for wind turbines. (GL) [German] Zeitgemaesse Planung und Entwicklung von Antriebssystemen bedarf eines interdisziplinaeren Vorgehens zwischen Elektrotechnik und Maschinenbau. Die erstmalig von VDE und VDI gemeinsam abgehaltene Tagung mit ca. 70 Fachbeitraegen ist folglich bewusst als interdisziplinaere Konferenz an der Nahtstelle von Maschinenbau und Eletrotechnik konzipiert worden. Die Schwerpunktthemen decken dabei die Bereiche Motion Control, Antriebsstrangmodellierung, Monitoring, Getriebetechnik, Motorentechnik/-bemessung, Umrichtertechnik, industrielle Antriebsapplikationen und Antriebe in der Windenergie ab. (orig.)

  6. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen ...

  7. Verletzungsschwere und -lokalisationen polytraumatisierter Kinder im Vergleich zu Erwachsenen und deren Bedeutung für das Schockraummanagement

    DEFF Research Database (Denmark)

    Zwingmann, J; Schmal, H; Südkamp, N P

    2008-01-01

    PURPOSE: The treatment of paediatric polytrauma patients in the emergency room is not common. The knowledge of specific injuries in consideration of the age-specific characteristics is of particular importance for precise diagnostics and therapy. The goal of this study is the aquisition of the fr......PURPOSE: The treatment of paediatric polytrauma patients in the emergency room is not common. The knowledge of specific injuries in consideration of the age-specific characteristics is of particular importance for precise diagnostics and therapy. The goal of this study is the aquisition...... of the frequency, the localisation and the severity of paediatric polytrauma (age: 0-16 years) in comparison with adults. PATIENTS AND METHODS: In the period 7 / 01 to 5 / 04 the localisation and injury severity of 23 paediatric polytrauma patients (age: 2-16 years) were compared retrospectivly with those of 324...

  8. Mortality in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Hauschild, Oliver; Strohm, Peter C; Culemann, Ulf

    2008-01-01

    hospitals were evaluated for age, gender, Injury Severity Score (ISS), Hannover Polytrauma Score (PTS), fracture type (using Tile's classification), peripelvic soft tissue injury, need for emergency measures, mortality, cause of death, and need for operative stabilization. We compared the patients...

  9. Multidisciplinaire aanpak bij aangezichtsletsel

    NARCIS (Netherlands)

    Dubois, L.; Schreurs, R.; Lapid, O.; Saeed, P.; Adriaensen, G. F.; Hoefnagels, F. M.; de Jong, V. M.

    2017-01-01

    Approximately one quarter of polytrauma patients has facial injuries, which usually lead to loss of form and function. Several specialties are involved in the acute and reconstructive phases of facial injuries, such as oral and maxillofacial surgery, otorhinolaryngology, plastic surgery,

  10. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Website Site Map Content Inventory Accessibility Privacy and Security Updating of Web Site Web Site Policies Important ... Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations ...

  11. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... a VA Appointment Conditions & Treatments See All Conditions & Treatments (A-Z) Hepatitis HIV Mental Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation ...

  12. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Home Apply for VA Care Apply Online Application Process Veteran Eligibility Active Duty Families of Veterans Women ... Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation Spinal Cord Injury ...

  13. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Types of Trauma Trauma Basics Disaster and Terrorism Military Trauma Violence & other Trauma Assessment Assessment Overview Adult ... Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma ...

  14. Can the 'Assessment Drives Learning' effect be detected in clinical skills training? - Implications for curriculum design and resource planning [Der “Assessment Drives Learning”-Effekt beim Training klinisch-praktischer Fertigkeiten - Implikationen für die Curriculumsgestaltung und die Planung von Ressourcen

    Directory of Open Access Journals (Sweden)

    Buss, Beate

    2012-11-01

    Full Text Available [english] Purpose: The acquisition of clinical-technical skills is of particular importance for the doctors of tomorrow. Procedural skills are often trained for the first time in skills laboratories, which provide a sheltered learning environment. However, costs to implement and maintain skills laboratories are considerably high. Therefore, the purpose of the present study was to investigate students’ patterns of attendance of voluntary skills-lab training sessions and thereby answer the following question: Is it possible to measure an effect of the theoretical construct related to motivational psychology described in the literature – ‘Assessment drives learning’ – reflected in patterns of attendance at voluntary skills-lab training sessions? By answering this question, design recommendations for curriculum planning and resource management should be derived.Method: A retrospective, descriptive analysis of student skills-lab attendance related to voluntary basic and voluntary advanced skills-lab sessions was conducted. The attendance patterns of a total of 340 third-year medical students in different successive year groups from the Medical Faculty at the University of Heidelberg were assessed.Results: Students showed a preference for voluntary basic skills-lab training sessions, which were relevant to clinical skills assessment, especially at the beginning and at the end of the term. Voluntary advanced skills-lab training sessions without reference to clinical skills assessment were used especially at the beginning of the term, but declined towards the end of term.Conclusion: The results show a clear influence of assessments on students’ attendance at skills-lab training sessions. First recommendations for curriculum design and resource management will be described. Nevertheless, further prospective research studies will be necessary to gain a more comprehensive understanding of the motivational factors impacting students’ utilisation of voluntary skills-lab training in order to reach a sufficient concordance between students’ requirements and faculty offers, as well as resource management.[german] Zielsetzung: Die Vermittlung klinisch-praktischer Fertigkeiten ist von entscheidender Bedeutung für die Berufsfähigkeit angehender Ärzte. Prozedurale Fertigkeiten werden dabei häufig zu allererst in sogenannten Skills-Labs trainiert, die eine geschützte Lernumgebung gewährleisten. Die Implementierung und auch Pflege von Skills-Labs stellt allerdings eine nicht geringfügige finanzielle Herausforderung dar. Aus diesem Grund hat sich die vorliegende Arbeit zum Ziel gesetzt, die Besuchsfrequenzen und –muster im Rahmen freiwilliger Skills-Lab-Unterrichtseinheiten zu untersuchen, um folgende Frage zu beantworten: Kann der in der Literatur beschriebene, motivationspsychologische Effekt des “Assessment drives learning” festgestellt werden und spiegelt sich dieser in dem Besuchsverhalten von Studierenden in freiwilligen Skills-Lab-Unterrichtseinheiten wider? Ausgehend von den Studienergebnissen sollen Empfehlungen für die Curriculumsplanung und das Ressourcenmanagement abgeleitet werden.Methode:. Eine retrospektive, deskriptive Analyse studentischen Inanspruchnahmeverhaltens sowohl von freiwilligen „Basic“- als auch „Advanced“ Skills-Lab-Unterrichtseinheiten wurde durchgeführt. Hierzu wurden Teilnahmemuster von 340 Medizinstudierenden des dritten Studienjahres verschiedener Jahrgänge an der Medizinischen Fakultät Heidelberg näher untersucht.Ergebnisse: Die Studierenden zeigten besonders zu Beginn und am Ende des Semesters eine Präferenz für die Teilnahme an freiwilligen “Basic“ Skills-Lab-Unterrichtseinheiten, die für die klinisch-praktische Prüfung relevant sind. Freiwillige “Advanced“ Skills-Lab”-Unterrichtseinheiten ohne Bezug zur klinisch-praktischen Prüfung wurden vor allem zu Beginn des Semesters genutzt, mit einem Rückgang der Besuche gegen Ende des Semesters.Fazit: Die Ergebnisse zeigen einen deutlichen Einfluss klinisch-praktischer Prüfungen auf die studentischen Teilnahmen an Skills-Lab-Unterrichtseinheiten. Empfehlungen für die Planung des Curriculums und das Ressourcenmanagement werden dargestellt. Weitere, prospektive Studien sind erforderlich, um ein umfassenderes Verständnis motivationaler Faktoren zu entwickeln, die Studierende dazu veranlassen, freiwillige Skills-Lab-Unterrichtseinheiten zu besuchen. Damit kann eine noch erfolgreichere Abstimmung zwischen studentischen Anforderungen und Fakultätsangeboten sowie ein effizientes Ressourcenmanagement erzielt werden.

  15. Basic concepts and estimated maximum possible employment effects of a consistent development of renewable energy systems in Nordrhein-Westfalen. 1st technical report; Konzeptionelle Grundlagen und Abschaetzung zukuenftig maximal moeglicher Bruttobeschaeftigungseffekte beim Ausbau erneuerbarer Energiesysteme in Nordrhein-Westfalen. 1. Technischer Fachbericht

    Energy Technology Data Exchange (ETDEWEB)

    Mohr, M.; Ziegelmann, A.; Unger, H.

    1995-12-01

    In the First Technical Report the fundamental ideas for the realization of this project are presented and the future possible maximum gross employment effects of an expansion of renewable energy systems in North-Rhine-Westphalia with consideration of the present-day cost structure are quantified in an initial stage. In this connection gross employment effects are defined as exclusive positive job effects without consideration of possible negative employment effects on the basis of less investments in other sectors of the economy. Based on a subdivided presentation of the intended course of the project and a formulation of its main objectives, a detailed description of the theoretical background of the applied methods of input-output analysis is provided. After the presentation of some different methods and the necessary assumptions, the analysis takes the so-called `Keynesian income multiplier` into account to accommodate the effects of an increase in national income. To use a known investment distribution, grouped in 21 sub-divisions according to categories of applications, within the scope of an input-output-analysis, the investments are converted. After the determination of the matrices, necessary to quantify employment effects, the maximum possible gross effects concerning the future job market of the Federal Republic of Germany will be assessed with consideration of the fluctuations in productivity on sector level. A total of 700.000 new jobs can be expected, of which about 27% are due to the increase of personal disposable income and the resulting rise in consumer spending respectively. (orig./UA) [Deutsch] Im vorliegenden 1. Technischen Fachbericht werden konzeptionelle Grundlagen zur Realisierung des Vorhabens eroertert und es wird eine erste Abschaetzung der potentiellen Bruttobeschaeftigungswirkungen eines Ausbaus erneuerbarer Energiesysteme in Nordrhein-Westfalen durchgefuehrt. Unter Bruttobeschaeftigungswirkungen werden dabei ausschliesslich positive Arbeitsplatzwirkungen ohne Beruecksichtigung moeglicher negativer Beschaeftigungseffekte aufgrund von Minderinvestitionen in anderen Wirtschaftsbereichen verstanden. Im Anschluss an die gegliederte Darstellung des geplanten Projektablaufs und Formulierung der einzelnen Zielsetzungen wird die fuer die Untersuchung notwendige Methode der Input-Output-Analyse vorgestellt. Neben der Erlaeuterung verschiedener Modelle und der notwendigen Annahmen wird die gewaehlte Analysemethode um den sogenannten `Keynes`schen Einkommensmultiplitkator` erweitert, um auch Auswirkungen eines erhoehten privaten Konsums zu beruecksichtigen. Eine nach 21 verschiedenen Nutzungsarten gegliederte Investitionsverteilung wird daran anschliessend zusammengefasst und fuer die Verwendung im Rahmen einer Input-Output-Analyse umgerechnet. Nach der Bestimmung der fuer die Quantifizierung der Beschaeftigungswirkungen notwendigen Berechnungsmatrizen koennen schliesslich die fuer den bundesdeutschen Arbeitsmarkt zu erwartenden Bruttobeschaeftigungseffekte in erster Naeherung ermittelt werden, wobei sektorielle Produktivitaetsaenderungen bis zum Zeitpunkt der Investitionen beruecksichtigt werden. Es ergeben sich insgesamt rund 700.000 neue Arbeitsplaetze, von denen etwa 27% auf die Erhoehung der verfuegbaren Einkommen bzw. den damit verbundenen Anstieg des privaten Konsums zurueckzufuehren sind. (orig./UA)

  16. Studies for reconstruction efficiency and background measurements of {tau} lepton identification in Z {yields} {tau}{tau} decays in data of the ATLAS experiment; Studien zur Messung von Rekonstruktionseffizienz und Untergrund der {tau}-Lepton-Identifikation im Zerfall Z {yields} {tau}{tau} beim ATLAS-Experiment aus Daten

    Energy Technology Data Exchange (ETDEWEB)

    Johnert, Sebastian

    2008-11-15

    In this diploma thesis two methods are presented, by which {tau} leptons shall be studied in the future data of the ATLAS experiment. The first part is formed by the determination of misidentification rates of jets from QCD 2-jet events as {tau} particles. The second part is the development of a method for the determination of the {tau} reconstruction and identification efficiency relatively to the {mu} efficiency. In this connection invariant masses from Z{yields}ll events are determined, the masses from Z{yields}{tau}{tau} events compared with those from Z{yields}ee and Z{yields}{mu}{mu}, {tau} efficiencies averaged over all ranges and in different {eta} ranges calculated as well as a mehtod for the determination of {tau} efficiencies in different transverse-momentum ranges presented. Furthermore an improved estimation of the QCD background is performed and the behaviour of the {tau} efficiency under regardment of the trigger studied. [German] In dieser Diplomarbeit werden zwei Methoden vorgestellt, mit denen {tau}-Leptonen in den zukuenftigen Daten des ATLAS-Experiments untersucht werden sollen. Den ersten Teil bildet die Bestimmung von Missidentifikationsraten von Jets aus QCD-2-Jet-Ereignissen als {tau}-Leptonen. Der zweite Teil ist die Entwicklung einer Methode zur Bestimmung der {tau}-Rekonstruktions und -Identifikationseffizienz relativ zur {mu}-Effizienz. In diesem Zusammenhang werden invariante Massen aus Z {yields} ll-Ereignissen bestimmt, die Massen aus Z {yields} {tau}{tau}-Ereignissen mit denen aus Z {yields} ee und Z {yields} {mu}{mu} verglichen, {tau}-Effizienzen gemittelt ueber alle Bereiche und in verschiedenen {eta}-Bereichen berechnet sowie eine Moeglichkeit zur Bestimmung von {tau}-Effizienzen in unterschiedlichen Transversalimpulsbereichen vorgestellt. Des Weiteren wird eine verbesserte Abschaetzung des QCD-Untergrunds vorgenommen und das Verhalten der {tau}-Effizienz unter Beruecksichtigung des Triggers untersucht. (orig.)

  17. Was Hänschen nicht lernt, lernt Hans durch Weiterbildung: Die Bibliothek eines Gesundheitsunternehmens als kompetenter Partner beim lebenslangen Lernen / What you do not learn as a child, you will learn through further education: The library of a health enterprise as a competent partner in lifelong learning

    Directory of Open Access Journals (Sweden)

    Schröder, Alexander

    2008-12-01

    Full Text Available The traditional wise saying "you can’t teach an old dog new tricks“ has long been outdated. The most important production factor in the establishing of a “health” service is no doubt the human capital. Well trained, highly qualified people who are able to learn further are needed in order to provide the patients with a service at its highest quality. This means, that the success of an enterprise in the health market resides in its ability to make it possible for its employees to acquire a lifelong education. The strategy of the HELIOS hospitals has thus been to increase the knowledge of its employees and to provide the optimal conditions for the appropriation of further knowledge. The aim is to gather the existing knowledge structures of the concern and to make it easily available on a platform. The central library of the concern is used as an example to illustrate how the library services can also be brought into the knowledge landscape of a health concern and how they could be linked with strategic partners in the field of knowledge.

  18. 20 January 2011 - Hessischer Minister für Bundesangelegenheiten und Bevollmächtigter des Landes beim Bund, Hessen, Germany M. Boddenberg signing the guest book with CERN Director-General R. Heuer and Head of International Relations F. Pauss; in the ALICE surafce exhibition and underground experimental area with P. Braun-Munzinger, V.Lindenstruth and Adviser R. Voss.

    CERN Multimedia

    Maximilien Brice

    2011-01-01

    Michael Boddenberg, Hessian Minister for Federal Affairs and Representative of Hessen in the Federal Government, visited CERN on 20 January. His tour included the ALICE experiment, the LHC tunnel, the CERN Computer Centre and CERN Control Centre.

  19. Material science studies on the formation and growth of pores in the production and creep of single-crystal nickel-based superalloys; Werkstoffwissenschaftliche Untersuchungen zur Bildung und zum Wachstum von Poren bei der Herstellung und beim Kriechen einkristalliner Nickelbasis-Superlegierungen

    Energy Technology Data Exchange (ETDEWEB)

    Buck, Heinrich Joergen

    2015-02-20

    Single crystal Ni-base superalloys (SX) are used for blades in fossil fuel fired power plants and aero engines. Here they have to withstand high mechanical stresses at temperatures close to their melting point. The blades are manufactured by a Bridgman type of directional solidification, followed by a multiple step heat treatment. During the dendritic solidification, pores can form due to undissolved gas, macroshrinkage by inadequate gating and microshrinkage caused by poor feeding between dendrites. Additional pores can form in the interdendritic regions during the multiple step heat treatment which follows solidification. It is believed, that these pores form on the basis of a Kirkendall effect which accounts for the fast diffusion of Al atoms away from microstructural regions with non-equilibrium γ/γ' eutectic. During creep, pores can grow and change their shapes. It has been shown, that during creep in the high temperature / low stress regime new pores form, which are smaller than those pores that can be found in the undeformed material. In the present work, the evolution of porosity in the single crystal Ni-base superalloy ERBO/1 during processing and creep is investigated. Quantitative microstructural analyses were performed on metallographic cross sections. Sampling fields of 4500 x 1000 μm{sup 2} were investigated by using a combination of scanning electron microscopy with quantitative image analysis. Interrupted creep tests with a miniature tensile creep specimen were performed with load direction parallel to left angle 100 right angle and left angle 110 right angle direction, respectively. Pore parameters (area, perimeter, Feret's diameter) for individual pores were obtained and two form factors were introduced. The evolution of the compiled statistical distributions of pore parameters and shape factors are discussed. The results are compared to recent findings by Link et al., 2006 and Maelzer et al., 2007. In the present study it was shown that the quantitative metallographic approach is able to qualitatively reproduce all important details of porosity evolution, which were identified by Link et al. using synchrotron radiation. Pores which the metallographic method detects directly after casting appear in a low density (17 pores/mm{sup 2}) and show very broad log-normal size distributions. Solidification pore sizes (in terms of pore areas on the metallographic cross section) can vary from 2 to 200 μm{sup 2}. During the multiple step homogenization heat treatment of ERBO/1, new pores form and the pore density increases to 34 pores/mm{sup 2}. Simultaneously, one can detect an increase in average pore sizes. The size distribution of pores shifts to higher values. During high temperature and low stress creep, new small pores form (pore density increases to values ranging from 139 pores/mm{sup 2} to 193 pores/mm{sup 2}) and the size distributions evolve from unimodal (as-cast and heat treated material state, prior to creep) to bimodal (early stages of creep). The present study furthermore represents the missing link between the synchrotron studies of Link et al., 2006 regarding the evolution of porosity and the metallographic investigations of Maelzer et al., 2007, who investigated the role of pores with respect to creep rupture. The advantage of the present study is that both, the investigation of porosity evolution and the investigation on the role of pores on creep rupture, were performed with one alloy at the same temperature/stress conditions. It has been shown, that the distribution of pores in the material and the alignment of pores relative to the loading direction are important. Maelzer et al. showed, that creep specimens with pores aligned parallel to the loading direction ([001] specimens) showed higher rupture strains compared to specimens, where pores were aligned perpendicular to the loading direction ([110] specimens). These findings have been confirmed by the present study. The metallographic results, presented in this work, suggest that creep rupture is associated with the formation of microcracks at larger solidification and heat treatment pores, which can grow, interlink and initiate final creep rupture. Creep pores appear, due to their size, to be less important with respect to creep rupture. The alignment of pores along the dendrites and their relative position to the loading direction are the key factors, that can limit creep life. Finally, the influence of the crystallographic orientation on the evolution of porosity was investigated. It has been shown, that there are no fundamental differences of the size and shape factor distributions, when [001] and [110] oriented specimens are compared, but there are differences in the appearance of crystallographic facets and an orientation dependency of pore growth is suggested.

  20. In competition for the best energy-plus building. German teams score at Solar Decathlon Europe 2012 with architecture, engineering and marketing opportunities; Im Wettkampf um das beste Plusenergiehaus. Deutsche Teams punkten beim Solar Decathlon Europe 2012 mit Architektur, Konstruktion und Vermarktungschancen

    Energy Technology Data Exchange (ETDEWEB)

    Gintars, Dorothee

    2012-07-01

    For the competition, 18 interdisciplinary student teams from all over the world developed and built houses that generate at least as much energy - using solar systems - as they consume. They were supported by their universities, researchers and companies. From Germany, students took part from Hochschule Konstanz University of Applied Sciences (HTWG) and RWTH Aachen University, supported with government energy research funds. Whereas the design from Constance has perfected a modular construction system, with the Aachen team the focus is on recycling. After ten disciplines, the two homes achieved 4{sup th} and 5{sup th} places. (orig.)

  1. Studies on the widening of the variation of the fatty acid pattern in flax (Linum usitatissimum L. ) by means of interspecific hybridisation and in-vitro techniques. Untersuchungen zur Erweiterung der genetischen Variation des Fettsaeuremusters beim Lein (Linum usitatissimum L. ) mit Hilfe von Artkreuzungen und in vitro Techniken

    Energy Technology Data Exchange (ETDEWEB)

    Nickel, M.

    1993-01-01

    Oil flux genotypes with strongly divergent fatty acid compositions of the seed oil are vegetable raw materials of great interest to industrial users, notably to manufacturers of edible oils and dietetic products. Compared with the moderately variable fatty acid pattern of Linum usitatissimum that of wild forms shows a far greater scatter. The studies on the widening of the genetic variation of the fatty acid pattern in cultivated flax by means of interspecific hybridization and embryo cultures have revealed the possibilities offered by, and limits to, these methods. Optimisation of the embryo culture techniques have for the first time made it possible to regenerate plants from globular embryos obtained by interspecific hybridization between Linum usitatissimum and L. monogynum. (orig./EF)

  2. Impact of pretreatment variables on the outcome of {sup 131}I therapy with a standardized dose of 150 Gray in Graves` disease; Einfluss praetherapeutischer Variablen auf die Wirkung einer standardisierten {sup 131}J-Therapie mit 150 Gray beim Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Pfeilschifter, J. [Heidelberg Univ., Radiologische Klinik (Germany). Abt. fuer Nuklearmedizin; Elser, H. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I; Haufe, S. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I; Ziegler, R. [Heidelberg Univ., Radiologische Klinik (Germany). Abt. fuer Nuklearmedizin; Georgi, P. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I

    1997-04-01

    Aim: We examined the impact of several pretreatment variables on thyroid size and function in 61 patients with Graves` disease one year after a standardized [131]I treatment with 150 Gray. Methods: FT3, FT4, and TSH serum concentrations were determined before and 1.5, 3, 6, and 12 months after therapy. Thyroid size was measured by ultrasound and scintigraphy before and one year after therapy. Results: One year after therapy, 30% of the patients had latent or manifest hyperthyroidism, 24% were euthyroid, and 46% had developed latent or manifest hypothyroidism. Age and initial thyroid volume were major predictors of posttherapeutical thyroid function. Thus, persistent hyperthyroidism was observed in 70% of the patients age 50 years and older with a thyroid size of more than 50 ml. With few exception, thyroid size markedly decreased after therapy. Initial thyroid size and age were also major predictors of posttherapeutical thyroid volume. Thyroid size normalized in all patients younger than 50 years of age, independent from initial thyroid size. Conclusion: Radioiodine treatment with 150 Gray causes a considerable decrease in thyroid size in most patients with Graves` disease. Age and initial thyroid volume are important determinants of thyroid function and size after therapy and should be considered in dose calculation. (orig.) [Deutsch] Ziel: Bei 61 Patienten mit einem Morbus Basedow haben wir den Einfluss praetherapeutischer Variablen auf die Funktion und das Volumen der Schilddruese ein Jahr nach einer {sup 131}J-Therapie mit 150 Gray untersucht. Methoden: FT3, FT4, und TSH wurden vor Therapie und eineinhalb, 3, 6 und 12 Monate nach Therapie gemessen. Das Schilddruesenvolumen wurde vor Therapie und ein Jahr nach Therapie sonographisch und szintigraphisch bestimmt. Ergebnisse: Ein Jahr nach Therapie waren 30% der Patienten latent oder manifest hyperthyreot, 24% euthyreot, und 46% latent oder manifest hypothyreot. Lebensalter und Ausgangsvolumen der Schilddruese waren die Hauptpraediktoren der posttherapeutischen Schilddruesenfunktion. Der Anteil an persistierenden Hyperthyreosen war bei aelteren Patienten mit einem Schilddruesenvolumen groesser 50 ml mit ueber 70% besonders hoch. Bei fast allen Patienten kam es zu einer deutlichen Verkleinerung der Schilddruese. Ausgangsvolumen und Lebensalter waren auch hier die Hauptpraediktoren der posttherapeutischen Schilddruesengroesse. Bei allen Patienten juenger als 50 Jahre kam es sogar unabhaengig von der Ausgangsgroesse zu einer Normalisierung des Schilddruesenvolumens. Schlussfolgerung: Eine Radiojodtherapie mit 150 Gray fuehrt bei den meisten Patienten mit einem Morbus Basedow zu einer deutlichen Verkleinerung der Schilddruese. Alter und initiales Volumen haben einen wesentlichen Einfluss auf die Funktion und Groesse der Schilddruese nach Therapie und sollten bei der Dosisfestlegung beruecksichtigt werden. (orig.)

  3. Analysis of the public debate on health hazards due to high-voltage transmission lines. Recommendations for the radiation protection related communication with respect of grid extension; Analyse des oeffentlichen Diskurses zu gesundheitlichen Auswirkungen von Hochspannungsleitungen. Handlungsempfehlungen fuer die strahlenschutzbezogene Kommunikation beim Stromnetzausbau

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Florian; Kuehne, Olaf; Jenal, Corinna; Sanio, Tina [Hochschule Weihenstephan-Triesdorf, Freising (Germany). Lehrgebiet Laendliche Entwicklung/Regionalmanagement; Langer, Kerstin [Hochschule Weihenstephan-Triesdorf, Freising (Germany). Lehrgebiet Kommunikation und Partizipation in der Landschaftsarchitektur; Igel, Michael [Hochschule fuer Technik und Wirtschaft des Saarlandes, Saarbruecken (Germany). Lehrgebiet Elektrische Energieversorgung und Gebaeudesystemtechnik

    2016-05-15

    With its phase-out of nuclear power generation and the expansion of renewably sourced energy, the German energy turnaround ('Energiewende') has radically changed existing power supply structures, with wide geographical repercussions. One aspect of this is changes to the national power grid. Existing networks are to be upgraded and new long-distance north-south power-lines built. This creates resistance and conflict. Commissioned by the Federal Office for Radiation Protection, and the Federal Ministry of the Environment, Nature Conservation, Building and Nuclear Safety, the research project entitled Analysis of public discourse on the health impacts of high-voltage power lines - recommendations for action in radiation-protection discourse related to the extension of the power grid starts precisely at the point of conflict. It first investigates from a discourse theory perspective how power grid extensions and possible health-related consequences are communicatively constructed, and what argumentation patterns dominate the discussion. From this it derives recommendations for action, with a focus on health politics information and discourse. Behind the research project stands a socio-constructivist discourse theory that sees 'social reality' not as a given but as a socially evolved entity, and its meanings, therefore, not as stable but as subject to change. The central mechanism for the communication of an objectivized social world is language. The analyses undertaken here of power grid extension are based on a methodological mix of quantitative and qualitative elements that facilitates both the differentiation of central issues and detailed examination of individual aspects. Analysis focuses on the discussion of health issues not only in the relevant literature and on civic initiative websites, but also in the first 50 Google hits, in articles from the Sueddeutsche Zeitung (SZ) and Focus, and in talk shows. The resultant discourse analysis highlights the decisive role played by different social systems and their specific logics in any evaluative judgment. While industry and politics argue from the technological and economic need for new long-distance power lines, and urge this as the basis for their legitimacy, citizens' initiatives base their objections on emotional and aesthetic grounds, rejecting the change to their domestic and social environment as a looming threat, with all its negative connotations. Plans are regularly criticized for their impact on landscape, nature conservation, local economies, tourism, and health. Citizens' initiatives almost unanimously cite health risks and fears in connection with electro/magnetic fields, while the advocates of grid extension - the Federal Network Agency and transmission system operators - take a variety of approaches to this matter. The Federal Network Agency generally marginalizes health issues, and does so in specialist language, or in terms that demand in-depth study. On the other hand Amprion GmbH, as one of the operators, uses language that is readily accessible to laypeople, and its explanations leave less room for doubt than do those of the Federal Network Agency. Amprion argues that it can fulfill its task within the existing legislative framework. Nevertheless, health issues are not the company's main concern. TenneT TSO GmbH takes a more comprehensive approach, and its statements are more readily understandable, even though they also tend to use specialist language, citing scientific studies and generally softening risk. Sound scientific results are so far notably lacking, but improved communication of the known pros and cons of this technology is also urgently required. Another consistent factor is the problematic light in which previous grid extension plans and implementation processes are typically set, and the massive civic protests to which this has at various times given rise. Transmission system operators should have learnt by now to involve citizen groups more actively in their extension plans: the desire for consultation is stronger and more vocal than it used to be. The Bavarian approach was different. The health impact of the plans was not ignored, but constituted only one among several other lines of argument, such as violation of the landscape, loss of 'home' environment, or economic impairment (especially a drop in property values - above all in the value of one's own property). In these contexts, electrosmog, electro/magnetic fields, and space charge clouds (corona discharges) become undispelled fears, or risks that are viewed as factually given rather than as 'under certain circumstances possible'. Against such opposition, to insist on the need for overhead power lines is viewed as morally depraved. In sum, the underlying need for grid extension and the technology involved on the one hand, and issues of landscape, natural environment, health, and local economies, as well as participation in the decision-making process on the other, form central fields of conflict to be negotiated at cognitive, emotional and aesthetic levels of discourse. For all these issues, recommendations geared to specific target groups can be drawn up. In accordance with the different logical systems of the protagonists, health issues in particular are approached differently, which suggests the need for a more forceful widening of perspectives. The information and communication materials produced so far by industry, politics and the grid extension lobby tends to hinder rather than help understanding of the issues by lay audiences. This state of affairs must be remedied if a cognitive dimension is to be introduced into arguments whose basis is as yet predominantly emotional and aesthetic. In this sense, a toolbox developed for professionals of the Federal Office for Radiation Protection provides a range of instruments for dealing with identified problems and situations within the conflict fields analyzed in this study.

  4. Prenatal, transplacental uptake of polychlorinated biphenyls and hexachlorobenzene in humans. Pt. 3.. Personal characteristics (gestational age, birth weight, maternal age, smoking habits of the parents) and geographic differences; Praenatale, transplazentare Uebertragung von polychlorierten Biphenylen und Hexachlorbenzol beim Menschen. T. 3. Personenbezogene Einflussfaktoren (Gestationsalter, Geburtsgewicht, muetterliches Alter, Tabakkonsum der Eltern) und geographische Unterschiede

    Energy Technology Data Exchange (ETDEWEB)

    Lackmann, G.M. [Duesseldorf Univ. (Germany). Zentrum fuer Kinderheilkunde

    2001-07-01

    It was the aim of the present study to investigate the influence of personal characteristics, like gestational age, birth weight, maternal age, smoking habits of the parents, and geographic origin, on the neonatal pollution with these harmful substances. Methods: Cord blood samples were taken from 200 full-term, healthy neonates born in Fulda or Duesseldorf, respectively, in 1998. The samples were immediately centrifuged, and serum was stored at-20 C up to analysis, which was performed in 1999. The parents must have lived life-long in each town and should never accidentally or at their working places have been exposed to high concentrations of PCBs or HCB. Six PCB congeners (28, 52, 101, 138, 153, and 180) and HCB were analysed with capillary gas-chromatography with electron capture detection. Results: We could demonstrate a statistically significant correlation between the prenatal uptake of PCBs and HCB and the gestational age of the newborns as well as the maternal age in the study group of 199 newborns (one child was excluded because of unusually high PCB values). Thereby, neonates born in the 42. week had 3.5-fold higher PCB values than children born in the 38. week, and newborns of a 50-year-old mother showed up to 500% higher values than children of a 20-year-old woman (p < 0.0001). A correlation with birth weight was not found. Furthermore, newborns of active smoking women exhibited significantly higher PCB and HCB values than children of passive smoking or non-smoking mothers. Prenatal uptake of PCBs was not different with regard to the geographic origin of the newborns, i.e. Fulda or Duesseldorf, whereas newborns from Duesseldorf showed about 62% higher HCB concentrations. (orig.) [German] Ziel der vorliegenden Untersuchung war es, den Einfluss personenbezogener Charakteristika, wie des Gestationsalters, des Geburtsgewichts, des muetterlichen Alters und des Tabakkonsums der Eltern, sowie geographischer Unterschiede auf die neonatale Schadstoffbelastung zu untersuchen. Methode: Es wurde von insgesamt 200 gesunden, reifen Neugeborenen, die 1998 entweder in Fulda oder in Duesseldorf geboren wurden, eine Nabelschnurprobe gewonnen. Die Eltern aller Kinder waren dabei zeitlebens in der betreffenden Stadt ansaessig und niemals beruflich oder akzidentell hohen PCB- oder HCB-Belastungen ausgesetzt. Das Serum wurde umgehend bei -20 C tiefgefroren; die Analysen wurden geschlossen und verblindet 1999 durchgefuehrt. Dabei wurden die sechs PCB-Kongenere 28, 52, 101, 138, 153 und 180 sowie HCB kapillar-gaschromatographisch mit ECD-Detektion bestimmt. Ergebnisse: Im Gesamtkollektiv (n = 199) - ein Kind wurde wegen ungewoehnlich hoher PCB-Konzentrationen von der Auswertung ausgeschlossen - fanden wir eine signifikante Korrelation zwischen der Schwangerschaftsdauer sowie dem muetterlichen Alter und der praenatalen Schadstoffakkumulation, wobei Kinder der 42. SSW um den Faktor 3,5 hoehere PCB-Konzentrationen aufwiesen, als Kinder der 38. SSW, und Neugeborene einer 50-jaehrigen Frau bis 500% hoehere PCB-Werte, als Kinder einer 20-jaehrigen Mutter (p < 0,0001). Ein Zusammenhang zum Geburtsgewicht bestand nicht. Ausserdem konnten wir zeigen, dass Neugeborene aktiv rauchender Muetter signifikant hoehere PCB- und HCB-Konzentrationen aufwiesen, als Kinder passiv oder nicht rauchender Muetter. Es bestand kein Unterschied in der praenatalen PCB-Akkumulation zwischen den Kindern aus Fulda und denen aus Duesseldorf, waehrend letztere um 62% hoehere HCB-Werte aufwiesen. (orig.)

  5. Prevalence of iodine- and thyroglobulin-negative findings in differentiated thyroid cancer. A retrospective analysis of patients treated from 1961 to 1998 in a university hospital; Haeufigkeit lod- und hTG-negativer Befunde beim differenzierten Schilddruesenkarzinom. Eine retrospektive Analyse der von 1961 bis 1998 in einer Universitaetsklinik behandelten Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Klutmann, S.; Jenicke, L.; Geiss-Toenshoff, M.; Bohuslavizki, K.H.; Mester, J.; Clausen, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin

    2001-10-01

    Aim: The prevalence of iodine- and thyroglobulin-negative findings was evaluated in all patients with differentiated thyroid cancer (DTC) treated from 1961 until 1998 at the Department of Nuclear Medicine, University Hospital Hamburg-Eppendorf. Methods: A total of 490 patients with papillary thyroid cancer (PCA) and 242 patients with follicular thyroid cancer (FCA) were analyzed retrospectively. Patients were divided into four groups: 1: no recurrence, 2: recurrent disease, 3: primary metastatic/progressive disease and 4: inconclusive follow-up. Results of iodine scan, serum-TG, and additional imaging modalities as well as histology were compared in all patients. Results: 21/490 (4,3%) of patients with PCA and 16/242 (6,6%) with FCA suffered from recurrent disease. 62/490 (12,7%) of patients with PCA and 59/242 (24,4%) with FCA had primary metastatic/progressive disease. 12/21 patients with PCA and 12/16 with FCA showing up with recurrent disease had a negative iodinescan. 11/21 of patients with PCA and 4/16 with FCA and tumor recurrence had negative serum-TG levels. 14/62 patients with PCA and 14/59 with FCA presenting with primary metastatic/progressive disease had negative iodinescan. 14/62 patients with PCA and 6/59 with FCA had negative serum-TG. Conclusion: The prevalence of iodine-negative recurrent/metastatic disease is in accordance to the literature, whereas the prevalence of TG-negative recurrent/metastatic was noted higher than reported previously. Thus, the commonly used follow-up scheme of DTC is confirmed. However, iodine scan should be regularly performed in patients with high risk of recurrence. (orig.) [German] Ziel: Retrospektiv wurden alle von 1961 bis 1998 in der Abteilung fuer Nukleamedizin des Universitaetsklinikums Hamburg-Eppendorf behandelten Patienten mit einem differenzierten Schilddruesenkarzinom bezueglich des Anteils lod- und/oder hTG-negativer Rezidive analysiert. Methoden: Es wurden 490 Patienten mit einem papillaeren Schilddruesenkarzinom (PCA) und 242 Patienten mit einem follikulaeren Schilddruesenkarzinom (FCA) untersucht. In Abhaengigkeit vom Krankheitsverlauf erfolgte eine Einteilung 1: kein Rezidiv, 2: Rezidiv, 3: primaer metastasierender/persistierender Verlauf und 4: unklarer Verlauf. Fuer alle Patienten wurden die Ergebnisse der lodszintigraphie, der hTG-Bestimmungen sowie weiterer bildgebender Verfahren und Histologie miteinander verglichen. Ergebnisse: 21/490 (4,3%) der Patienten mit PCA und 16/242 (6,6%) mit FCA erlitten ein Rezidiv. Bei 62/490 (12,7%) mit PCA und 59/242 (24,4%) mit FCA fand sich ein primaer metastasierender/persistierender Verlauf. Bei nachgewiesenem Rezidiv wiesen 12/21. Patienten mit PCA und 12/16 mit FCA keine ladspeicherung auf. Bei 11/21 mit PCA und 4/16 mit FCA und einem Tumorrezidiv fand sich kein erhoehter hTG-Wert. Bei primaer metastasierendem/persistierendem Verlauf wiesen jeweils 14/62 Patienten mit PCA und 14/59 mit FCA keine lodspeicherung auf. Bei 14/62 Patienten mit PCA und 6/59 mit FCA fand sich kein erhoehter hTG-Wert. Schlussfolgerung: Diese Ergebnisse bestaetigen einerseits die in der Literatur angegebenen Haeufigkeiten lodnegativer Rezidive/Metastasen, andererseits fanden sich hTG-negative Rezidive/Metastasen haeufiger. Das derzeit gueltige Nachsorgeschema wird durch die vorliegende Analyse grundsaetzlich bestaetigt. Von regelmaessigen lodszintigraphien profitieren hierbei insbesondere Patienten mit einem erhoehten Rezidivrisiko. (orig.)

  6. Studies on the influence of processing methods on the corrosion characteristics of electroslag-tape-plating with NiMo16Cr16Ti. Untersuchungen zum Einfluss der Prozessfuehrung auf die Korrosionseigenschaften beim Elektroschlacke-Bandplattieren mit NiMo16Cr16Ti

    Energy Technology Data Exchange (ETDEWEB)

    Blum, J

    1991-01-01

    The aim of the project was to demonstrate an economic possibility of using NiMo16Cr16Ti reliably as a plating material with simple to use methods. For this, the electroslag and submerged arc welding with tape electrodes as a coating technology are compared with each other. As the research showed, it is possible to coat large surface area, thick walled components economically with NiMo16Cr16Ti using electroslag (RES) tape plating. The choice of powder is important for the hot crack freedom and the precipitation poverty and thus the corrosion resistance of the plating. The silicon content was proved to be of importance in the plating. With the right choice of powder, the second layer already possesses the endurance of laminated materials against intercrystalline corrosion in coating tests as well as against pitting in a 10% FeCl{sub 3} solution. The coating capability lies at 0.5 m{sup 2}/h. - In addition the use of video thermography for on-line surveillance of seam on RES plates is documented. The evaluation of the pictures makes possible the targeting of the external magnets and thus the influencing of the melting bath flux. (orig./RHM) With 80 figs., 12 tabs.

  7. Transmission contracts and procurement law. Applicability of the instructions of the procurement law to the selection procedure in the connection with the conclusion of transmission contracts according to paragraph 46 EnWG?; Konzessionsvertraege und Vergaberecht. Anwendbarkeit der Vorschriften ueber das Vergaberecht auf das Auswahlverfahren beim Abschluss von Wegenutzungsvertraegen nach paragraph 46 EnWG?

    Energy Technology Data Exchange (ETDEWEB)

    Niehof, Roland

    2011-01-15

    The conclusion of transmission contracts between the municipalities and the operators of supply lines (electricity, natural gas) is regulated by law. paragraph 46 of the Energy Economy Law (EnWG) describes the requirements concerning the selection a power supply company and concerning the procedure to be followed. The contribution under consideration examines whether the regulations of the procurement right can be applied directly or similarly beside paragraph 46 EnWG to the conclusion of transmission contracts. The author of the contribution under consideration deals with the newer jurisdiction of the European Court of Justice.

  8. The hearing at the Federal Constitutional Court on the nuclear phase-out. No space left for legal ''tricks''; Die Verhandlung beim Bundesverfassungsgericht ueber den Kernenergieausstieg. Kein Raum fuer juristische ''Zaubertricks''

    Energy Technology Data Exchange (ETDEWEB)

    Leidinger, Tobias [Luther Rechtsanwaltsgesellschaft, Duesseldorf (Germany)

    2016-05-15

    Can lawyers do magic? At least some lawyers believe (even) to do. But does this work? Observers of the hearing of the German Constitutional Court trying the nuclear phase and the revision of the German Atomic Act on 15/16 March 2016 may believe it. The German Constitutional Court is trying the constitutional complaint proceedings of E.ON, RWE and Vattenfall on the legality of nuclear phase-out in Germany, essentially to the question of the compatibility of this law with the fundamental rights of the operating companies, in particular their right to property, to freedom of occupation, to equal treatment and protection of legitimate expectations.

  9. Demolition to Green-Field conditions of the FRJ-1 (MERLIN) research reactor. Successes and hurdles in the demolition of a research reactor of the megawatt class; Der Rueckbau des Forschungsreaktors FRJ-1 (MERLIN) bis zur 'Gruenen Wiese'. Erfolge und Huerden beim Rueckbau eines Forschungsreaktors der Megawatt-Klasse

    Energy Technology Data Exchange (ETDEWEB)

    Stahn, Burkhard; Printz, Rudolf; Matela, Karel; Zehbe, Carsten; Stauch, Bernhard; Zander, Iven [Forschungszentrum Juelich GmbH, Juelich (Germany)

    2010-02-15

    The Juelich-1 Research Reactor (FRJ-1), also referred to as MERLIN (Medium Energy Research Light Water Moderated Industrial Nuclear Reactor), was a light-water moderated and cooled swimming pool reactor of British design. The cornerstone in the erection of the reactor building was laid on June 11, 1958. Reactor operation was started on February 23, 1962. The plant was last run at a thermal power of 10 MW and shut down for good in 1985 after 23 years of operation. After the fuel elements had been removed and most of the experimental installations dismantled, some first steps towards demolition were taken in 1995. Demolition on a large scale began in 1996. September 8, 2008 was a special day: On the area of the former reactor hall, an oak tree was planted as a symbol of the 'green field' and of the original oak wood which had to make way for the construction of reactors in Juelich. An oak tree now stands in the place of the reactor unit. Was that all? It was not, for there were ancillary systems, operations, utility and hygiene buildings which had to be pulled down. Decontamination and clearance measurements were completed. The application for clearance was prepared and completed. Conventional demolition was started in 2009. After completion of that step, the last chapter about demolition of the FRJ-1 research reactor has been written, and the book can be closed. (orig.)

  10. [TraumaNetwork, Trauma Registry of the DGU®, Whitebook, S3 Guideline on Treatment of Polytrauma/Severe Injuries - An Approach for Validation by a Retrospective Analysis of 2304 Patients (2002-2011) of a Level 1 Trauma Centre].

    Science.gov (United States)

    Schoeneberg, C; Schilling, M; Keitel, J; Kauther, M D; Burggraf, M; Hussmann, B; Lendemans, S

    2017-04-01

    Background: In the last decades, a reduction in mortality in severely injured patients with an ISS ≥ 16 could be observed. Some authors report a death rate of about 22 %. Moreover, there were some new insights in the last years such as the reduction in mortality by use of whole-body CT and the introduction of the S3 guideline of the German Society of Trauma Surgery "Treatment of Patients with Severe and Multiple Injuries" have supported the evidence-based treatment of severely injured patients. Methods: A retrospective analysis of 2304 patients was performed between 2002 and 2011. The data of the authors' clinic for the trauma registry of the DGU® were used. After applying the inclusion criteria, ISS ≥ 16 and primary transfer from the accident site, 968 patients remained. Results: In the study population, a mean ISS of 29.81 and a mean GCS of 9.42 were found. The average age was 46.04 years. The mortality rate was 28.7 %. A significant difference between decedents and survivors was found at the ISS, GCS, RTS, new ISS, TRISS, RISC, AIS head, AIS skin, RR pre-clinical, pre-clinical heart rate and age. To test whether the lethality was reduced by the increased use of whole-body CT, a division into a group prior to and from 2009 was performed. Results revealed a significant increase in the whole-body CT rate from 56.96 to 71.7 %. The mortality rate declined from 32.3 to 24.5 %. In the same way it was verified whether the S3 guideline had an impact on mortality. Therefore, a division into groups before and from 2011 was conducted. Here, the mortality rate decreased from 30.4 to 18.4 %. In addition, a comparison between 2010 and 2011 was performed. Overall, there were statistically significant differences in the trauma room time, the surgical time, the volume infused, the rate of multiple organ failure and the rate of whole-body CTs performed. Conclusion: In the period from 2002 to 2011 a mortality rate of 28.7 % was found. The higher rate in comparison to published data is most likely explained by the high rate of serious and severe head injuries. The increased use of whole-body CT and the introduction of the S3 guideline led to a significant decrease in mortality in the authors' patient population. This is due particularly to the accelerating of the treatment of severely injured patients, the reduction of the infused volume, shortened surgical phase within the first 24 hours and the increased use of whole-body CT. Georg Thieme Verlag KG Stuttgart · New York.

  11. Cycles of selected trace elements in the South Atlantic: Vertical transport and interactions between particulates and solution; Zum Kreislauf ausgewaehlter Spurenmetalle im Suedatlantik: Vertikaltransport und Wechselwirkung zwischen Partikeln und Loesung

    Energy Technology Data Exchange (ETDEWEB)

    Dierssen, H

    1999-07-01

    Subjects: Concentrations, vertical and regional distributions of dissolved and suspended particulate trace elements; Trace element fluxes - vertical, regional, seasonal; The role of particulate organic carbon and atmospheric dust in vertical transport; Fractionation of trace elements in particulate material during transport. [German] Themen dieser Arbeit sind: Konzentrationen, vertikale und regionale Verteilungen von geloesten und suspendierten partikulaeren Spurenelementem (SE); SE-Fluesse vertikal, regional und saisonal; die Rolle des partikulaeren organischen Kohlenstoffs und des atmosphaerischen Staubeintrags beim Vertikaltransport; Fraktionierung von SE im partikulaeren Material beim Transport. (orig./SR)

  12. Ungleiche Ungleichheiten:Zu den Gemeinsamkeiten und Unterschieden von Sexismus und Rassismus

    OpenAIRE

    Späte, K. (Katrin)

    2011-01-01

    Sexismus durchzieht fast alle gesellschaftlichen Teilbereiche und deren Grundlagen, im Kern ging es schon Jahrtausende lang um die Rechtfertigung der Herrschaft von Männern über Frauen. Die Minderwertigkeit „der Frau“ wurde unter Rückgriff auf natürliche Begebenheiten bewiesen. Die Grundlage sowohl von Sexismus als auch von Rassismus ist eine Konstruktion: Beim Sexismus die des „weiblichen Geschlechts“, beim Rassismus die der „Rasse“. Während sich die Benennung des Objekts von Rassismus im...

  13. Der Preis als Kaufbarriere?

    DEFF Research Database (Denmark)

    Mueller Loose, Simone

    2012-01-01

    Konsumenten im benachbarten europäischen Ausland (vgl. BVE 2011). Auch der im europäischen Vergleich hohe Marktanteil von Discountern ist ein Indi-kator dafür, dass die Deutschen beim Einkauf von Lebensmitteln weniger qualitäts- und stärker preisorientiert sind (vgl. Zühlsdorf/Spiller 2012). Nicht nur durch......-braucher beim Einkauf von Lebensmitteln hat und gibt einen Überblick über vorhandene empirische Ergebnisse zur Preisbereitschaft für gesunde Lebensmittel....

  14. Germany's first CO{sub 2} skating rink. Axima Kaeltetechnik builds new skating rink at Ravensburg; Die erste CO{sub 2}-Kunsteisbahn Deutschlands. Axima Kaeltetechnik baut in Ravensburg

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2004-04-01

    Natural refrigerants are frequently used in skating rinks. Increasingly, CO2 is preferred to brine, as in the new Ravensburg skating rink. It is the first time this technology is applied in Germany, but more systems of this kind are sure to come. [German] Beim Bau von Kunsteisbahnen sind natuerliche Kaeltemittel kein Novum. Immer haeufiger erhaelt allerdings der Kaeltetraeger CO{sub 2} den Vorzug vor einer Sole, so auch beim Bau der neuen Kunsteisbahn in Ravensburg. Damit wurde erstmals in Deutschland in diesem Bereich der Schritt hin zu einer Systemtechnologie gemacht, die aller Voraussicht nach noch zahlreiche weitere Anwendungen nach sich ziehen wird. (orig.)

  15. Percutaneous pedicle screw for unstable spine fractures in polytraumatized patients: A report of two cases

    Directory of Open Access Journals (Sweden)

    Boon Beng Tan

    2012-01-01

    Full Text Available Unstable spine fractures commonly occur in the setting of a polytraumatized patient. The aim of management is to balance the need for early operative stabilization and prevent additional trauma due to the surgery. Recent published literature has demonstrated the benefits of early stabilization of an unstable spine fracture particularly in patients with higher injury severity score (ISS. We report two cases of polytrauma with unstable spine fractures stabilized with a minimally invasive percutaneous pedicle screw instrumentation system as a form of damage control surgery. The patients had good recovery from the polytrauma injuries. These two cases illustrate the role of minimally invasive stabilization, its limitations and technical pitfalls in the management of unstable spine fractures in the polytrauma setting as a form of damage control surgery.

  16. Evaluating the Joint Theater Trauma Registry as a data source to benchmark casualty care.

    Science.gov (United States)

    O'Connell, Karen M; Littleton-Kearney, Marguerite T; Bridges, Elizabeth; Bibb, Sandra C

    2012-05-01

    Just as data from civilian trauma registries have been used to benchmark and evaluate civilian trauma care, data contained within the Joint Theater Trauma Registry (JTTR) present a unique opportunity to benchmark combat care. Using the iterative steps of the benchmarking process, we evaluated data in the JTTR for suitability and established benchmarks for 24-hour mortality in casualties with polytrauma and a moderate or severe blunt traumatic brain injury (TBI). Mortality at 24 hours was greatest in those with polytrauma and a severe blunt TBI. No mortality was seen in casualties with polytrauma and a moderate blunt TBI. Secondary insults after TBI, especially hypothermia and hypoxemia, increased the odds of 24-hour mortality. Data contained in the JTTR were found to be suitable for establishing benchmarks. JTTR data may be useful in establishing benchmarks for other outcomes and types of combat injuries.

  17. Investigations to single and combined effects of organic pollutants (PAH, PCB) and heavy metals (Cd, Cu) on biomass production and soil-plant transfer by cultivation of raw and energy plants. Final report; Bodenoekologische Untersuchungen zur Wirkung und Verteilung von organischen Stoffgruppen (PAK, PCB) in ballungsraumtypischen Oekosystemen. Untersuchungen zu Einzel- und Kombinationswirkungen von organischen Schadstoffen (PAK, PCB) und Schwermetallen (Cd, Cu) auf Biomasseertrag und Boden-Pflanze-Transfer beim Anbau von Rohstoff- und Energiepflanzen. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Metz, R.; Dorn, J.; Sauer, W.

    1997-05-01

    Together with polycyclic aromatic hydrocarbons, polychlorinated biphenyls and heavy metals other elements and compounds as well as nutrients are present in typical contaminated areas like sewage fields. They are found as mixed undisturbed contamination and the transfer of these pollutants into food or forage plants is dangerous for people. So far investigations of ecological effects of these substances are focused mainly on single agents or on some agents of the same chemical group. But in most cases the mixture of different chemical compounds in extremely contaminated fields cause synergistic effects resulting in yield reduction and decrease of microbiological activity. Therefore the aim of the present report is to show combined effects of selected organic pollutants (benzo-a-pyren, 2,2`, 5,5` tetrachlorbiphenyl) and heavy metals (cadmium, copper) on parameters of soil biology, biomass production and pollutant uptake by plants. Resulting changes of cellulose decomposition, CO{sub 2}-release from soil and N-mineralization after separated and combined enrichment of weakly polluted sewage field soil with said pollutants up to concentrations of extremely polluted sewage field soils are presented in this paper. Data of yields and pollutant contents of plants (rye, maize and potatoes) cultivated on experimental soils are summarised and ecotoxicological risks resulting form pollutants and their interactions discussed. (orig.) [Deutsch] Polycyclische aromatische Kohlenwasserstoffe, Polychlorierte Biphenyle und Schwermetalle sind zusammen mit anderen Elementen und Verbindungen u.a. auch mit Naehrstoffen als gemischte gewachsene Kontamination in ballungsraumtypischen Belastungsflaechen (z.B. Rieselfelder) vorhanden und stellen bei einem Transfer in Nahrungs- und Futterpflanzen eine besondere Gefaehrdung fuer den Menschen dar. Bei Untersuchungen hinsichtlich oekosystemarer Konsequenzen dieser Substanzen wurden bisher vor allem Einzelstoffbetrachtungen angestellt bzw. mehrere Vertreter einer Stoffgruppe untersucht. Ursache fuer Ertragsdepressionen und Minderungen der mikrobiellen Aktivitaet auf hocheblasteten Flaechen ist aber immer eine Komplexwirkung der verschiedenen Bodeninhaltsstoffe, so dass sich synergistische Effekte einstellen koennen. Im vorliegenden Bericht wird daher die kombinierte Wirkung ausgewaehlter organischer Schadstoffe (Benzo-a-pyren, 2,2`, 5,5` Tetrachlorbiphenyl) sowie relevanter Schwermetalle (Cadmium, Kupfer) auf bodenmikrobiologische Parameter, Biomasseproduktion und Schadstoffpflanzenaufnahme erfasst und aufgetrennt. Veraenderungen von CO{sub 2}-Freisetzung, Cellulosezersetzung und N-Mineralisierung in einem schwachbelasteten Rieselfeldboden nach dessen Einzelstoff- bzw. Mischanreicherung mit den genannten Schadstoffen in Konzentrationen, wie sie in hochbelasteten Rieselfeldern vorliegen, werden dargestellt. Desweiteren erfolgt eine umfangreiche Auswertung der Daten zu Ertraegen und Schadstoffgehalten der auf den Versuchsboeden geprueften Pflanzen (Roggen, Mais und Kartoffeln). Oekotoxikologische Risiken der untersuchten Schadstoffe und ihre Wechselbeziehungen untereinander werden diskutiert. (orig.)

  18. Fat embolism syndrome in femoral shaft fractures: does the initial treatment make a difference?

    Directory of Open Access Journals (Sweden)

    Janio Jose Alves Bezerra Silva

    Full Text Available ABSTRACT Objective: To identify the risk factors correlated with the initial treatment performed. Methods: This is a retrospective study involving a total of 272 patients diagnosed with femoral shaft fractures. Of the patients, 14% were kept at rest until the surgical treatment, 52% underwent external fixation, 10% received immediate definitive treatment, and 23% remained in skeletal traction (23% until definitive treatment., Results: There were six cases of fat embolism syndrome (FES, which showed that , polytrauma is the main risk factor for its development and that initial therapy was not important. Conclusion: Polytrauma patients have a greater chance of developing FES and there was no influence from the initial treatment.

  19. Temporomandibular Joint: MRT Diagnostics; Temporomandibulargelenk: MRT-Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Kress, B. [Universitaetsklinikum Heidelberg (Germany). Abteilung Neuroradiologie; Universitaetsklinikum Heidelberg (Germany). Neurologische Klinik; Schmitter, M. [Universitaetsklinikum Heidelberg (Germany). Poliklinik fuer zahnaerztliche Prothetik; Universitaetsklinikum Heidelberg (Germany). Abteilung Neuroradiologie

    2005-09-01

    MRI of the temporomandibular joint (TMJ) requires 1.5 T. The radiologist must be familiar with the anatomy and pathology of the TMJ. This review gives a description of MRI protocols for the TMJ, and MRI anatomy and pathology of the TMJ (open and closed mouth) by means of MR images and drawings. Diagnosing of the TMJ related diseases depends on standardized clinical and MR examinations. Therefore close interdisciplinary cooperation between dentist and radiologist is necessary. (orig.) [German] Magnetresonanztomographie bei Kiefergelenkbeschwerden erfordert neben guter technischer Ausstattung Kenntnisse der Anatomie und Pathologie des Kiefergelenks. Diese Uebersicht stellt neben MRT-Protokollen die Anatomie und die pathologischen Befunde des Kiefergelenks bei geoeffnetem und geschlossenem Mund anhand von Abbildungen und Graphiken systematisch dar. Bildgebende Diagnostik des Kiefergelenks gruendet sich auf eine standardisierte klinische und magnetresonanztomographische Untersuchung und erfordert eine enge interdisziplinaere Kooperation zwischen Zahnmedizin und Radiologie. (orig.)

  20. Mechatronic Carlab - Eine System-Entwicklungsumgebung mit realen und virtuellen mechatronischen Fahrzeug-Komponenten

    OpenAIRE

    Bünte, Tilman

    2004-01-01

    Bei der Entwicklung mechatronischer Komponenten sind verschiedene Ingenieurdisziplinen beteiligt: Das Fachwissen auf dem Gebiet Mechanik, Elektronik und Informatik ist gefragt, wenn auf kleinem Raum die unterschiedlichsten Funktionen zu einem Produkt integriert werden. Beim DLR in Oberpfaffenhofen hat diese Technologie schon Tradition - ein großes Anwendungsfeld ist inzwischen die Fahrzeugtechnik

  1. Mehrkörpersimulation eines ebenen Koppelgetriebes mittels Matlab / ADAMS -Co-Simulation

    OpenAIRE

    Gollee, Christian; Troll, Clemens

    2017-01-01

    Mit Hilfe der Matlab/ADAMS-Co-Simulation wird ein ebenes Koppelgetriebe (5- Gelenk) untersucht und anschließend die Wirkpaarung mit einem Stückgut betrachtet. Dabei werden verschiedene Modellierungsstufen angewendet und die Simulationsergebnisse Messergebnissen vom Versuchsstand gegenübergestellt. Daneben wird die grundlegende Herangehensweise beim Einsatz dieser Simulationswerkzeuge erläutert.

  2. Resonance – Journal of Science Education | Indian Academy of ...

    Indian Academy of Sciences (India)

    Jürgen Drissner1 Hans-Martin Haase2 Mara Nikolajek1 Katrin Hille3. Botanical Garden, University of Ulm, D–89081 ULM, Germany. University of Education, Oberbettringer Str. 200, D–73525 Schwäbisch Gmünd, Germany. Transfercenter for Neuroscience and Learning, University of Ulm, Beim Alten Fritz 2 D–89075 ULM, ...

  3. Die Brustflosse des Grönlandswales (Balaena mysticetus L.)

    NARCIS (Netherlands)

    Kükenthal, W.

    1922-01-01

    Das Studium der Brustflosse des Grönlandswales hat zu Fragen von allgemeinerem Interesse geführt. Ihre kurze und breite Form sowie ihre anscheinende Fünffingerigkeit, die ausserdem nur noch beim südlichen Glattwal (Balaena australis) vorkommt, liess sie ursprünglicher erscheinen als die schlankere

  4. Praxis des Klebens

    CERN Document Server

    Theuerkauff, Petra

    1989-01-01

    Bei diesem Buch handelt es sich um einen Leitfaden fur Klebepraktiker. Es werden die verschiedenen Einzelschritte beim kleben beschrieben, als auch die vorbereitenden Massnahmen und anschliessenden Prufverfahren auf Festigkeit behandelt. Das Buch sollte an keinem Arbeitsplatz fehlen, wo man sich mit Problemen der Fugetechnik des Klebens beschaftigt.

  5. Theory of rubber friction and traction properties of car tyres; Theorie der Gummireibung und Traktionseigenschaften von Reifen

    Energy Technology Data Exchange (ETDEWEB)

    Klueppel, M.; Alshuth, T.; Schuster, R.H. [Deutsches Inst. fuer Kautschuktechnologie e.V., Hannover (Germany)

    1998-12-31

    ABS braking on dry and wet roads involves different mechanisms of rubber friction on rough surfaces. This improves car safety in terms of higher manoeuvrability and shorter braking lengths especially on wet roads. Current research focuses on optimisation of tyrecontact surface materials with better traction characteristics and lower rolling resistance. Laboratory predictions of the traction properties of tyre faces must be based on fundamental knowledge of the local sliding phenomena in the tyre contact surface and the resulting energy dissipation during ABS braking. This contribution therefore attempts to relate the elementary mechanisms of tyre mechanics in ABS braking processes to theoretical concepts of rubber friction on rough surfaces. [Deutsch] Beim ABS-Bremsen auf trockenen und nassen Strassen werden unterschiedliche Mechanismen der Gummireibung auf rauhen Oberflaechen wirksam. In der Summe bewirkt dies eine hoehere Fahrsicherheit, da neben der Manoevrierfaehigkeit des Autos auch der Bremsweg, vor allem auf nassen Strassen, verkuerzt sein kann. In diesem Zusammenhang wird zur Zeit verstaerkt an einer Optimierung von Laufflaechenmaterialien durch den Einsatz von massgeschneiderten Loesungs-SBR-Typen in Verbindung mit gefaellten Kieselsaeuren gearbeitet, wodurch neben einer Verbesserung der Traktionseigenschaften beim ABS-Bremsen auch eine Verringerung des Rollwiderstandes erreicht wird. Fuer Laborvorhersagen der Traktionseigenschaften von Reifenlaufflaechen ist ein grundlegendes Verstaendnis der lokalen Gleitphaenomene in der Reifenaufstandsflaeche und der damit verbundenen Energiedissipation beim ABS-Bremsen erforderlich. In dieser Arbeit wird deshalb angestrebt, die elementaren Mechanismen der Reifenmechanik beim ABS-Bremsen mit theoretischen Konzepten der Gummireibung auf rauhen Oberflaechen in Verbindung zu bringen. (orig.)

  6. Viertes LSDMA Symposium: Neue Entwicklungen im Bereich Big Data

    OpenAIRE

    Çayoğlu, Uğur

    2015-01-01

    Auch in diesem Jahr trafen sich zahlreiche Wissenschaftler aus unterschiedlichen Wissenschaftsgebieten beim internationalen Symposium „The Challenge of Big Data in Science“, der Helmholtz Initiative Large-Scale Data Management and Analysis (LSDMA). Das Steinbuch Centre for Computing veranstaltete diese Tagung nun das vierte Mal. Es waren über 90 Teilnehmer aus Deutschland, Frankreich, Spanien, China und den Vereinigten Staaten zu Gast.

  7. Vom Terrorismus zum Wandel durch Annäherung: Houellebecqs ‚Soumission‘

    Directory of Open Access Journals (Sweden)

    Wolfgang Asholt

    2016-03-01

    Full Text Available Es handelt sich um den Text eines Vortrags beim von Ursula Hennigfeld und Elmar Schafroth organisierten Workshop „Zensur, Political Correctness und Terrorismus“  (Universität Düsseldorf, 30.6. – 2.7. 2015.

  8. Selection of paediatric patients for intensive care

    African Journals Online (AJOL)

    illness, particularly near-drowning, cardiomyopathy, gastro- enteritis and complicated infectious illness (Table Ill). Cardiorespiratory resuscitation prior to ICU admission was associated with increased mortality (7/11 v. 27/106,. P < 0,05, two-tailed Fisher's exact test). There were no deaths in patients with polytrauma without ...

  9. The lectin complement pathway serine proteases (MASPs) represent a possible crossroad between the coagulation and complement systems in thromboinflammation

    DEFF Research Database (Denmark)

    Kozarcanin, H; Lood, C; Fog, Lea Munthe

    2016-01-01

    by AT during clotting without the assistance of heparin. In all other cases the MASPs were, as previously reported, inactivated by C1-INH. In systemic lupus erythematosus patients with thrombotic disease and in polytrauma patients, the levels of activated MASP-1 and MASP-2 in complex with both AT and C1-INH...

  10. Primary fixation and delayed nailing of long bone fractures in severe trauma

    DEFF Research Database (Denmark)

    Friedl, H.P.; Stoker, R.; Czermak, B.

    1996-01-01

    skeletal conditions (particularly of the lower extremities) impede optimal intensive care of these patients. Therefore in a polytrauma setup, primary operative stabilization of the femur is mandatory and generally accepted, whereas the optimal fixation procedure is still a source of controversies...

  11. Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia

    Directory of Open Access Journals (Sweden)

    Maja S