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Kaufentscheidungen - Entscheidungstheorien (German Edition) - Kindle edition by Robin Wuchter. Download it once and read it on your Kindle device, PC. Branchen- und Marktstruktur des Automobilmarkts China (German Edition) ( Institut für Entscheidungstheorie und Unternehmensforschung), Sprache: Deutsch.
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The vascular femoral head necrosis is a serious illness, especially when appearing in patients aged 30 to 50 years. Many etiologic factors cause a femoral head necrosis such as, for example, high-dose steroids, abuse of alcohol, defect of bone marrow and trauma of the hip.
Often the X-ray photograph leads to the diagnosis in the second stage ARCO or in the third stage, when the femoral head has begun to collapse. The characteristics of the contrast media enhancement argue for an active concomitant process of destruction and regeneration. This stage has the best chances for a drug or a surgical therapy. The evaluation of the signal intensity by the dynamic screening sequence is considered as an objective contribution for the staging of the femoral head necrosis. This enables one to differentiate between the curable stage IIc and the stage III, showing the beginning of breakdown of the femoral head.
Ein Vielzahl von aetiologischen Faktoren wie Einnahme von hohen Dosen Steroiden ueber mehrere Monate, Alkoholmissbrauch, Knochenmarkschaeden und Huefttraumata spielen unabhaengig voneinander eine Rolle. Das Kontrastmittelaufnahmeverhalten spricht fuer einen gleichzeitig aktiven destruierenden und regenerativen Prozess, der fuer einen operativen und medikamentoesen Eingriff das guenstigste Stadium mit den besten Heilungschancen ist.
Electrochemical incineration of Ccontaining liquid wastes. First results and outlook; Behandlung Chaltiger fluessiger Abfaelle mittels elektrochemischer Totaloxidation. Erste Ergebnisse und Ausblick. Liquid radioactive wastes containing carbon are not acceptable for radioactive waste repository.
At present incineration is the only approved way of treatment in Germany. But capacities are limited and incineration by itself is known to be a technically complex and rather expansive process. Therefore within an experimental proof of concept it should be examined whether an electrochemical incineration process is also applicable for this purpose. The R and D activities mainly comprised the gathering of informations about the chemical nature and constitution of such liquid wastes from enterprises, research laboratories and a number of the state owned collecting facilities, numerous electrochemical examinations with typical organic substances and finally electrolysis tests with original carbon waste solution at lab-scale.
We were able to demonstrate that electrochemical oxidation permits almost quantitative mineralization of the organic waste substances. The carbon dioxide released during electrolysis was completely fixed as solid calcium carbonate which is acceptable for final repository. An estimate shows that in comparison to conventional incineration a substantial decrease in the costs of treatment and repository can be expected.
With regard to technical application further steps of development are necessary. Robot-assisted biopsies in a high-field MRI system. First clinical results; Roboterunterstuetzte Punktion in einem Hochfeld-Kernspintomografen. The purpose of this study was to examine the clinical use of MR-guided biopsies in patients with suspicious lesions using a new MR-compatible assistance system in a high-field MR system. Six patients with suspicious focal lesions in various anatomic regions underwent percutanous biopsy in a high-field MR system 1.
A servopneumatic drive then moved the guiding arm automatically to the insertion point. An MRI compatible 15G biopsy system Somatex was introduced by a physician guided by the needle holder and multiple biopsies were performed using the coaxial technique. The feasibility, duration of the intervention and biopsy findings were analyzed. The proposed new system allows accurate punctures in a high-field MR system. The assistance device did not interfere with the image quality, and guided the needle virtually exactly as planned.
Histological examination could be conducted on every patient. The lesion was malignant in four cases, and an infectious etiology was diagnosed for the two remaining lesions. Regarding the differentiation of anatomical and pathological structures and position monitoring of the insertion needle, TrueFISP images are to be given preference. The average intervention time was 41 minutes. Lesions up to The proposed MR-guided assistance system can be successfully utilized in a high-field MR system for accurate punctures of even deep lesions in various anatomic regions.
For this purpose the BMFB has drawn together diverse integrated research projects to bring a well-coordinated force of activities to bear on this problem in a manner unprecedented in Germany. Its declared aim in doing so is, firstly, to compile a guide on biological remediation and, secondly, to funnel the output of all ongoing German research in this field into the second phase of its research activities at the ''Tanne'' plant in Clausthal-Zellerfeld, which is dedicated to practice-oriented testing of methods for the biological remediation of STV contaminated sites. Durch die bislang in der bundesweiten Forschung einmalige, Forschungsverbund uebergreifende, koordinierte Buendelung saemtlicher wissenschaftlicher Aktivitaeten ist es erklaertes Ziel, zum einen einen Leitfaden zur biologischen Sanierung herauszuarbeiten, zum anderen, die aktuellen, bundesweiten, wissenschaftlichen Erkenntnisse in die seit Mai am Standort 'Werk Tanne' in Clausthal-Zellerfeld laufende Phase 2 der BMBF-Forschungsaktivitaeten, naemlich die praxisorientierte Erprobung von Verfahren zur biologischen Sanierung von STV-belasteten Standorten, einzugreifen.
Cellular phone network and health: Design and first results; Mobilfunk und Befinden - eine Pilotstudie. Design und erste Ergebnisse. We aimed to examine feasibility of such a study in the field and to assess adequacy of personal dosimetry. Exposure to frequencies within the mobile communication range D-net, E-net, universal mobile telecommunications system UMTS , and wireless local area networks WLAN was measured and recorded every second.
Simultaneously we used computer assisted personal interview CAPI to collect data on participants' symptoms, socio-demographic characteristics, and potential confounders. The initial results are now available for 42 children ages years , 57 adolescents ages years , and 64 adults ages years , all of them residents of Munich, Germany. The duration of the cumulative exposure to all frequencies in excess of 0. The exposure was dominated by frequencies in the D-net range. Personal dosimeters have been optimised and fine-tuned through continuous use.
The association between the exposure and health can now be further assessed in a dedicated study. Full Text Available The aim of this paper is to measure the sensitivity of commercial banks from the Erste Group to the confidence crisis on the interbank market and to compare their sensitivity with average sensitivity of banks in particular countries. We have used the methodology of scenario analysis for the liquid asset ratio.
All banks belonging to the Erste Group should be able to withstand the confidence crisis on the interbank market. In some cases, banks from the Erste Group are more sensitive; while in other cases are banks belonging to the Erste Group less vulnerable than corresponding banking sectors. Except of banks from Hungary, Romania and Slovakia, subsidiary banks are less sensitive to the confidence crisis than the parent bank.
Banks and banking sectors who are net borrowers on the interbank market are much more sensitive to the confidence crisis on this market. A study of 67 cases]. The aim of this study was to identify the clinical differences of the Dupuytren 's disease in gender. Testosterone induces an increase of the Dupuytren 's fibroblast proliferation via androgen's receptors. Testosterone rate increases during pregnancy and menopausis. We also reached a link between this factors and the clinical aspects of Dupuytren ' disease in the women of our study.
This retrospective, comparative study was about all women and a randomized number of men, who underwent surgery for Dupuytren ' disease between and We analysed all the epidemiologic and clinical data, the surgery procedures and the complications. Pre- and postoperative measurements of the extension lack of all the joints were performed with a manual goniometer. This specific data of women were reached. Sixty-seven women and 69 men were compared. The complex regional pain syndrome was significantly more common in women and the correction of the proximal interphalangeal joint was significantly lower in women.
Recurrence rate and mean follow up were not statistically different. Mean DASH score was higher in women. We have not found any association between menopausis, pregnancy and the average age at presentation of the disease, the recurrence rate or the extension rate. The prognosis of the Dupuytren 's disease is worse in women than in men. Other studies are necessary to reach the link between the testosterone and the clinical history of the disease in women. Recurrence of Dupuytren 's contracture: Full Text Available One of the major determinants of Dupyutren disease DD treatment efficacy is recurrence of the contracture.
Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence.
To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren 's research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as "more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment".
In addition, "recurrence should be reported individually for every treated joint" and afterwards measurements should be repeated and reported yearly. This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives. Purpose To evaluate the short-term effectiveness of collagenase Clostridium histolyticum to treat thumb and first web contractures in Dupuytren disease. Methods We prospectively included 14 thumbs in 12 patients with a contracture at the metacarpophalangeal or interphalangeal joint of at least Percutaneous needle fasciotomy for Dupuytren 's disease: Het effect van deze twee behandelingen op het totale.
Dupuytren 's disease is an inherited disorder in which patients develop fibrotic contractures of the hand. Current treatment strategies include surgical excision or enzymatic digestion of fibrotic tissue. MicroRNAs, which are key posttranscriptional regulators of genes expression, have been shown to. Dupuytren 's disease metabolite analyses reveals alterations following initial short-term fibroblast culturing. Dupuytren 's disease DD is an ill-defined fibroproliferative disorder affecting the palm of the hand, resulting in progressive and irreversible digital contracture. In view of the abnormal gene dysregulation found in DD, and its potential effect on metabolites at a functional level, we chose to.
First clinical experience with extended planning and navigation in an interventional MRI unit; Erste klinische Erfahrungen mit einer erweiterten Eingriffsplanung und Navigation am interventionellen MRT. Augustin Germany ; Trantakis, C. Der Informationsgehalt dieser Referenzdaten wird durch Ueberlagerung zusaetzlicher Bildmodalitaeten u. Der durchschnittliche Zeitaufwand der 64 Hirnoperationen wurde mit dem von 36 Eingriffen mit herkoemmlicher Navigation verglichen. Gewebeverlagerungen lassen sich fruehzeitig intraoperativ erkennen und die Navigation kann durch Aktualisierung der Referenzdaten sicher fortgefuehrt werden.
Das System zeichnete sich durch eine hohe Stabilitaet, effiziente Systemintegration und einfache Bedienbarkeit aus. Die bildgestuetzten Hirnoperationen dauerten trotz zusaetzlicher, noch zu optimierender Arbeitsschritte nicht signifikant laenger. Full Text Available Mergers and acquisitions are ways used by banks to improve their profitability and to obtain other advantages. The purpose of this study is to analyze the impact of mergers and acquisitions on the performance of the bidder bank.
For this study, I have chosen to research the impact of acquisitions and mergers of Erste Group during , considering the target bank is in Central and Eastern Europe. Using the event study methodology, the result of the study shows that a merger or an acquisition does not improve the value market of the shares of the bidder bank. Dupuytren 's disease is one of the fibro-proliferative conditions affecting the palmar and digital fascia. Dupuytren 's disease is very common in Northern Europe and also in countries inhabited by immigrants from Northern Europe.
Dupuytren 's contracture is stated to be uncommon in Indian subcontinent and very little has been written about this disease in India. The authors have however come across 30 patients with Dupuytren 's contracture and they are the subject of this paper, with special emphasis on its surgical correction and complications of surgical treatment. Most of wounds were closed by primary closure with z-plasty. In rest of the patients free skin grafts were used to close the wound, when primary closure was not possible. The results were excellent in 23 patients Post operative edema and some stiffness was seen in two patients.
Wound infection was seen in one patient and haematoma in one patient. The correct surgical technique and meticulous post operative care is needed to achieve higher rates of correction and to limit the complications and recurrence.
A diabetic patient presenting with stiff hand following fasciectomy for Dupuytren 's contracture: Reported is the case of a year-old male presenting with severe wrist and hand stiffness following surgery for a Dupuytren 's contracture. Complications of surgery or rehabilitation and complex regional pain syndrome were excluded as factors explaining this stiffness. Given the patient's diabetes mellitus and the striking similarity with the typical diabetic stiff hand, it is suggested that diabetes may have contributed to the development of the complication.
Identification of histological patterns in clinically affected and unaffected palm regions in dupuytren 's disease. Full Text Available Dupuytren 's disease is a fibro-proliferative disease characterized by a disorder of the extracellular matrix ECM and high myofibroblast proliferation. However, studies failed to determine if the whole palm fascia is affected by the disease.
The objective of this study was to analyze several components of the extracellular matrix of three types of tissues- Dupuytren 's diseased contracture cords DDC, palmar fascia clinically unaffected by Dupuytren 's disease contracture NPF, and normal forehand fascia NFF. Histological analysis, quantification of cells recultured from each type of tissue, mRNA microarrays and immunohistochemistry for smooth muscle actin SMA, fibrillar ECM components and non-fibrillar ECM components were carried out. The results showed that DDC samples had abundant fibrosis with reticular fibers and few elastic fibers, high cell proliferation and myofibroblasts, laminin and glycoproteins, whereas NFF did not show any of these findings.
Interestingly, NPF tissues had more cells showing myofibroblasts differentiation and more collagen and reticular fibers, laminin and glycoproteins than NFF, although at lower level than DDC, with similar elastic fibers than DDC. Immunohistochemical expression of decorin was high in DDC, whereas versican was highly expressed NFF, with no differences for aggrecan.
All these results suggest that NPF tissues may be affected, and that a modification of the therapeutic approach used for the treatment of Dupuytren 's disease should be considered. Periostin differentially induces proliferation, contraction and apoptosis of primary Dupuytren 's disease and adjacent palmar fascia cells.
Dupuytren 's disease, DD , is a fibroproliferative condition of the palmar fascia in the hand, typically resulting in permanent contracture of one or more fingers.
Therapeutic success was achieved in a significant percentage of patients. We reviewed the reference lists of short-listed articles to identify additional suitable studies. Mean DASH score was higher in women. In , admissions were: Alle bisher durchgefuehrten Verifikationsexperimente waren erfolgreich. Bisherige Ergebnisse der grundlegenden Entwicklungsarbeiten sind in diesem Statusbericht zusammengefasst. Dupuytren 's disease is a common fibroproliferative condition of the hand characterized by fibrotic lesions nodules and cords , leading to disability through progressive digital contracture.
This fibromatosis is similar to scarring and other fibroses in displaying excess collagen secretion and contractile myofibroblast differentiation. In this report we expand on previous data demonstrating that POSTN mRNA, which encodes the extra-cellular matrix protein periostin, is up-regulated in Dupuytren 's disease cord tissue relative to phenotypically normal palmar fascia.
We demonstrate that the protein product of POSTN, periostin, is abundant in Dupuytren 's disease cord tissue while little or no periostin immunoreactivity is evident in patient-matched control tissues. The relevance of periostin up-regulation in DD was assessed in primary cultures of cells derived from diseased and phenotypically unaffected palmar fascia from the same patients. These cells were grown in type-1 collagen-enriched culture conditions with or without periostin addition to more closely replicate the in vivo environment.
We hypothesize that periostin, secreted by disease cord myofibroblasts into the extra-cellular matrix, promotes the transition of resident fibroblasts in the palmar fascia toward a myofibroblast phenotype, thereby promoting disease progression. Radiation therapy for Morbus Ledderhose - indication and clinical results; Strahlentherapie beim Morbus Ledderhose - Indikation und klinische Ergebnisse. 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. 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. Von Juni bis Dezember wurden zwoelf Frauen und 13 Maenner im Alter von 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. Die Orthovolt-Radiotherapie erfasste alle tastbaren Knoten und Straenge.
Es wurden zwei Serien zu je 5 x 3 Gy pro Woche gesamt: Primaerer Endpunkt war die Vermeidung einer Progression bzw. Operation; sekundaere Endpunkte waren mehrere objektive morphologisch-funktionelle sowie subjektive Parameter visuelle analogskala VAS. Nach 38 Monaten medianem FU war kein Fuss progredient oder musste operiert werden. Experimental geothermal well at Bad Schinznach. First results; Geothermiebohrung Bad Schinznach. The spa of Bad Schinznach Canton Argovia, Switzerland endeavours to cover its heating requirements with geothermal energy.
A recently drilled well to a depth of meters encountered the regional acquifer of thermal water Oberer Muschelkalk, Triassic in three levels. Preliminary results indicate a productive aquifer in the uppermost level with a wellhead temperature of 42 C. An additional exploitation of the bottomhole formation temperature of 63 C is envisaged.
Eine neulich abgeteufte Bohrung bis auf Meter Tiefe hat die Formation auf drei Niveaus angetroffen. Erste Resultate deuten auf ein nutzbares Vorkommen im obersten Horizont mit einer Austrittstemperatur von 42 C. Eine zusaetzliche Nutzung der hohen Formationstemperatur von 63 C auf Endtiefe wird erwogen. Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren contracture: Dupuytren 's disease DD is a fibroproliferative pathology that affects the palmar aponeurosis causing the development of nodules and collagen cords and the progressive flexion of the fingers.
The standard procedure is surgical fasciectomy, followed by high recurrence rates. Collagenase Clostridium histolyticum CCH injection represents an innovative noninvasive approach to the treatment of DD. This prospective study was designed to examine the efficacy and safety of CCH injection performed in the outpatient, using local anesthesia. The mean age was All joints were treated with a single vial of collagenase injection and manual breaking of the cord 24 h after. All adverse effects AEs were monitored. Patients were checked 7, 30, 90, and days after the injection. Secondary endpoints were the improvement of range of motion, the evaluation of AEs incidence, and cost-effectiveness of collagenase treatment.
At 6 months, a further 7. The mean contracture of treated joints was 5. Twenty-three patients had one or more mild-to-moderate side effects. The use of collagenase appears to be an effective and safe method for the treatment of Dupuytren 's contracture. Therapeutic success was achieved in a significant percentage of patients.
The incidence of side effects was higher, but they were local reactions of short duration. The use of a single collagenase vial in patients treated in day surgery appears more cost-effective than surgery. Dupuytren 's disease is a fibroproliferative disorder of the palmar fascia. The treatment used to date has mostly been surgery, but there is a high recurrence rate. Modality-dependent dose requirements in the Austrian breast cancer early detection program. First results from technical quality assurance; Geraeteabhaengiger Dosisbedarf im Oesterreichischen Brustkrebsfrueherkennungsprogramm.
Erste Ergebnisse aus der technischen Qualitaetssicherung. Referenzzentrum fuer technische Qualitaetssicherung im Brustkrebsfrueherkennungsprogramm. In order to ensure that all participating women can rely on a sufficient cancer detection rate while at the same time the required dose is as low as reasonably achievable, all participating radiology institutes approx. The control and certification is performed by the Reference Center for Technical Quality Assurance RefZQS , which has been developing the methods and tolerances in a pilot project since From the requirement for optimized image quality while simultaneously following the ALARA principle, we found modality-dependent dose requirements, which we had expected but which have now been compiled for the first time for Austria.
AC - Archeology, Anthropology, Ethnology. Whole-body MR imaging in children with suspected osteonecrosis after intensive chemotherapy: Depiction of the whole body, including clinically non-apparent sites is mandatory for starting early and proper treatment, including surgical approaches in lesions near the joints. We analyzed the value of whole-body MRI in the detection of osteonecrosis, 1 in relation to conventional X-ray imaging and clinical symptoms, 2 using different MRI sequences, 3 with follow-up examinations.
The whole-body MRI showed in 4 of 5 children bone marrow lesions compatible with osteonecrosis. In addition to the symptomatic sites, MRI revealed additional lesions at the following sites: The lesions were able to be detected most easily with heavily T2-weighted TIRM sequences, and the diagnosis was most easily established using the non-enhanced TSE T1-weighted sequences.
In the follow-up examinations, a higher number of patients showed no changes in the lesions as to size and distribution. First results from the field test of households with dynamic tarif and automatic control in the regenerative model region Harz; Erste Ergebnisse des Haushaltsfeldtests mit dynamischen Tarif und automatischer Steuerung in der Regenerativen Modellregion Harz.
A system developed in the project and consisting of a dynamic tariff, appliance control and monitoring system is tested. Concomitant to this, the acceptance of this system by the participants of the field test is evaluated. First results from the commissioning of the system are already available. Currently, the second phase of the field test is performed. At this, the participants of the field test can adjust their power consumption actively and automatically to the availability of electricity from renewable energy sources in the model region.
Fluoroscopic-guided primary single-step percutaneous gastrostomy. Zentrum fuer Radiologie; Herrmann, J. In 39 patients mean age The clinical data and outcome as well as any complications originated from the electronic archive of the University Medical Center Hamburg-Eppendorf. The intervention was technically successful in all 39 patients.
Within the mean follow-up time of Complications manifested after a mean of One patient had to be surgically revised under suspicion of a malpositioned tube and suspected intestinal perforation. Clinically relevant wound infections were not detected. The total costs per patient were Material costs as well as human and time resources could be significantly reduced using the single-step treatment.
Ergebnisse einer empirischen Untersuchung zur Klangfarbenwahmehmung von Vorschulkindern mit einem Klangmemory. Im Unterschied zu anderen Bereichen der musikalischen Wahrnehmung gibt es zur Klangfarbenwahmehmung nur wenige Untersuchungen. Die Ergebnisse dieser empirischen Studie werden The role of diabetes mellitus, liver disease, and epilepsy as risk factors for Dupuytren disease remains unclear. In this systematic review and meta-analysis, the strength and consistency of these associations were examined. The frequencies of Dupuytren disease and diabetes mellitus, liver disease, and epilepsy were extracted, as was information on potential confounders.
Generalized linear mixed models were applied to estimate pooled odds ratios, adjusted for confounders. Heterogeneity between studies was quantified using an intraclass correlation coefficient and was accounted for by a random effect for study. One thousand two hundred sixty unique studies were identified, of which 32 were used in the meta-analyses. An association between Dupuytren disease and diabetes mellitus was observed OR, 3. An association between Dupuytren disease and liver disease was observed OR, 2. Dupuytren disease and epilepsy were associated, yielding an OR of 2.
Heterogeneity between studies was moderate to low. These findings demonstrate an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy. Prospective, longitudinal studies are needed to elucidate the pathways causing these associations. Hand function and quality of life before and after fasciectomy for Dupuytren contracture.
To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol.
The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Generally, patients with surgery on multiple fingers had worse scar pliability. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.
Published by Elsevier Inc. Radiotherapy in early-stage Dupuytren 's contracture. Long-term results after 13 years. In early-stage Dupuytren 's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. The extent of disease was described according to a modified classification of Tubiana et al. Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response.
There was no evidence for a second malignancy induced by radiotherapy. In case of disease progression after radiotherapy, a ''salvage'' operation is still feasible. Cost-effectiveness in the management of Dupuytren 's contracture. A Canadian cost-utility analysis of current and future management strategies. In Canada, Dupuytren 's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy PNA.
Injectable collagenase will soon be available. The optimal management of Dupuytren 's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren 's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren 's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective.
Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren 's contracture affecting a single finger.
Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing. The nature of intrinsic muscle involvement in Dupuytren 's disease of the middle fingers long and ring remains poorly characterized. Over the years, the authors have observed that both the spiral and lateral digital cords in the middle fingers receive contribution from intrinsic muscle-tendon units.
This report describes the anatomical characteristics and frequency of intrinsic muscle-tendon unit involvement in Dupuytren 's disease of the middle fingers. Intrinsic muscle involvement in the middle digits was recorded in the operative reports of patients undergoing Dupuytren 's surgery between October of and February of The anatomical variations of diseased fascia were delineated and classified. Of the digits with Dupuytren 's contracture operated on during this period, 52 involved the middle fingers 12 long and 40 ring fingers. Intrinsic muscles were found to be involved in the contracture of 14 of these digits.
Two unique contracture patterns were identified: The frequency of type I and type II contractures was 6 percent and 12 percent, respectively. Intrinsic hand muscles may contribute to Dupuytren 's disease in the middle digits, and the authors suggest resecting cords as close as possible to their musculotendinous origin to improve postoperative outcomes. Current surgical treatments for Dupuytren 's contracture DC include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period. Variables included demographics, OPCS, patient status and physician specialty.
Over 5 years, 75, DC admissions were recorded; 64, were analyzed. Mean admissions per year were 12, and stable. The percent of patients having two or more admissions per year increased from 5. In , classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy.
In , admissions were: Between and , fasciectomy was the most common surgical procedure for DC in. Over time, it thickens into a cord-like band. Usually, there is no pain. There is usually little pain afterward. Late complications of clinical clostridium histolyticum collagenase use in Dupuytren 's disease.
While Dupuytren 's disease can cause disabling contractures requiring open surgery, a less-invasive option using Clostridium Histolyticum collagenase CHC via percutaneous injection was recently reported. A recent prospective, randomized trial demonstrated few complications during 90 days follow-up, however did not assess any longer term follow-up for these patients. Long-term outcomes in this setting have not been adequately reported, and the current manuscript aims to identify late complications from the clinical use of percutaneous CHC.
The current manuscript reports an extended month follow-up for a cohort of twelve of patients enrolled in the original prospective, randomized trial, treated at a single institution. An analysis of complications requiring surgical intervention was undertaken. Two of twelve patients reported debilitating pain and triggering requiring surgical intervention. Extensive deep-tissue scarring and adhesions were identified, providing the first visual and qualitative analysis of the pathologic effects of CHC. Longer term follow-up of such patients is thus essential, and further investigation and characterization of the late effects of CHC use is warranted.
Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren 's disease. The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren 's disease. Eighty-one patients undergoing surgery and hand therapy were consecutively recruited.
The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life EQ-5D index explained Safety and social issues of hand function and quality of life had an evident association with functional recovery. Concurrent inhibition of TGF-beta and mitogen driven signaling cascades in Dupuytren 's disease - Non-surgical treatment strategies from a signaling point of view.
Dupuytren 's disease DD is a benign progressive fibro-proliferative disorder of the fascia palmaris of the hand. Currently, treatment consists of surgical excision with a relatively high recurrence rate and risk of complications. To improve long-term outcome of DD treatment, research focus has. The results obtained so far by the first two austenitic weld research projects show that the approach taken was the right one, as the modelling work in connection with the pulse-echo testing techniques did in fact achieve enhancements in the ultrasonic inspection of austenitic welds.
The tools developed are: Ray tracing, point source synthesis, and EFIT, and can be successfully applied for NDE of transverse-isotropic weld microstructures, as was shown by all verification experiments. The project tasks for EFIT simulation and verification of the ultrasonic test method applied to anisotropic, dissimilar welds are expected to be concluded towards the end of the project period. If these activities prove to be successful, too, there will be several examples available giving evidence of the feasibility and suitability of the tools for an optimisation of the test parameters.
The results available to date have been obtained with tests at several welds, assuming flaw types such as root defects perpendicular to the surface, which were introduced into the specimens by notches. Alle bisher durchgefuehrten Verifikationsexperimente waren erfolgreich. Wenn auch dies gelingt, ist exemplarisch an einigen Beispielen gezeigt, dass die o. Werkzeuge tauglich sind, durch Vorausrechnung reale Ultraschallpruefungen hinsichtlich der Pruefparameter zu optimieren. Die bisherigen Ergebnisse wurden. Involvement of pro-inflammatory cytokines and growth factors in the pathogenesis of Dupuytren 's contracture: Dupuytren 's contracture DC is a benign fibro-proliferative disease of the hand causing fibrotic nodules and fascial cords which determine debilitating contracture and deformities of fingers and hands.
The present study was designed to characterize pro-inflammatory cytokines and growth factors involved in the pathogenesis, progression and recurrence of this disease, in order to find novel targets for alternative therapies and strategies in controlling DC. The expression of pro-inflammatory cytokines and of growth factors was detected by immunohistochemistry in fibrotic nodules and normal palmar fascia resected respectively from patients affected by DC and carpal tunnel syndrome CTS; as negative controls.
Histological analysis showed high cellularity and high proliferation rate in Dupuytren 's tissue, together with the presence of myofibroblastic isotypes; immunohistochemical staining for macrophages was completely negative. These results were confirmed by RT-PCR and by immunofluorescence in pathological and normal primary cell cultures. Collagenase clostridium histolyticum for the treatment of Dupuytren 's contracture: Dupuytren 's disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords.
Contracture of the cords produces deformities of the fingers. Collagenase clostridium histolyticum CCH has been developed as a minimally invasive alternative to surgery for some patients. To assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren 's contracture with a palpable cord. We searched all major electronic databases from to February Two reviewers independently extracted data and assessed risk of bias of included studies.
A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy PNF and limited fasciectomy LF. Results were reported as incremental cost per quality-adjusted life-year QALY gained.
Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty. Five RCTs comparing collagenase with placebo participants , three RCTs comparing surgical techniques participants , two non-randomised studies comparing collagenase and surgery participants , five non-randomised comparative studies assessing various surgical procedures participants and 15 collagenase case series participants were included. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of motion compared with placebo-treated participants.
Budget impact analysis in Spanish patients with Dupuytren 's contracture: The aim of this study was to estimate the budget impact of collagenase Clostridium histolyticum CCH vs. A cost minimization analysis was adopted effectiveness was assumed to be equivalent for both techniques.
DD related costs were considered. CCH costs including drug, administration and visits were obtained from clinical trials and a real-life study. FSC costs including type of admission, visits, operating room, re-admissions, tests, drugs and rehabilitation costs were collected through a retrospective, observational, local study. Results were presented from the NHS perspective for the next 3 years. All the data were validated through an expert panel.
A sensitivity analysis was performed with the main variables. First robotized assembly line in for multivalve cylinder heads in Europe; Erste roborterautomatisierte Montagelinie fuer Mehrventilzylinderkoepfe in Europa. From its earliest days the automotive industry has pioneered the automation of factory operations. This reputation is being added to by yet another new development in the assembly area.
The trendsetter is ABB Flexible Automation GmbH, based in Butzbach, Germany, which has developed a future-oriented concept for vehicle engine assembly in which jointed-arm robots play a key role. Einmal mehr zeigt sich dies im Montagebereich. Gelenkarmroboter spielen dabei eine entscheidende Rolle. Eine AWB ist prospektiv aufgebaut. Der Patient mit Osteoporose mit den typischen alterskorrelierten Begleiterkrankungen. Klimaanpassung in Land- und Forstwirtschaft: Der folgende Artikel zeigt anhand einer experimentellen Studie, welche Akzeptanz Friedensjournalismus beim Leser finden kann, auch wenn dies teilweise den Theorien der Nachrichtenwertforschung widerspricht.
Des weiteren wird gezeigt, wie sich konstruktive Berichterstattung auf die mentalen Modelle der Rezipienten auswirkt und in welchem Zusammenhang diese beiden Ergebnisse miteinander stehen. Zu jedem Ereignis wurden vier verschiedene Textvarianten verwendet: What do we know about managing Dupuytren 's disease cost-effectively? Dupuytren 's disease DD is a common and progressive, fibroproliferative disorder of the palmar and digital fascia of the hand.
Various treatments have been recommended for advanced disease or to retard progression of early disease and to prevent deterioration of the finger contracture and quality of life. Recent studies have tried to evaluate the clinical and cost-effectiveness of therapies for DD, but there is currently no systematic assessment and appraisal of the economic evaluations.
A systematic literature review was conducted, following PRISMA guidelines, to identify studies reporting economic evaluations of interventions for managing DD. Cost-effectiveness analyses of treating DD were identified and their quality was assessed using the CHEERS assessment tool for quality of reporting and Phillips checklist for model evaluation. A total of studies were screened, of which 4 met the study inclusion criteria.
They all assessed the same interventions for advanced DD, namely collagenase Clostridium histolyticum injection, percutaneous needle fasciotomy and partial fasciectomy. All studies conducting a cost-utility analysis, two implemented a decision analytic model and two a Markov model approach. None of them were based on a single randomised controlled trial, but rather synthesised evidence from various sources. Studies varied in their time horizon, sources of utility estimates and perspective of analysis. The quality of the model reporting in terms of model structure, data synthesis and model consistency varied across the included studies.
MRI of the temporomandibular joint. Technique, results, indications; Magnetresonanztomographie des Temporomandibulargelenkes: Untersuchungstechnik, Ergebnisse , Indikationsstellung. The MRI protocol is based on an optimized coil technology, sequence design, and a programmed examination protocol for diagnostics of the TMJ. Depending on the clinical findings, MRI provides an all-in-one diagnostic protocol for the diagnosis of degenerative, inflammatory and tumorous lesions of the TMJ. MRI using an optimized examination protocol should become the primary examination protocol for diseases of the TMJ.
Es werden die Spulentechnik, das Sequenzdesign, die Schichtorientierung und der programmierte Untersuchungsablauf in Abhaengigkeit von der klinischen Fragestellung praesentiert. In Einzelfaellen muessen ergaenzend weitere radiologische Techniken wie die Orthopantomographie, die direkte Arthrographie und die Computertomographie zum Einsatz kommen. Full Text Available Abstract Background Splinting as part of the overall post-surgical management of patients after release of Dupuytren 's contracture has been widely reported, though there is variation in practice and criteria for using it.
The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. Using a centrally administered computer randomization system consented patients will be allocated to one of two groups: Secondary outcomes are total active flexion and extension of fingers, patient satisfaction and recurrence of contracture. Outcome measures will be collected prior to surgery, 3 months, 6 months and 1 year after surgery. An intention-to-treat analysis will be used. Discussion This pragmatic randomized controlled trial will provide much needed evidence on the clinical effectiveness of post-operative night splinting in patients who have undergone fasciectomy or dermofasciectomy for Dupuytren 's contracture of the hand.
Transjugular liver core biopsy: Indikationen, Ergebnisse , Komplikationen. Bern Switzerland ; Dufour, J. Bern Switzerland ; Zimmermann, A. Nutzen, Durchfuehrbarkeit und Komplikationsrate der transjugulaeren Leberbiopsie mit einem halbautomatischen Stanzbiopsiesystem wurden retrospektiv evaluiert.
Als erfolgreiche Biopsie wurde die Gewinnung eines Gewebszylinders definiert, der eine eindeutige histologische Diagnose gestattete. Komplikationen wurden anhand der Akten erfasst. In die Mortalitaetsrate flossen alle Todesfaelle innerhalb von 30 Tagen ein. Die prozedurbedingte Mortalitaet umfasst alle Todesfaelle, die mit der Leberbiopsie in Verbindung standen. In 5 Faellen scheiterte sie an einem unguenstigen Lebervenenabgangswinkel 1 bei einem Patienten mit Budd-Chiari Syndrom und vollstaendigem Lebervenenverschluss, 4 bei schwierigen anatomischen Verhaeltnissen.
Bei 22 Patienten wurde einmal, bei 45 zweimal und bei 14 Patienten dreimal oder oefter - jeweils in gleicher Sitzung - gestanzt. Since Dupuytren 's contracture is a common disorder, the costs for its surgical treatment impose a considerable burden on the healthcare system. For the first time in the German-speaking area, this study aimed to provide a comparative cost-effectiveness analysis for partial fasciectomy vs.
A retrospective monocentric study of the period from to comprised 40 patients with previously untreated Dupuytren 's contracture of one finger. The direct pre-interventional treatment and post-interventional costs were compared. The direct post-interventional and postoperative results were comparable. Group 1 CCH showed a mean reduction in contracture of There were fewer complications in Group 1 than in Group 2.
Treatment with CCH is more cost effective than with partial fasciectomy. This is due to greater costs for personnel, time and surgical material, as well as the treatment of the more frequent complications in Group 2. Despite the limited comparability, our findings are consistent with the present international literature. Full Text Available Objetivo: Surgical management of Dupuytren 's contracture in Europe: We explored regional variations in the surgical management of patients with Dupuytren 's contracture DC in 12 European countries using a surgeon survey and patient chart review.
Descriptive statistics are reported. Most surgeons were satisfied with fasciectomy over other procedures. Recommended time away from work and duration of physical therapy increased with the invasiveness of the procedure. The intra-operative complication rate was 4. Important inter- and intraregional differences in these aspects of patient management are described. Understanding current regional treatment patterns and their relationships to country-specific health systems may facilitate earlier identification of, and intervention for, DD and help to optimise the overall treatment for patients with this chronic condition.
Full Text Available Abstract Background Dupuytren 's disease DD is a debilitating fibro-proliferative disorder of the hand characterized by the appearance of fibrotic lesions nodules and cords leading to flexion contractures of the fingers and loss of hand function. Results Contraction of the FPCLs occurred significantly faster and to a greater extent in disease cells compared to control cells. Bioavailability of very finely distributed metallic platinum in the lungs and first orienting studies on effects. Part 2; Bioverfuegbarkeit von feinstverteiltem metallischem Platin in der Lunge und erste orientierende Wirkungsuntersuchungen VPT 09; 2.
Platinum is emitted from automotive catalytic converters in particulate form. The first organ to be exposed to it after its uptake by the organism is the lung. Lung macrophages therefore constitute the first barrier of the immune system which can to react to platinum. In this study the production of nitrogen oxides and cytokines was studied. These parameters play an important role in the initiation of inflammation and in the maintenance of chronic inflammatory processes that can lead to fibrosis of the lung. Das erste Zielorgan fuer eine Aufnahme im Organismus ist deshalb die Lunge.
Die Lungenmakrophagen stellen also die erste Barriere des Immunsystems dar, das auf Platin reagieren kann. In vitro wurde die Produktion von Stickoxiden und Zytokinen untersucht. Diese Parameter spielen eine Rolle bei der Initiation von Entzuendungen und auch bei der Aufrechterhaltung chronisch entzuendlicher Prozesse, die in der Lunge zu einer Fibrose fuehren koennen.