Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines.

BACKGROUND: Whole body computed tomography in trauma (WBCTT) is a standardized CT examination of trauma patients. It has a relatively high radiation dose. Therefore, well-defined clinical indications and imaging protocols are needed. This information regarding Nordic countries is limited. PURPOSE: To identify Nordic countries' WBCTT imaging protocols, radiation dose, and integration in trauma care, and to inquire about the need for common Nordic guidelines. MATERIAL AND METHODS: A survey with 23 multiple choice questions or free text responses was sent to 95 hospitals and 10 trauma centers in and outside the Nordic region, respectively. The questions were defined and the hospitals selected in collaboration with board members of "Nordic Forum for Trauma and Emergency Radiology" (www.nordictraumarad.com). RESULTS: Two Nordic hospitals declined to take part in the survey. Out of the remaining 93 Nordic hospitals, 56 completed the questionnaire. Arterial visualization is routine in major trauma centers but only in 50% of the Nordic hospitals. The CT scanner is located within 50 m of the emergency department in all non-Nordic trauma centers but only in 60% of Nordic hospitals. Radiation dose for WBCTT is in the range of 900-3600 mGy × cm. Of the 56 responding Nordic hospitals, 84% have official guidelines for WBCTT. Eighty-nine percent of the responders state there is a need for common guidelines. CONCLUSION: Scanning protocols, radiation doses, and routines differ significantly between hospitals and trauma centers. Guideline for WBCTT is presently defined locally in most Nordic hospitals. There is an interest in most Nordic hospitals to endorse new and common guidelines for WBCTT.

Gender differences in the longitudinal predictors of adolescent dating violence.

BACKGROUND: Adolescent dating violence is a public health problem. The public health approach to prevention is to identify predictors of problem behaviors and develop interventions to eliminate or reduce those predictors with the intention of altering the chain of causation. Longitudinal data are preferred for identifying predictors of behavior but all dating violence studies have used cross-sectional data. We use longitudinal data to examine predictors of adolescent dating violence from several domains guided by an ecological perspective. METHODS: Eighty percent (N = 1,965) of the 8th- and 9th-graders in one county completed baseline questionnaires in school and 90% (N = 1,759) of those adolescents completed questionnaires again 1&1/2 years later. Proportional odds models were used to identify cross-sectional correlates and longitudinal predictors of dating violence perpetration that occurred between baseline and follow-up. RESULTS: Most of the study variables were correlated with dating violence in cross-sectional analyses. Having friends who are victims of dating violence, using alcohol, and being of a race other than white predicted dating violence perpetration by females. Holding attitudes that are accepting of dating violence predicted dating violence perpetration by males. CONCLUSION: The findings suggest that intervention strategies should vary for males and females and that when basing interventions on cross-sectional findings, scarce resources may be stretched to address persons who may not truly be at risk of beginning to perpetrate dating violence.

[X-ray computed tomographic diagnosis of primary cardiac malignant lymphoma in AIDS]. / Diagnostic tomodensitométrique d'un lymphome malin cardiaque primitif au cours du SIDA.

Primary lymphomas rarely affect the heart. The myocardial disease is usually latent and the diagnosis is based on post mortem observations. The cardiac symptoms do not reveal the disease and symptomatology is not specific. Our observation shows the complementarity of non invasive techniques, for a better screening of cardiac tumoral forms. Although echocardiography is the main examination, CT scan provides a detection of infiltrative forms and of extracardiac extension. Concurrently, MRI remains the method of choice to display beginning infiltrative forms, revealed by pericardial effusion in AIDS disease.

[Significance of primary radical surgery for survival following treatment of breast cancer. Problems of interpretation of treatment results of prospective, nonrandomized studies exemplified by the Southwest Germany Breast Cancer Study]. / Die Bedeutung der primären operativen Radikalität für das Uberleben nach Mammacarcinombehandlung. Interpretationsprobleme der Behandlungsergebnisse prospektiver, nichtrandomisierter Studien am Beispiel der Südwestdeutschen Mammacarcinom-Studie.

In a prospective non-randomised trial 1642 patients were included. After a mean time of 10 years a follow-up analysis was performed. The importance of the radicality of the primary operative therapy of breast cancer should be evaluated. The mean 5 years survival rate was 67.3%, the 10 year survival rate 51.6%. Tumor stage and age had a highly significant influence on the survival rate. Patients with simple mastectomy had a lower survival rate as patients with radical mastectomy. This apparent difference was caused by a different age distribution in the therapy groups. Accordingly the mean life deficiency was the lowest in the simple mastectomy group. In a multiple hazard statistical analysis tumor stage and age showed a highly significant influence on the survival rate. The intraoperative radicality classification showed a significant correlation to the prognoses of the patients. The operative therapy itself had no significant influence on the survival rate of the patients.

Acquired arterio-venous fistulas. Report of 223 operated cases.

More than 200 years ago William Hunter described the first arteriovenous fistula (a.v.). Fragments of low velocity are the most frequent cause for a combined vascular trauma. However, a.v. fistulas may also develop after a skull fracture, after surgical interventions (lumbar disc operation, suture ligation for the removal of an organ like the kidney, the spleen and others). Three circulatory disorders may follow an a.v. fistula. Local signs at the location of trauma (machinery murmur, varicose veins). Cardiac dilatation due to the increase of heart volume. Degenerative changes and aneurysm formation in the artery above the fistula. Late complications may arise in the dilated central segment of the artery (aneurysm or thrombosis). The etiology of 223 traumatic a.v. fistulas (1939-1973) were in the majority (82%) of patients caused by war time injuries. Fractures and stab wounds were also common causes of a.v. fistulas. The location of a.v. fistulas was in about 50% in the lower extremities and only in 3% in the trunk. As to therapy - in contrast to the older quadruple ligature - the separation method should be the method of choice. The repair in arterio-venous fistulas should be done as early as possible. The operative cure rate in our series was 96%.

[Tumors of the glomus caroticum]. / Tumoren des Glomus caroticum.

From 1952 to 1982 15 patients (6 male, 9 female) with 20 carotid body tumors have been treated in the surgical departments of the universities of Berlin and Heidelberg. A recurrent tumor occurred in 3 patients, in one case appeared a further recurrence. Two patients presented with a tumor of the glomus jugulare as well as the tumors of the carotid body and with a familial accumulation. While still in the 60's the surgical procedure was in doubt due to high complications and lethality rates today, because of the progress in carotid surgery with the insertion of an intraluminal shunt, the operation is recommended without risk. An important part plays a certain preoperative diagnosis through the B-mode sonography for the operative strategy.

Malignancies of the endocrine glands.

Patients with malignant tumors of the endocrine system can be effectively treated by surgery, the 5 year survival rate varying between 30-90 per cent, depending on organ involvement. In the Federal Republic of Germany, 1 out every 5 persons dies as a result of malignancy. Less than 1 per cent of the total annual rate of such deaths relates to malignancies originating in the endocrine glands.

[Malignant tumors of the endocrine system (author's transl)]. / Maligne Tumoren des endokrinen Systems.

The malignant forms of endocrine tumors are a worthwhile target for surgery, particularly since radiotherapy and chemotherapy have shown far less, if any, results. In contrast, the combination of scalpel and anatomical reduction of the hormonal matrix proved to be of high therapeutic values. The well-known saying of Moynihan: "A surgeon is an internist who operates" refers to the necessary prerequisite for such interventions--a well founded pathophysiological knowledge.

[The place of surgery in the modern treatment of cancer (author's transl)]. / Die Stellung der Chirurgie in der neuzeitlichen Krebs-Therapie.

Cancer is now the second most frequent cause of death in the Federal Republic of Germany. According to medical estimates, surgery is the primary treatment for 80-90% of all tumors, and it is curative in 30-40% with or without concomitant radiotherapy. Chemotherapy is potentially curative in about 7%, immunotherapy in only +/- 0%. After a general discussion of radical and palliative operative techniques, the place of surgery in prophylactic indications, in recurrences, and in metastases is dealt with. Special problems occur in various organ tumors (thyroid, breast, esophagus, stomach, colon, and Wilms' tumors). In Heidelberg, an interdisciplinary oncologic group has been in existence since 1966; this group forms the basis of a tumor center, consisting of the two academic clinics and the German Cancer Research Center. Whether a speciality in surgical oncology is also needed in Germany is a question for further consideration.