Der Ileus - ein Findling in der modernen Medizin?

Zusammenfassung: Kaum einem Krankheitsbild liegt ein so breites differenzialdiagnostisches Spektrum zugrunde wie dem Ileus. Insbesondere die hochgradige Obstruktion und der komplette Ileus können über eine bakterielle Translokation und Mikroperfusionsstörungen des dilatierten Darmes zu intestinalen Perforationen und einer Kreislaufinstabilität führen. Klare Algorithmen zur schnellen Kategorisierung des Ileus sind deshalb unabdingbar. Dabei sind insbesondere die Lokalisation des Kalibersprungs beim mechanischen Ileus als auch der Grad der Obstruktion wichtige Kriterien. Die Anamnese, klinische Untersuchung und das konventionelle Röntgenbild des Abdomens sind elementare Bestandteile der Basisdiagnostik. Als Goldstandard der erweiterten bildgebenden Diagnostik hat sich die Computertomographie etabliert. Während für die meisten hochgradigen mechanischen Obstruktionen des Dünndarms, die in drei Vierteln der Fälle durch Adhäsionen und Briden bedingt sind, eine explorative Laparotomie indiziert ist, stehen beim obstruierenden Dickdarmileus auch endoskopische Optionen zur Verfügung. Das Stenting von malignen kolorektalen Tumoren aboral der linken Flexur als überbrückende oder palliative Intervention hat sich ebenso wie die koloskopische Detorquierung des Volvulus etablier

Criteria for establishing shielding of multi-detector computed tomography (MDCT) rooms

The aim of this work is to compare two methods used for determining the proper shielding of computed tomography (CT) rooms while considering recent technological advances in CT scanners. The approaches of the German Institute for Standardisation and the US National Council on Radiation Protection and Measurements were compared and a series of radiation measurements were performed in several CT rooms at the Lausanne University Hospital. The following three-step procedure is proposed for assuring sufficient shielding of rooms hosting new CT units with spiral mode acquisition and various X-ray beam collimation widths: (1) calculate the ambient equivalent dose for a representative average weekly dose length product at the position where shielding is required; (2) from the maximum permissible weekly dose at the location of interest, calculate the transmission factor F that must be taken to ensure proper shielding and (3) convert the transmission factor into a thickness of lead shielding. A similar approach could be adopted to use when designing shielding for fluoroscopy rooms, where the basic quantity would be the dose area product instead of the load of current (milliampere-minute

Probing the boundaries of the Hadronic Phase through a Strangeness including Statistical Bootstrap Model (S-SBM)

A recently constructed strangeness-including Statistical Bootstrap Model (S-SBM), which defines the limits of the hadronic phase and provides for a phase beyond, is further extended so as to include a factor that describes strangeness suppression. The model is then used to analyse the multiplicity data from collision experiments in which the colliding entities form isospin symmetric systems, the primary focus being on S+S interactions (NA35 collaboration). An optimal set of thermodynamical variables is extracted through a fit to both the inclusive full phase space and midrapidity data. The assumption that the measured particles originate from a thermally and partial-chemically equilibrated source described by the S-SBM is satisfactorily established. The proximity of the thermodynamical variables extracted from the S+S data to the limits of the hadronic phase is systematically investigated. Finally, experimental data from proton-antiproton collisions (UA5 collaboration) are similarly analysed.Comment: 39 pages, 17 figures, all the figures joined in one file. Submitted in Phys. Rev.

Comparison of organ doses and image quality between CT and flat panel XperCT scans in wrist and inner ear examinations

The aim of this study was to evaluate and compare organ doses delivered to patients in wrist and petrous bone examinations using a multislice spiral computed tomography (CT) and a C-arm cone-beam CT equipped with a flat-panel detector (XperCT). For this purpose, doses to the target organ, i.e. wrist or petrous bone, together with those to the most radiosensitive nearby organs, i.e. thyroid and eye lens, were measured and compared. Furthermore, image quality was compared for both imaging systems and different acquisition modes using a Catphan phantom. Results show that both systems guarantee adequate accuracy for diagnostic purposes for wrist and petrous bone examinations. Compared with the CT scanner, the XperCT system slightly reduces the dose to target organs and shortens the overall duration of the wrist examination. In addition, using the XperCT enables a reduction of the dose to the eye lens during head scans (skull base and ear examinations

Integration of external and internal dosimetry in Switzerland

Individual monitoring regulations in Switzerland are based on the ICRP60 recommendations. The annual limit of 20 mSv for the effective dose applies to the sum of external and internal radiation. External radiation is monitored monthly or quarterly with TLD, DIS or CR-39 dosemeters by 10 approved external dosimetry services and reported as Hp(10) and Hp(0.07). Internal monitoring is done in two steps. At the workplace, simple screening measurements are done frequently in order to recognise a possible incorporation. If a nuclide dependent activity threshold is exceeded then one of the seven approved dosimetry services for internal radiation does an incorporation measurement to assess the committed effective dose E50. The dosimetry services report all the measured or assessed dose values to the employer and to the National Dose Registry. The employer records the annually accumulated dose values into the individual dose certificate of the occupationally exposed person, both the external dose Hp(10) and the internal dose E50 as well as the total effective dose E = Hp(10)+E50. Based on the national dose registry an annual report on the dosimetry in Switzerland is published which contains the statistics for the total effective dose, as well as separate statistics for external and internal exposur

The First 1 1/2 Years of TOTEM Roman Pot Operation at LHC

Since the LHC running season 2010, the TOTEM Roman Pots (RPs) are fully operational and serve for collecting elastic and diffractive proton-proton scattering data. Like for other moveable devices approaching the high intensity LHC beams, a reliable and precise control of the RP position is critical to machine protection. After a review of the RP movement control and position interlock system, the crucial task of alignment will be discussed.Comment: 3 pages, 6 figures; 2nd International Particle Accelerator Conference (IPAC 2011), San Sebastian, Spain; contribution MOPO01

Environmental changes and violent conflict

This letter reviews the scientific literature on whether and how environmental changes affect the risk of violent conflict. The available evidence from qualitative case studies indicates that environmental stress can contribute to violent conflict in some specific cases. Results from quantitative large-N studies, however, strongly suggest that we should be careful in drawing general conclusions. Those large-N studies that we regard as the most sophisticated ones obtain results that are not robust to alternative model specifications and, thus, have been debated. This suggests that environmental changes may, under specific circumstances, increase the risk of violent conflict, but not necessarily in a systematic way and unconditionally. Hence there is, to date, no scientific consensus on the impact of environmental changes on violent conflict. This letter also highlights the most important challenges for further research on the subject. One of the key issues is that the effects of environmental changes on violent conflict are likely to be contingent on a set of economic and political conditions that determine adaptation capacity. In the authors' view, the most important indirect effects are likely to lead from environmental changes via economic performance and migration to violent conflict. © 2012 IOP Publishing Ltd

Study of the impact of tissue density heterogeneities on 3-dimensional abdominal dosimetry: comparison between dose kernel convolution and direct monte carlo methods.

Dose kernel convolution (DK) methods have been proposed to speed up absorbed dose calculations in molecular radionuclide therapy. Our aim was to evaluate the impact of tissue density heterogeneities (TDH) on dosimetry when using a DK method and to propose a simple density-correction method. METHODS: This study has been conducted on 3 clinical cases: case 1, non-Hodgkin lymphoma treated with (131)I-tositumomab; case 2, a neuroendocrine tumor treatment simulated with (177)Lu-peptides; and case 3, hepatocellular carcinoma treated with (90)Y-microspheres. Absorbed dose calculations were performed using a direct Monte Carlo approach accounting for TDH (3D-RD), and a DK approach (VoxelDose, or VD). For each individual voxel, the VD absorbed dose, D(VD), calculated assuming uniform density, was corrected for density, giving D(VDd). The average 3D-RD absorbed dose values, D(3DRD), were compared with D(VD) and D(VDd), using the relative difference Δ(VD/3DRD). At the voxel level, density-binned Δ(VD/3DRD) and Δ(VDd/3DRD) were plotted against ρ and fitted with a linear regression. RESULTS: The D(VD) calculations showed a good agreement with D(3DRD). Δ(VD/3DRD) was less than 3.5%, except for the tumor of case 1 (5.9%) and the renal cortex of case 2 (5.6%). At the voxel level, the Δ(VD/3DRD) range was 0%-14% for cases 1 and 2, and -3% to 7% for case 3. All 3 cases showed a linear relationship between voxel bin-averaged Δ(VD/3DRD) and density, ρ: case 1 (Δ = -0.56ρ + 0.62, R(2) = 0.93), case 2 (Δ = -0.91ρ + 0.96, R(2) = 0.99), and case 3 (Δ = -0.69ρ + 0.72, R(2) = 0.91). The density correction improved the agreement of the DK method with the Monte Carlo approach (Δ(VDd/3DRD) < 1.1%), but with a lesser extent for the tumor of case 1 (3.1%). At the voxel level, the Δ(VDd/3DRD) range decreased for the 3 clinical cases (case 1, -1% to 4%; case 2, -0.5% to 1.5%, and -1.5% to 2%). No more linear regression existed for cases 2 and 3, contrary to case 1 (Δ = 0.41ρ - 0.38, R(2) = 0.88) although the slope in case 1 was less pronounced. CONCLUSION: This study shows a small influence of TDH in the abdominal region for 3 representative clinical cases. A simple density-correction method was proposed and improved the comparison in the absorbed dose calculations when using our voxel S value implementation

Sub MeV Particles Detection and Identification in the MUNU detector ((1)ISN, IN2P3/CNRS-UJF, Grenoble, France, (2)Institut de Physique, Neuch\^atel, Switzerland, (3) INFN, Padova Italy, (4) Physik-Institut, Z\"{u}rich, Switzerland)

We report on the performance of a 1 m$^{3}$ TPC filled with CF$_{4}$ at 3 bar, immersed in liquid scintillator and viewed by photomultipliers. Particle detection, event identification and localization achieved by measuring both the current signal and the scintillation light are presented. Particular features of $\alpha$ particle detection are also discussed. Finally, the ${54}$Mn photopeak, reconstructed from the Compton scattering and recoil angle is shown.Comment: Latex, 19 pages, 20 figure