Separating different contributions to the crystal-field parameters using Wannier functions.

We discuss the calculation of crystal-field splittings using Wannier functions and show how contributions to the crystal-field splitting that are due to hybridization with different ligand states can be separated from the bare Coulomb contribution by constructing sets of Wannier functions incorporating different levels of hybridization. We demonstrate this method using SrVO3 as a generic example of a transition metal oxide. We then calculate trends in the crystal-field splitting for two series of hypothetical tetragonally distorted perovskite oxides and discuss the relation between the calculated 'electrostatic' contribution to the crystal field and the simple point charge model. Finally, we apply our method to the charge disproportionated 5d electron system CsAuCl3. The proposed procedure elucidates the way in which the negative charge transfer energy in this material leads to a reversal of the p-d ligand contribution to the crystal-field splitting such that the eg states of the nominally Au(3+) cation are energetically lower than the corresponding t2g states.

[Quality control in patient education. Results of a patient survey about the patient education protocol of the Swiss Society of Surgery in 6 Swiss hospitals]. / Qualitätskontrolle der Patientenaufklärung. Resultate der Patientenbefragung über das Aufklärungsprotokoll der Schweizerischen Gesellschaft für Chirurgie (SGC) in sechs Schweizer Spitälern.

In the past years the number of malpractice suits due to lack of patient information has increased. Because there have been no generally accepted guidelines for preoperative patient information, the Swiss Society of Surgery has decided to work out an informative brochure tailored to the needs of patients. It takes into account that the need to know beforehand is increasing rapidly. In collaboration with the judiciary service of the Swiss Medical Federation all the items and points of legal relevance have been compiled to establish an informative brochure. Based on this protocol, patients in surgical departments of 6 Swiss community hospitals were asked before discharge to qualify the preoperative information offered to them. 2660 questionnaires were evaluated. The majority of patients considered the information regarding their diagnosis, the complications, risks, treatment and postoperative care, the sketches describing the operation and the overall degree of information as good or very good. Almost 60% of all patients stated that no alternative treatment had been discussed with them other than the planned procedure. In most of these patients operative procedures were chosen and carried out for which there were few or no other acceptable options. 2/3 of the patients asked for immediate preoperative written information, especially if they had malignant disease. Barely 4% of the patients were not reassured by the information provided to them. The fact that 2/3 of all patients re-read the informative protocol before the operation underlines how important it is to hand out a copy of the protocol to satisfy the informative needs of the patients. To our surprise the vast majority of patients uttered little concern about giving their signature to forms that were presented to them. Only 2% of the patients felt that giving a signature would cause them grave reservations. The informative protocol devised by the Swiss Society of Surgery is well adapted to the informative needs of the patients and allows for a structured conversation. It facilitates documentation and offers valid legal proof for the physician that he/she has provided adequate information.

Three-dimensional reconstruction of fracture surfaces: area matching algorithms for automatic parallax measurements.

This paper describes two solutions for systematic measurement of surface elevation that can be used for both profile and surface reconstructions for quantitative fractography case studies. The first one is developed under Khoros graphical interface environment. It consists of an adaption of the almost classical area matching algorithm, that is based on cross-correlation operations, to the well-known method of parallax measurements from stereo pairs. A normalization function was created to avoid false cross-correlation peaks, driving to the true window best matching solution at each region analyzed on both stereo projections. Some limitations to the use of scanning electron microscopy and the types of surface patterns are also discussed. The second algorithm is based on a spatial correlation function. This solution is implemented under the NIH Image macro programming, combining a good representation for low contrast regions and many improvements on overall user interface and performance. Its advantages and limitations are also presented.

Snow avalanches

For alpine countries, avalanches represent one of the major hazards, threatening people on villages as well as on highways and railways. Measures have to be taken to reduce the avalanche risk. Avalanche hazard mapping, as a basis for land use planning, and avalanche warning are the most cost - effective measures to reduce or even avoid avalanche exposure. Long - term technical measures, such as supporting structures, deflecting dams and afforestations, or short - term measures, such as avalanche forecasting, artificial avalanche release of evacuation, might be chosen to reduce the avalanche risk to an acceptable level. It is important to evaluate the different measures within the framework of an overall risk management procedure. (AU)

[Late results of Childs-Phillips mesenteric plication for therapy and prevention of small intestine ileus]. / Spätresultate der Mesenterialplikatur nach Childs-Phillips zur Therapie und Prophylaxe des Dünndarmileus.

During the past 7 years 45 patients have been operated upon using the Childs-Phillips method. Of those, 37 were subsequently examined for the study--7 patients had died in the meantime. None of the deaths occurred as a direct result of transmesenteric small-bowel plication. An early recurrence of intestinal obstruction occurred in 4.4% and a laparotomy was repeated. During the most recent examinations 86.5% of those patients checked had (virtually) no complaints--91.9% based upon the Visick classification. A subtotal intestinal obstruction occurred during the period of the study in 8.1% of cases, but could be conservatively treated. Up until the most recent examination there were still no instances of a late recurrence. Most intestinal obstruction recurrences are due to errors specific to the technique and are early recurrences. On the basis of our results, we are of the opinion that plication in the presence of existing peritonitis, as well as partial plication, is acceptable.

[Emergency carotid endarterectomy in acute infarction--case report and literature review]. / Notfallmässige Carotisendarterektomie im akuten Infarkt--Case Report und Literaturübersicht.

Elective operation of carotid stenosis over 70% is uncontested since publication of the interim results of NASCET and ECST [1,2] trials. Even though emergency carotid endarterectomy for rapidly progressing cerebral infarction (stroke in evolution) remains very controversial outcome depends on how fast cerebral perfusion is reestablished, complete recovery is possible if carotid thrombendarterectomy is successfully performed in between the first 6-8 hours. We report the case of a female patient developing a cerebral infarction on the first postoperative day after femoropopliteal bypass grafting. Diagnosis of an acute carotid occlusion was established by cerebral duplex sonography, intracerebral hemorrhage was excluded by emergency computed tomography. Emergency thrombendarterectomy successfully reverted all cerebral symptoms. Postoperative course was uneventful, the patient was dismissed on the 12th postoperative day without any neurological residual deficit.

[Thoracic sympathectomy in palmar hyperhidrosis: comparison of open with thorascopic procedure]. / Die thorakale Sympathektomie bei der Hyperhidrosis palmarum: Vergleich / thorakoskopisches Vorgehen.

Between 1976 and 1994 we performed 26 thoracic sympathectomies for treatment of therapy-resistant palmar hyperhidrosis. Until the end of 1992 the operation was performed using an open transaxillary approach, since 1993 sympathectomy was done by video-assisted thoracoscopy. Both procedures consisted in excision of the thoracic ganglia T2 to T5. The only complication was a pneumothorax in the open surgery group (successfully treated by drainage). Compensatory sweating occurred in 70% of our patients, compared to results in the literature of 60-90%. We did not note further complications, e.g. no Horner's syndrome. All of our patients were satisfied with the result of the operation. Comparison of the two collectives shows significant advantages for video-assisted thoracoscopic surgery. the procedure is easier to perform, exposure is better, cosmetic results are favourable, operation-time and hospital stay are reduced.

[Vascular injuries. Diagnosis and technical procedure]. / Gefässverletzungen. Diagnostik und taktisches Vorgehen.

Fractures complicated by vascular trauma are rare but very complicated injuries. Clinical diagnosis is confirmed by Doppler sonography and/or arteriography. Time effectiveness in investigation and therapy is most important, cooperation between orthopedic and vascular surgeons is crucial. If indication is correct, arterial reconstruction has excellent results in these severe injuries.

[Surgical treatment of varices at the stage of trophic disorders in chronic venous insufficiency]. / Le traitement chirurgical des varices au stade des troubles trophiques lors d'insuffisance veineuse chronique.

Most ulcers of the lower limbs are caused by existing chronic venous insufficiency. Later on, true social and professional problems will arise, with serious economic and psychological consequences not only for the patient himself, but for the community as well, such as huge medical costs--hence the importance of prevention and treatment, which must in no case be purely symptomatic. The ligation of the arch and of the perforating veins and stripping of the affected vein are part of the classical management of varices. These procedures can may prove to be virtually impossible in case of chronic venous insufficiency, if the patient also presents with subcutaneous liposclerosis or atrophy in an already pregangrenous skin. This preulcerous stage can be aggravated later on if the requirements for surgical repair are not met. Necrosis can then occur, if too aggressive surgery directly or indirectly injures the microcirculatory system of the damaged skin. Omitted or undesirable acts are dangerous at the stage of trophic disorders and surgery may fail to reach its aim, which of course would be to definitively and quickly eliminate the varicose disease.

[Infected vascular prostheses]. / Infizierte Gefässprothesen.

Szilagyi's statement: 'The management of cases with infected arterial implants proves to be a task of grave and sometimes insurmountable difficulty' has kept its validity until today. In spite of restrictive patient selection, perfect surgical skill and perioperative antibiotic prophylaxis, infection of vascular grafts still do occur. Diagnosis has to be established without delay, and treatment of such often fatal infections is an aggressive surgical one.

Swiss adjuvant trial (OSAKO 06/74) with chlorambucil, methotrexate, and 5-fluorouracil plus BCG in node-negative breast cancer patients: nine-year results.

Between 1974 and 1977, a total of 254 patients with stages T1-3a, N0-1, and M0 operable breast cancer (node negative and node positive, stratified) were randomized to either modified radical mastectomy alone or the same surgery and adjuvant chlorambucil, methotrexate, 5-fluorouracil (LMF) plus BCG. After a median follow-up of 9 years (January 1985), we concluded that LMF plus BCG significantly increased relapse-free survival (RFS) in 240 fully evaluated patients, especially postmenopausal women. This gain in RFS ceased to transform into a gain in overall survival (OAS) after 7 years of median follow-up for the whole patient group. In the 122 node-negative patients studied, LMF plus BCG produced a marked increase in RFS up to the fifth year and in OAS up to 8 years after initial surgery, thus prolonging significantly the median disease-free interval compared with surgical control patients. This trend favoring LMF plus BCG-treated patients continues. Although median time to first relapse and to generalized disease were increased in relapsing patients by LMF plus BCG, the subsequent intervals from local relapse to distant disease and from distant metastases to death were equal for both treatment regimens. Subjective and objective acute toxicity from LMF plus BCG was mild. At 9 years of median follow-up, fewer second tumors were noted in the node-negative group receiving LMF plus BCG than in surgical controls.