Chest lifting.

The male chest has a female appearance in patients with gynecomastia and those who have experienced a huge weight loss. The disadvantages of reduction mammaplasty for men are the visible scars on the chest wall necessitated because of skin redundancy. The aims of the chest-lifting procedure are to reposition the breast, to create a male appearance by thinning the amount of glandular and fatty tissue, to avoid noticeable scars on the chest wall, and to hide the scar in the middle axillar line.

Anisotropy of human linea alba: a biomechanical study.

BACKGROUND: Recently, a new model of fiber architecture of the linea alba has been described consisting of an oblique fiber layer of intermingling oblique fibers, a transverse fiber layer containing mainly transverse fibril bundles, and a variable, small irregular fiber layer. In this study the morphological model was proven using direction-specific biomechanical measurements of the linea alba. MATERIAL AND METHODS: Thirty-one human abdominal walls were analyzed (16 male and 15 female). Six strips of collagen tissue with a width of 1 cm were exsected from each linea alba transversely, obliquely, and longitudinally according to the main fiber directions. An increasing force from 2 to 24 N was applied to these strips, and the corresponding strain represented by the relative elongation was measured, which allows the calculation of a direction-specific compliance of the tissue. RESULTS: The compliance is highest in longitudinal and smallest in transverse direction. In the infraumbilical part of the female linea alba the compliance was significantly smaller in the transverse direction than in the oblique direction. Moreover, the compliance in the transverse direction was significantly smaller in women than in men. CONCLUSIONS: A distinct anisotropy of morphological and biomechanical properties was demonstrated as well as sex-dependent differences. The compliance correlates with the distribution of fiber orientation in the linea alba. These biomechanical results constitute the functional correlation with the fiber morphology of the linea alba and correspond well to our earlier proposed model of fiber architecture.

[DRG reimbursement for multiple trauma patients -- a comparison with the comprehensive hospital costs using the German trauma registry]. / DRG-Entlohnung beim Polytrauma. Ein Vergleich mit den tatsächlichen Krankenhauskosten anhand des DGU-Traumaregisters.

UNLABELLED: The introduction of diagnosis related groups (DRG) will radically change the payment system for German hospitals. In 2002 the values for most DRG's were published for the german system (G-DRG). The polytrauma working group of the German Trauma Society developed a calculating algorithm to estimate the comprehensive hospital costs for every patient in the German trauma registry. The aim of this study was to compare these costs with the reimbursement according the the G-DRG's for a standardized population of polytrauma patients. MATERIAL AND METHODS: For polytrauma patients treated at Hannover Medical School in 2000 and 2001 the reimbursement according to the G-DRG's was calculated using a base value of 2900 euro. In the same patients the total cost of inpatient treatment was calculated according to the algorithm developed by the polytrauma working group of the German Trauma Society. The difference between these values represents the economic result. This was calculated as an overall result, but also for specific subgroups of patients (injury severity, mortality, G-DRG grouping). RESULTS: Datasets of 103 polytrauma patients were included. The following G-DRG's were most frequently occuring: A06Z (n=41), A07Z (n=16), W01Z (n=13). All other G-DRG's were documented less than 3 times. The mean reimbursement according to the G-DRG was 21.380+/-12.300 euro for a polytrauma patient. However, the mean hospital cost accounted to 34.274+/-22.501 euro, which resulted in a mean deficit of 12.893+/-15.534 euro. Analysis of subgroups revealed, that an ISS of more than 35 points, patients with a prolonged hospital stay and patients of the G-DRG group A06Z show a particularly negative result. CONCLUSION: The comprehensive hospital costs for treating polytrauma patients are on average 12.893 euro higher than the reimbursement according the G-DRG's. For hospitals to be fully reimbursed G-DRG values have to be reconfigured according to the German health care system. Thus, inclusion criteria to specific G-DRG have to be changed and a specific G-DRG group for very severely injured patients needs to be established.

The application of fuzzy-based methods to central nerve fiber imaging.

This paper discusses the potential of fuzzy logic methods within medical imaging. Technical advances have produced imaging techniques that can visualize structures and their functions in the living human body. The interpretation of these images plays a prominent role in diagnostic and therapeutic decisions, so physicians must deal with a variety of image processing methods and their applications. This paper describes three different sources of medical imagery that allow the visualization of nerve fibers in the human brain: (1) an algorithm for automatic segmentation of some parts of the thalamus in magnetic resonance images based on the differences in myelin content in various thalamic subnuclei; (2) polarized light for classifying the 3D orientation of the nerve fibers at each point; and (3) confocal laser scanning microscopy (CLSM) for calculating semiquantitative variables for myelin content. Fuzzy logic methods were applied to analyze these pictures from low- to high-level image processing. The solutions presented here are motivated by problems of routine neuroanatomic research demonstrating fuzzy-based methods to be valuable tools in medical image processing.

A 3D fiber model of the human brainstem.

A new neuroanatomic approach to evaluate the fiber orientation in gross histological sections of the human brain was developed. Serial sections of a human brainstem were used to derive fiber orientation maps by analysis of polarized light sequences of these sections. Fiber inclination maps visualize angles of inclination, and fiber direction maps show angles of direction. These angles define vectors which can be visualized as RGB-colors. The serial sections were aligned to each other using the minimized Euclidian distance as fit criterion. In the 3D data set of the human brainstem the major fiber tracts were segmented, and three-dimensional models of these fiber tracts were generated. The presented results demonstrate that two kinds of fiber atlases are feasible: a fiber orientation atlas representing a vector in each voxel, which shows the nerve fiber orientation, and a volume-based atlas representing the major fiber tracts. These models can be used for the evaluation of diffusion tensor data as well as for neurosurgical planning.

Specific reverse transcription-PCR quantification of vascular endothelial growth factor (VEGF) splice variants by LightCycler technology.

BACKGROUND: Overexpression of vascular endothelial growth factor (VEGF) is associated with increased angiogenesis, growth and invasion in solid tumors, and hematologic malignancies. The expression of isoforms of VEGF, which mediate different effects, can be discriminated by splice-variant-specific quantitative reverse transcription-PCR (RT-PCR), but current methods have only modest sensitivity and precision and suffer from heteroduplex formation. METHODS: We used a real-time RT-PCR assay on the LightCycler system. Applicability for detection of different VEGF mRNAs and total VEGF message was tested on seven healthy tissues (each pooled from healthy donors) and seven correlated malignant tissues. Results were normalized to beta(2)-microglobulin mRNA. Amplification of VEGF splice variants was performed exclusively with variant-specific reverse primers, whereas forward primer and fluorescent probe were common to obtain similar RT-PCR kinetics. RESULTS: Highly specific detection of VEGF splice variants was achieved with minor intra- and interassay variation (<0.22 threshold cycle). Total VEGF expression was higher in malignant tissues. In healthy tissues, the mRNA encoding diffusible variants VEGF(121) and VEGF(165) constituted on average 78% (SD = 9.3%) of the total VEGF message, and the cell-adherent variant VEGF(189) constituted on average 22% (SD = 5.4%). In contrast, in malignant tissues VEGF(121) and VEGF(165) accounted for 94% (SD = 7.6%) and VEGF(189) only 6% (SD = 3.7%). CONCLUSIONS: Because of the ability for quantification of VEGF splice variants with high specificity, sensitivity, and reproducibility, this new LightCycler assay is superior to conventional semiquantitative competitive RT-PCR and immunological assays and may contribute to better understanding of VEGF-mediated angiogenesis.

[Interest in early active controlled mobilization and flexion following flexor tendon repair in zone 2]. / Intérêt de la mobilisation en flexion active protégée après suture des tendons fléchisseurs en zone 2.

INTRODUCTION: Primary repair of flexor tendons in zone II of the hand and early post-operative rehabilitation is no longer challenged. However, early rehabilitation methods vary from one unit to another. Although currents techniques such as of Kleinert's and Duran's have brought considerable improvements in functional outcomes, they do not allow early active motion of repaired flexor tendons. METHODS: A promising method of active controlled mobilization has been proposed by the Bordeaux Hand Unit and adopted by our rehabilitation unity since 1995. The aims of this method are: to avoid of proprioceptive inhibition linked to passive methods and prevention of adhesions. This method has been assessed by a prospective study of 22 consecutive patients with average follow-up of 11.8 months. RESULTS: Our rating was based on the Strickland scoring technique. 81% of good and excellent results were observed. Our score rates confirm the results published by others authors who have applied the same active protocols. The results observed in our series tend to confirm the advantages of early controlled active mobilization techniques and lead us to pursue their application in the future.

[Chronic fascioliasis with destructive cholangitis]. / Chronische Faszioliasis mit destruierender Cholangitis.

A 56-year-old Greek working in an electroplating shop, in Germany since 1965, had experienced abdominal pain with weight loss for about 16 years. He had received treatment for a variety of diagnoses. With the aid of ERC and aspired bile, the diagnosis of chronic fascioliasis was finally established.

Proton NMR-relaxation dispersion in meconium solutions and healthy amniotic fluid: possible applications to medical diagnosis.

In order to show that for a possible application in medical diagnosis NMR-relaxation experiments at low Larmor frequencies (v0 less than or equal to 20 kHz) are more sensitive than the up to now done high field measurements in the MHz-range, we present dispersion curves (v0 = 50 Hz to 50 MHz) of the proton longitudinal relaxation time T1 and values of the transversal relaxation time T2 for the example of amniotic fluids. Only for Larmor frequencies below congruent to 100 kHz the relaxation times for healthy amniotic fluid and pathological meconium solutions are significantly different, whereas at high Larmor frequencies, i.e. in the conventional MHz-range, the observed changes are rather small.

[Diagnosis of the presence of meconium in amniotic fluid by dispersion curves of the longitudinal relaxations of protons]. / Diagnostic de la présence de méconium dans le liquide amniotique par dispersion de la relaxation longitudinale des protons.

Dispersion curves of the longitudinal relaxation T1 of protons in healthy amniotic fluid in a meconium solution are distinct at low Larmor frequencies (V0 less than 100 kHz). We are thus able to distinguish these fluids by T1 measurements in this range.

Mineral analysis of ancient Peruvian hair.

Ancient Peruvian hair has been excavated from a series of archaeological sites on the Peruvian coast. After careful cleaning, examination by scanning electron microscopy revealed most of the samples to be in a state of preservation comparable to modern hair. No evidence of pathological conditions was observed. Trace metal composition was determined by atomic absorption and flame emission spectrophotometry and nitrogen by Kjeldahl analysis, producing the following results: (1) nitrogen is lost with time, while all other tested minerals except zinc and copper showed irregular increases; (2) relatively high chromium levels may indicate that diabetes was not present in the samples; and (3) no consistent trend in the ratio of calcium to strontium was found through time and across corresponding dietary shifts.