Overcoming challenges to support us resumption of high specific activity cobalt-60.

Domestic production of high specific activity 60Co was halted after a target rupture in 2012 at the Advanced Test Reactor (ATR). The Isotope Program (IP) within the US Department of Energy (DOE) Office of Science tasked a multilaboratory team of researchers and managers from Oak Ridge and Idaho National Laboratories with the redesign the radioisotope capsule. The objective of this effort was to create a more robust and reliable design, compared to the pre-2012 target. The team successfully completed this task to produce the DOE-IP cobalt (Co) production capsule design. Furthermore, 66 capsules were successfully fabricated by Oak Ridge National Laboratory (ORNL) and delivered to Idaho National Laboratory (INL) for irradiation in the ATR between January 2014 and October 2016. This paper describes the efforts of the team to prepare and disposition the two initial DOE-IP Co production capsules that were processed in March 2020. These efforts include performing accurate production predictions, experimentally validating predictions with assay measurements, shipping with the Orano-furnished Battelle Energy Alliance Research Reactor shipping package, and disassembling capsules at the isotope vendor site.

[Combined split ALT/TFL flap for soft tissue coverage in large thoracical defects]. / Kombinierter Split-ALT/TFL-Lappen zur Deckung großer Defekte im Thoraxbereich.

BACKGROUND: Large, ulcerating tumors of the chestwall require soft tissue coverage after resection. Depending on size and location usually a latissimus dorsi flap, VRAM or TRAM flap is performed. In very large defects a combined split ALT/TFL flap is a new technique for coverage. PATIENT AND METHODS: In 4 patients (3 female, 1 male) a soft tissue reconstruction after tumor resection was necessary. The mean age was 54 years. The mean size of the defect was 656 cm(2). RESULTS: In 3 cases the coverage was achieved by a unilateral, and in 1 case a bilateral combined split ALT/TFL flap. All flaps healed without flap loss. The donor site closure was achieved primarily in 2 cases. In 3 cases a small split skin graft was needed. CONCLUSION: The indications for combined split ALT/TFL flaps are large defects which cannot be covered by one single flap. The combination of these two long-known flaps on one pedicle is a new development.

[Challenges in building a surgical obesity center]. / Herausforderungen beim Aufbau eines operativen Adipositaszentrums.

BACKGROUND: It is estimated that approximately 1 million adults in Germany suffer from grade III obesity. The aim of this article is to describe the challenges faced when constructing an operative obesity center. METHODS: The inflow of patients as well as personnel and infrastructure of the interdisciplinary Diabetes and Obesity Center in Heidelberg were analyzed. The distribution of continuous data was described by mean values and standard deviation and analyzed using variance analysis. RESULTS: The interdisciplinary Diabetes and Obesity Center in Heidelberg was founded in 2006 and offers conservative therapeutic treatment and all currently available operative procedures. For every operative intervention carried out an average of 1.7 expert reports and 0.3 counter expertises were necessary. The time period from the initial presentation of patients in the department of surgery to an operation was on average 12.8 months (standard deviation SD ± 4.5 months). The 47 patients for whom remuneration for treatment was initially refused had an average body mass index (BMI) of 49.2 kg/m(2) and of these 39 had at least the necessity for treatment of a comorbidity. Of the 45 patients for whom the reason for the refusal of treatment costs was given as a lack of conservative treatment, 30 had undertaken a medically supervised attempt at losing weight over at least 6 months. Additionally, 19 of these patients could document participation in a course at a rehabilitation center, a Xenical® or Reduktil® therapy or had undertaken the Optifast® program. For the 20 patients who supposedly lacked a psychosomatic evaluation, an adequate psychosomatic evaluation was carried out in all cases. CONCLUSIONS: The establishment of an operative obesity center can last for several years. A essential prerequisite for success seems to be the constructive and targeted cooperation with the health insurance companies.

[Aesthetic breast augmentation]. / Ästhetische Mammaaugmentation.

Breast augmentation has become one of the most popular procedures in aesthetic plastic surgery. In addition to the well-established procedure for breast enlargement with silicone implants, two further procedures have become established in recent years. The use of autologous fat for augmentation is not new but has become more important due to further developments in the sampling method and preparation of fatty tissue. Since 2006 a product based on hyaluronic acid has complemented the available options and offers an additional clinically tested method for breast enlargement. The correct method for each patient must be decided on an individual basis. This article gives a review of the individual procedures for breast enlargement and sketches the known advantages and disadvantages.

[Microsurgical techniques for breast reconstruction]. / Mikrochirurgische Brustrekonstruktion.

The results of a survey show that less then 10% of affected women are aware of the various options for breast reconstruction. However, in modern medicine the correlation between emotional well-being and physical health has been established as an important factor. The first successful autologous breast reconstruction was performed by Czerny in 1895. After introduction of silicon implants for breast augmentation this method was also increasingly used for breast reconstruction. Worldwide most reconstructions are implant based, however the symptomatic rate of capsular contracture is up to 38% and the reoperation rate for implant-based reconstruction and radiotherapy up to 35%. Autologous reconstruction procedures have a significantly lower complication rate. This article describes the modern microsurgical techniques for breast reconstruction and discusses the indications and achievable results.

Optimizing Suprathel®-therapy by the use of Octenidine-Gel®.

OBJECTIVE: A prospective, randomized, non-blinded, clinical study was conducted to evaluate the feasibility and practicability as well as pain reduction and ease of handling of Flammazine® versus Octenidine-Gel® s a primary local antiseptic before synthetic skin substitute application in partial-thickness burns. METHODS: Thirty patients with a median age of 42 years suffering from second-degree burns were included in the study. Burns were randomly selected, one area was treated with Flammazine®/gauze, another area in the same patient was treated with Octenidine-Gel®/gauze as initial antiseptic treatment. Within 24 h the first gauze change was performed followed by wound inspection, disinfection and synthetic skin substitute application. The study focused on patient pain score, analysis of wound bed and ease of handling of the two local antiseptic agents. RESULTS: There was a significant difference between Flammazine® versus Octenidine-Gel® regarding patient pain score and ease of handling. Octenidine-Gel® was less painful (p < 0.05) and easier to handle (p < 0.05). There was no significant difference for wound bed evaluation between the two antiseptic agents. A tendency for better wound bed preparation was seen with the use of Octenidine-Gel®. CONCLUSION: Based on the findings of this study Octenidine-Gel® is recommended as a local antiseptic agent, because when compared to Flammazine®, Octenidine-Gel® proved to be better in terms of ease of care, simplicity application, with gentler and faster detachment of the gel from wound surfaces and consequently far less pain during dressing changes.

Surgical management of chronic actinic dermatitis.

SUMMARY: Chronic actinic dermatitis (CAD) is a persistent, ultraviolet (UV) radiation-induced eczema by either UVA, UVB or visible light. We present the case of a 48-year-old woman suffering from severe CAD. Various therapeutic approaches, including topical and local corticosteroids and other systemic immunosuppressives, were used without success, making surgical treatment the only option. Two sessions of manual dermabrasion were necessary to improve the cutaneous disorder. We document the successful treatment of a severe case of CAD with dermabrasion. Chronic actinic dermatitis (CAD) describes a serious and persistent photoinduced skin disorder. It is usually characterised by a perennial, chronic dermatitis that predominantly affects sun-exposed sites, but may also affect shaded sites or even present as erythroderma. Daily application of sun protection has to be combined with topical and local corticosteroids and other systemic immunosuppressives. However, these various therapeutic regimens are often limited by severe side-effects and consecutive failure of therapy. [Dawe RS, Ferguson J. Diagnosis and treatment of chronic actinic dermatitis. Dermatol Ther 2003;16:45-51 [review], Hawk JL, Magnus IA. Chronic actinic dermatitis: an idiopathic photosensitivity syndrome including actinic reticuloid and photosensitive eczema [proceedings]. Br J Dermatol 1979;101(Suppl. 17):24.].

[Body contouring surgery in the massive weight loss patient]. / Körperstraffung nach morbider Adipositas.

An increasing number of patients desire body contouring surgery after massive weight loss, whether from bariatric surgery or a change in lifestyle. The fact that many body regions lose their elasticity and tissue-tension has led to stepwise treatments including abdominoplasty, thigh lift, buttocks and hip lift or liposuction. However, these procedures often do not treat the reason for the deformities. The lower body lift first described by Ted Lockwood in 1993 is a procedure that allows simultaneous skin resection and tightening of different regions including the abdomen, buttocks, hips, and thighs. In this article the authors present their 10-year experience with the body lift. Patient selection, technical details, pre- and postoperative care, complications, and expected results are all discussed.

[Strategical approach for the treatment of the horizontal laxity of the lower lid]. / Strategisches Vorgehen in der Behandlung der horizontalen Lidverlängerung.

Horizontal laxity of the lower lid is often unrecognized and leads to a wrong treatment. The proper analysis of periorbital anatomy is most important to identify the pathophysiology in each case. Typically, the lateral canthal tendon becomes lax, resulting in eyelid malpositions. The mainstay of treatment includes tightening of either the inferior crus of the lateral canthal tendon or repositioning the entire lateral canthal tendon. The types of procedure performed will be reviewed in detail. The evaluation of the tarsal strip and the lateral dermal orbicular pennant flap as unique reconstructive tools and as adjuncts to aesthetic surgery will be discussed.

[Male breast contouring after massive weight loss]. / Bruststraffungen beim Mann nach starkem Gewichtsverlust.

Morbid obesity is an increasing problem of our present affluent society. Simultaneously with a duplication of the number of obese patients in the course of the 20th century, a significant and continual increase can be recognized in patients introducing, after massive weight loss, to plastic surgeons due to improvements in bariatric surgery can be recognized simultaneously. The male breast, a body-region that symbolizes manhood and strength and often remaining as a deflated skin-envelope, is one of the most disturbing body regions, causing extreme lack of confidence in post-weight-loss patients. In this context there are alternative procedures which can be applied locally or in combination with other body-contouring procedures in flanking regions.

[Comparison of the nipple projection after reconstruction with three different methods]. / Langzeitergebnisse nach Mamillenrekonstruktion mit verschiedenen Verfahren.

The creation of the nipple-areola complex represents the final stage in the surgical treatment of breast cancer patients. Preservation of the nipple projection is important and difficult to achieve. A huge number of different methods for nipple reconstruction have been well described, but some of them fail secondary to scar contraction with loss of projection. Furthermore, there are only few studies investigating the degree of shrinkage over time in nipple projection. Aim of this study was to determine the long-term projection of the reconstructed nipple. We compared three different methods that have been used in our department for nipple-reconstruction. Between May 1994 and December 2001, reconstruction of the breast mound was performed in 146 patients. 86 patients who underwent a unilateral reconstruction of the nipple have been examined. The nipple reconstructions were performed by using either a modified skate-flap (n = 29), a quadrapod-flap (n = 37) or by nipple sharing (n = 20). Nipple projection was measured at least six months after the reconstruction. Patients were followed an average of 10.9 +/- 3.62 months. 38 patients had tissue expansion and implantation for breast mound reconstruction. 29 patients had autologous breast mound reconstruction and 19 patients were treated by a combination of both. The mean projection was 3.45 mm (+/- 1.23) in the nipple sharing group, 6.03 mm (+/- 1.86) in the quadrapod-flap group and 9,24 mm (+/- 2.45) in the skate-flap group. The mean decrease in projection for the nipple sharing was 27.6 +/- 18.2 % while the skate flap lost 45.0 +/- 11.1 % and the quadrapod flap 49.9 +/- 11.56 %. Comparison between the three groups using a Student-t test showed a statistical significance between the nipple sharing and the two other groups (p < 0.001), while there was no significance between the local flap groups (p = 0.082). The best long-term nipple projection was obtained by the nipple sharing, but the indication therefore is rare whereas local flaps are used more often. We conclude that although both methods are effective, the skate flap allows the surgeon to overbuild the nipple and achieve a higher projection. In addition, the results also indicated that nipple projection on the breast mound reconstructed with autologous tissue achieved a better long-term outcome.

[Nickel sensitization in women and its relevance to occupation]. / Zur Nickelsensibilisierung bei Frauen und ihre Relevanz zur beruflichen Tätigkeit

213 women and 26 men out of 7835 persons examined in the course of 9 years (1967--1975) had a positive reaction to nickle sulfate. The frequency of the sensitization to nickel increased during this time, from 0.9 to 5.01%. 121 of the sensitized women were less than 30 years old. The first manifestations of that contact eczema due to metal ions appeared on the earlobes, the fingers in the ring-region, the hands, the wrists and the neck. In most of the men but only in 20 women (1 photograph, 19 metallists), a professional cause could be revealed, and an occupational disease was recognized. In the other women, a non-professional cause was found. No hair-dresser had been sensitized to nickel, by an occupational contact. The increase of the allergy ot nickel from 1967 to 1975 was mainly due to wearing costume-jewelry since the localisation of the contact eczemas ofter corresponded to the trend of fashion. Before demanding the recognition as an occupational disease in case of positive tests, the relevance of the latter to the occupation of the subject should be elucidated.

[Dyshidrosis as a pacemaker for occupational dermatoses]. / Die Dyshidrosis als Schrittmacher für berufliche Dermatosen

Out of 335 persons of less than 25 years, 236 had an intermittent dyshidrosis; half of them showed an allergic contact eczema of the hands. Microscopical and cultural investigations revealed a foot mycosis in 24 persons, and in 13 a candidiasis of the hands. Hence, dyshidrosis is obviously not of mycotic origin. 113 out of 150 sensitized persons of this group of age were dyshidrotics; 50% of them had not yet finished their apprenticeship. Obviously, dyshidrosis favours an early sensitization in professions in which allergens are frequently encountered.

[Fatal vitamin D intoxication]. / Vitamin-D-Intoxikation mit tödlichem Ausgang

A 43-year-old man with alopecia maligna was treated for 4 weeks with a total of 130 mg vitamin D3. Two weeks later, after intensive exposure to the sun, he developed a hypercalcaemic crisis and died 5 weeks later of acute cardiac failure. The hypercalcaemia proved treatment-resistant despite good diuresis. Causes other than vitamin D intoxication were excluded clinically and on histopathological investigations. It is suggested that vitamin D should be administered only on the strictest indications and with regular control of the patient.