Neutral-pion photoproduction off protons in the energy range 0.3 GeV<E(gamma)<3 GeV

Single pi(0) photoproduction has been studied with the CB-ELSA experiment at Bonn using tagged photon energies between 0.3 and 3.0 GeV. The experimental setup covers a very large solid angle of approximately 98% of 4pi. Differential cross sections dsigma/dOmega have been measured. Complicated structures in the angular distributions indicate a variety of different resonances being produced in the s channel intermediate state gammap-->N(*)(Delta(*))-->ppi(0). A combined analysis including the data presented in this letter along with other data sets reveals contributions from known resonances and evidence for a new resonance N(2070)D15.

Benzodiazepine receptor-dependent modulation of neutrophil (PMN) free amino- and ?-keto acid profiles or immune functions

We have examined the effects of midazolam, Ro 5-4864 (agonist for "peripheral" [p] benzodiazepine receptors [BR]), PK 11195 (antagonist for pBR), flumazenil (antagonist for "central" BR), naloxone (antagonist for opiate receptors) and the combination of midazolam and Ro 5-4864, PK 11195, flumazenil or naloxone on intracellular amino- and alpha-keto acids and the immune function markers superoxide anion (O(2)(-)), hydrogen peroxide (H(2)O(2)) and released myeloperoxidase (MPO) activity in neutrophils (PMN). Only midazolam and Ro 5-4864 led to significant changes in the dynamic PMN free amino- and alpha-keto acid pools. Concerning PMN immune function markers, midazolam and Ro 5-4864 significantly decreased O(2)(-) and H(2)O(2) formation and released MPO. When midazolam and Ro 5-4864 were applied together they appeared to act additively. Pre-incubation with PK 11195 partially neutralized the midazolam effects whereas flumazenil or naloxone showed no effects. We therefore believe that pBR are involved in the signal transmission of anesthetic-induced cellular metabolic changes in PMN.

Tagged-particle dynamics in a hard-sphere system: mode-coupling theory analysis

The predictions of the mode-coupling theory of the glass transition (MCT) for the tagged-particle density-correlation functions and the mean-squared displacement curves are compared quantitatively and in detail to results from Newtonian- and Brownian-dynamics simulations of a polydisperse quasi-hard-sphere system close to the glass transition. After correcting for a 17% error in the dynamical length scale and for a smaller error in the transition density, good agreement is found over a wide range of wave numbers and up to five orders of magnitude in time. Deviations are found at the highest densities studied, and for small wave vectors and the mean-squared displacement. Possible error sources not related to MCT are discussed in detail, thereby identifying more clearly the issues arising from the MCT approximation itself. The range of applicability of MCT for the different types of short-time dynamics is established through asymptotic analyses of the relaxation curves, examining the wave-number and density-dependent characteristic parameters. Approximations made in the description of the equilibrium static structure are shown to have a remarkable effect on the predicted numerical value for the glass-transition density. Effects of small polydispersity are also investigated, and shown to be negligible.

Effects of ornithine on neutrophil (PMN) free amino acid and ?-keto acid profiles and immune functions in vitro

The objective of this study was to determine the effects of ornithine on polymorphonuclear leucocyte (PMN) free amino- and alpha-keto acid profiles, superoxide anion (O2-) generation, hydrogen peroxide (H2O2) formation and released myeloperoxidase activity (MPO). Exogenous ornithine significantly increased PMN asparagine, glutamine, aspartate, glutamate, arginine, citrulline, alanine, alpha-ketoglutarate and pyruvate as intracellular ornithine increased. Concerning PMN immune function markers ornithine increased H2O2-generation and MPO activity while O2- -formation was decreased. We believe therefore that ornithine is important for affecting PMN "susceptible free amino- and alpha-keto acid pool" although the mechanisms are not yet clear. This may be one of the determinants in PMN nutrition considerably influencing and modulating PMN host defense capability.

[What is the profile of palliative care in Germany. Results of a representative survey]

Since 1996 a working group of palliative care physicians has been developing a core documentation for palliative facilities. The data on a total of 1304 patients were collected in 2001. Treatment in palliative care units was provided for 531 patients until their death (Pat-V), 604 patients could be discharged home, and 169 patients were transferred to other facilities (Pat-E). Infusion therapy, physical therapy, positioning and mobilization, together with counseling and social services were initiated in more than 30% of the patients, while specific measures such as ascites or pleura puncture were instituted in less than 10%. Chemotherapy, radiotherapy, immunotherapy, urinary catheter, physical therapy, mobilization, positioning, psychotherapy, and social services were documented more frequently in the Pat-E group than in the Pat-V group. Chemotherapy was started in only 35 patients and radiotherapy in only 31 patients while they were in the palliative care unit. Parenteral nutrition, infusion therapy, wound management, and counseling were documented more frequently in the Pat-V group. Advanced directives were available for 9,9% of the patients omission or discontinuation of therapies was documented for 28,1%. Specific indications for the quality of palliative care provided could not be identified with the documentation instruments applied. The core documentation does however furnish data from a representative sample of in-patient palliative care in Germany, which can be used as a comparative data pool for other studies and quality assurance measures.

[Long-term results after conservative treatment of pediatric femoral shaft fractures]

The principles of treatment for fractures of the femoral shaft in children include conservative and operative management. Traditionally, these fractures have been treated conservatively with skeletal traction. More frequent consideration is being given to the psychological and economical outcome. At what age of the patient surgery can be performed is still open to debate. From 1988 to 1999, 52 children with closed femoral shaft fractures were treated conservatively in the Klinik für Unfallchirurgie, Plastische und Wiederherstellungschirurgie der Universität Göttingen (until 1994 Klinik für Allgemeinchirurgie). Overhead traction was applied in 27 children with a mean age of 19.9 months (group I), and a 90-90 skeletal traction was performed in 25 children with a mean age of 47 months (group II). This treatment was followed by spica casting on an outpatient basis. At a mean follow-up of 6 11/12 years (2 4/12-12 5/12) in 33 children all fractures were healed and no malalignment with clinical relevance could be observed. In four patients the limb overgrowth was 15-20 mm. The assessment of psychological and somatic aspects revealed disturbances in the family environment. The average length of hospitalization was much shorter in group I (mean: 17.4 days) than in group II (mean: 23.7 days). Our study confirms the good long-term results after conservative treatment of femoral shaft fractures in children up to 6 years. Social and psychological problems due to the prolonged period of hospitalization as well as the high costs of skeletal traction favor surgical treatment for children older than 3-4 years.

Ergebnisse der palmaren Plattenosteosynthese bei instabilen distalen Radiusfrakturen

For unstable fractures of the distal radius, the dorsal plate requires exposure of the fragments, frequently spongioplasty, and usually removal of the implant later on. However, with the palmar approach for the reconstruction of the articular surface and restoration can easily be achieved with the T-plate. In the Traumatology Department of the University at Göttingen, we have gained experience in the treatment with the palmar T-plate in more than 400 patients. In a prospective study, we investigated the functional and radiological results after palmar T-plate osteosynthesis in Colles fractures. From September 1994 to December 1998 we treated 200 patients with the palmar T-plate (AO, 3.5 mm, titanium). 166 patients (83%), mean age 59 years, could be followed up >18 months. AO classification: A2:10, A3:45, B1:18, B2:10, C1:24, C2:40, C3:19. We compared group 1 (younger than 60 years, n=88) vs group 2 (older than 60 years, n=78). The patients' evaluation of the usability of the hand was normal in 56% and in 26,5% slightly reduced. 12,5% felt handicapped and 5% felt severely handicapped. 5% of the patients changed the domain hand, 15,4% at least partly. Function according to Lidström: 23% excellent, 58% good, 15% fair and 4% poor results. Radiological results according to Lidström were excellent and good in 88,3% and fair in 11,7%. Gartland and Werley score was excellent in 66%, good in 24%, fair in 6% and poor in 4%. There was no significant difference between group 1 and group 2 in the age-depending results. The secondary dislocation, the average dorsal tilt was 3 degrees, the mean shortening of the radius was 1,5 mm. We saw steps in the joint surface from 0,5-1 mm in 10%. An algodystrophy occurred in 5%. 12% of the patients complained of limited sensitive irritations of the medianus nerve most likely originating in the formerly used approach close to the medianus nerve. After changing this approach, we saw no irritation of the Nervus medianus among 50 patients so far. Evaluation of the functional and radiological investigations: The palmar T-plate has produced reliable and good results in the treatment of unstable distal fractures of the radius without angle-stable screws up to now. This type of osteosynthesis is stable for exercise and ensures early mobilization with good functional results even in elderly patients.

[Refixation of osteochondral fragments using absorbable implants. First results of a retrospective study]

An osteochondral lesion in a weight bearing joint causes therapeutic problems. Surgical therapy focuses on the restoration of the articular surface, unlimited motion of the joint and prevention of cartilaginous degeneration. A causal therapy to prevent posttraumatic osteoarthritis is the fixation of osteochondral fragments. Various absorbable implants for the purpose of refixation are available, but only a few have proved to be biocompatible. This retrospective study presents the preliminary results after refixation of osteochondral fragments of the ankle and knee joints. We used self-reinforced absorbable pins, nails and screws made of polylactide acid. The results for 15 patients with 17 fractures of 16 joints were evaluated. All patients were scored by the Tegner-activity-level, the McDermott-score and the DGKKT-score, and 13 of them were monitored by postoperative magnetic resonance imaging (MRI). The follow-up extended for an average of 14.3 months (range: 4-43 months). The clinical results for all patients were good (McDermott-score: Ø 89 points, DGKKT-score: Ø 78.8 points, Tegner: pre-op vs post-op=Ø 4.6 vs Ø 5.1) and the surgical therapy proved to be successful. The MRI showed the complete incorporation and vitality of the fragment as well as a congruence of the joint surface. The clinical course and the MRI gave little reference to an inflammatory reaction due to the implants that complicated the course of two patients. These results indicate that absorbable implants made of polylactide acid are biocompatible and effective in the fixation of osteochondral fragments.

[Variability of ventilation parameters of home ventilation equipment]

The performance of pressure- and volume controlled ventilators used for invasive and non-invasive ventilation in the home were tested on a patient lung model. In order to determine the influence of tidal volume preset, breathing rate, resistance, compliance and leakage to the variability of delivered tidal volume and peak airway pressure a factorial plan with adapted analysis of variance was used. The influence of tidal volume preset, compliance and leakage to the delivered tidal volume is significant. The peak airway pressure depends hardly on the influence factors. All tested ventilators meet the legal demands. But in some clinical situations there are considerable deviations of the breathing parameters depending on the brand. In conclusion ventilators of different brands are not interchangeable.

[Teleteaching in otorhinolaryngology. Part 2: the European database "medicstream"]

Searching the medical literature is mainly characterized by the use of databases. The time for reviewing and printing a paper causes a delay between the first presentation of scientific results in a lecture and the appearance of the appropriate journal publication. Moreover, the possibilities for the integration of multimedia data are limited. Because of the development of new compression algorithms for audiovisual digitization software, the near simultaneous transmission of scientific presentations, both visually and aurally, has been possible since 1999. The section telemedicine of the interdisciplinary study group on image guided surgical navigation from the University of Leipzig has developed "medicstream" as a unique, audiovisual, scientific internetdatabase. It allows the documentation of presentations at congresses and courses, including the discussion,over a freely accessible, widely available homepage, using a home developed streaming technology. All presentations are examined by an authorized editorial committee consisting of representatives with different medical specializations for content before the admission to the data base. A total of 392 presentations from seven scientific meetings can be selected by an integrated search machine and viewed with Windows Media Player or Real Player using a conventional or faster internet connection to the homepage www.medicstream.de. The quality of the audiovisual transmission depends on the receiver-lateral data transmission rate,whereby the minimum variant of 56 kB/s is characterized by good detectability of the contents. In an analysis period of 242 days,we registered 44,199 accesses and 4,488 attendances. The telemedicine data base "medicstream" can optimize quality and extend medical education by live-streaming as well as by archiving scientific presentations as audiovisual data.

[The cannulated blade plate 90 degrees for displaced proximal humeral fractures in elderly patients]

Aim of the study was to analyse the results following osteosynthesis of proximal humerus fractures with cannulated blade plate 90 degrees (Synthes, Mathys Medizinaltechnik AG, Bettlach, Schweiz) in elderly patients. Between 6/1998 and 12/1999 we treated 20 patients (12 female, 8 male) > 65 years (65-92 y, 75 y) with the cannulated blade plate (fracture type according to AO: 8 x 11-A3, 5 x 11-B1, 3 x 11-B2, 1 x 11-B3 und 3 x 11-C2). Regarding to mechanical and functional advantages we modified the 90 degrees angulation of the implant by bending intraoperatively up to 110-120 degrees. Early post-op physiotherapy was permitted. The radiological results of all patients were evaluated and in 13 patients a clinical follow-up (median 8 months) was obtained. According to the Constant-score 62 points on average were achieved, which corresponds to a satisfactory result (contralateral shoulder 92 points). Complications due to the implant were loosening of the blade plate in 3 cases (A3, B2, C2) and 1 perforation of the blade plate (C2). The consecutive reoperation consisted in a compound osteosynthesis with the blade plate (A3, B2) in 2 cases, a prosthetic replacement and a removal of the implant (C2) in 1 case respectively. Neither infection, major nerve and vessel trauma nor avascular necrosis occurred. The cannulated blade plate 90 degrees represents a justified alternative in the treatment of displaced fractures of the proximal humerus in elderly patients. Commendable indications are fracture types A and B according to AO with stable fixation of the blade plate in the humeral head, which allow early physiotherapy and avoid an alteration of the rotator cuff. C-type fractures tend to complications (2/3).

[Teleteaching in otorhinolaryngology (part 1). Real-time transmission of a congress in picture and tone into the Internet]

The transmission of scientific seminars into the Internet represents a new application of modern technologies for teleteaching. We digitally recorded 74 seminars and discussions during the 8th annual meeting of the German Society of Skull Base Surgery with five cameras and eight microphones, and transformed the data live with the real-Producer using a video card.This transferred data stream was sent via ISDN (128 kbit/s) to a real-server at the university, which was used for distribution in the net. The seminars could be called up in the display format of 320x240 pixels with a delay of 3 min (minimum: 30 s, as a function of the connection of the user) at each computer with Internet entrance. Altogether,we registered 3,284 accesses to the presentations following the congress until June 2002. The quality of picture transmission (24-36 kbit/s) and the quality of tone (audio stream: 5 kbit/s) were sufficient to understand the contents of the slide, video or computer presentation. The transmission of scientific meetings into the Internet can increase, with a justifiable technical expenditure, their efficiency by the ubiquitous availability of the information and the extension of the audience.