[Suicidal gas embolism in hospital]. / Suizidale Gasembolie im Krankenhaus.

Air embolisms are a common entity seen in clinical practice after traumatic or iatrogenic events. Cases of a suicidally induced air embolism are rare. The connectivity of air-carrying and fluid-carrying tubing systems allow large gas volumes to be infused in a short period of time, usually with fatal outcome. In such cases, the use of computed tomography prior to autopsy is mandatory and provides a comprehensive visualization of introduced gas volumes. We present an unusual case of a suicidal gas embolism, in which a man in hospital connected a tube supplying oxygen to a venous catheter.

Implementation of a miniaturised navigation system in head and neck surgery for the detection and removal of foreign bodies.

The removal of embedded blast-generated fragments from soft tissue is very difficult, especially in the head and neck regions. First, because many retained foreign materials are non-metallic and can, therefore, not be detected by fluoroscopy, and second, because a broad exploration of the soft tissue is not possible in the facial area for functional and cosmetic reasons. Intraoperative navigation computer-assisted surgery (CAS) may facilitate the retrieval of foreign bodies and reduce exploration trauma. In a blind trial, five test specimens of different materials (glass, metal, wood, plastic, and stone) were inserted on the left and right sides of the head and neck of ten body donors through an intraoral incision. A second physician then detected and removed the foreign bodies from one side of the body without and from the other side of the body with navigation. We measured the duration of surgery, the extent of tissue trauma caused during surgery, the time it took to remove the foreign bodies, and the subjective evaluation of the usefulness of navigation. With the aid of the navigation system, the various foreign bodies were detected after an average of 26.7 (±35.1) s (p < 0.0001) and removed after an average of 79.1 (±66.2) s (p = 0.0239), with an average incision length of 10.0 (±3.5) mm. Without the navigation system, the foreign bodies were located after an average of 86.5 (±77.7) s and removed after an average of 74.1 (±45.9) s, with an average incision length of 13.0 mm (±3.6) mm (=0.0007). Intraoperative navigation systems are a valuable tool for removing foreign bodies from the soft tissue of the face and neck. Both the duration of surgery and the incision length can be reduced using navigation systems. Depending on the material of the foreign bodies and the signal intensity in the CT/MRI scanner, however, the detection reliability varies. All in all, navigation is considered to be a useful tool.

[Anatomy of the eustachian tube]. / Anatomie der Tuba Eustachii.

The auditory tube is part of a complex anatomical functional system, which even today is not completely explained. It plays a crucial role in the understanding of the pathogenesis of chronic middle ear infections and possible therapeutic interventions--particularly in infants. This paper summarizes the current knowledge of eustachian tube gross anatomy and histology, its peritubular structures and its topographic relationship to the internal carotid artery in adults. Anatomical aspects specific to infancy are related to their possible influence on tube function.

["Problem-based learning--inflammation and transplantation": an integrated, subject-centred course in the clinical section of the medical curriculum at the medical school of the University of Muenster]. / Problemorientiertes Lernen--Entzündungsmedizin & Transplantation: ein integrierter, themenzentrierter Kurs im klinischen Studienabschnitt an der Medizinischen Fakultät der Westfälischen Wilhelms-Universität (WWU) Münster.

Conventional medical curricula present information pertinent to chronic inflammatory diseases, infectious diseases and transplantation, via systematic lectures and courses in medical specialties without any integrated approach. The authors report on a 3-week model course that attempts to provide students with an overview of clinical presentation, diagnostics, and therapy of representative disease entities with particular emphasis on the interdisciplinary approach to these problems in hospital practice. In addition to problem-based learning in small groups, the model course comprises interdisciplinary concept lectures, practical demonstrations of specific diagnostic procedures, and bedside teaching. In the meantime, the course "Problem-Based Learning--Inflammation and Transplantation" has been held twice successfully as a mandatory course in the clinical part of the curriculum at the Muenster Medical School.

Sustained suppression of serum LH, FSH and testosterone and increase of high-density lipoprotein cholesterol by daily injections of the GnRH antagonist cetrorelix over 8 days in normal men.

OBJECTIVE: Recently we have shown that single dose injections of the new GnRH antagonist cetrorelix ([Ac-D-Na(2)1, D-Phe(4Cl)2, D-Pal(3)3, D-Cit6, D-Ala]GnRH; SB-75) decrease serum LH and testosterone in a dose-dependent manner in normal men. These results prompted us to investigate the effectiveness and safety of multiple daily injections of cetrorelix in normal male volunteers. DESIGN AND VOLUNTEERS: Following two control examinations 16 young men were randomly assigned to four study groups (n = 4/group). Daily doses of 0 (placebo), 2, 5, and 10 mg cetrorelix were injected subcutaneously at 0800 h for 8 days and morning and evening blood samples were obtained for 3 weeks. RESULTS: One day after the first cetrorelix injection, serum LH and testosterone concentrations were significantly suppressed in all treatment groups. Whereas in the 2 and 5-mg dose groups LH and testosterone showed some fluctuations, daily injections of 10 mg cetrorelix consistently suppressed LH and testosterone in all men. In addition, in this group serum FSH concentrations were significantly suppressed to subnormal values 1 day after the first injection and remained in this range up to 5 days after the last injection. A time and dose-dependent increase of high-density lipoprotein cholesterol was observed during cetrorelix-induced testosterone deprivation with a maximal increase of 0.38 +/- 0.13 mmol/l (14.8 +/- 5.1 mg/dl; mean +/- SEM) in the 10-mg dose group. In addition, parallel to suppressed testosterone the volunteers' libido was significantly reduced under the GnRH antagonist. Apart from those symptoms caused by androgen deficiency, the only adverse side-effect observed was a mild painless local erythema at the injection site that disappeared within an hour. CONCLUSIONS: Daily injections of 10 mg cetrorelix effectively and consistently suppress serum LH, FSH and testosterone concentrations, and therefore it has potential for treatment of sex hormone-dependent diseases and for male contraception.