Intraoperative 3-D mapping of parathyroid adenoma using freehand SPECT

Background: Freehand single photon emission computed tomography (fSPECT) is a three-dimensional (3-D) tomographic imaging modality based on data acquisition with a handheld detector that is moved freely, in contrast to conventional, gantry-mounted gamma camera systems. In this pilot study, we evaluated the feasibility of fSPECT for intraoperative 3-D mapping in patients with parathyroid adenomas. Methods: Three patients (range 30 to 45 years) diagnosed with hyperparathyroidism (one primary and two tertiary) underwent parathyroid scintigraphy with technetium-99m sestamibi (99mTc-MIBI) to localize parathyroid adenomas. Two patients were referred with persistent hyperparathyroidism after conventional parathyroidectomy. In all three patients, a planar scintigraphy of the neck was performed 10 min after injection (p.i.) followed by SPECT/CT (Symbia T2, Siemens Healthcare) and a correlative ultrasound 2 h p.i. 99mTc-MIBI scan was performed the day before surgery in two patients and at the same day in one patient. fSPECT images were acquired intraoperatively using declipse SPECT (SurgicEyeTM). Results: A total of five parathyroid adenomas were successfully located with SPECT/CT. fSPECT allowed intraoperative detection of all adenomas, and successful parathyroidectomy was accomplished. Parathyroid hormone level decreased intraoperatively in all three patients, on average, by 79% (range 72% to 91%). Conclusion: In this preliminary study, we could demonstrate that intraoperative localization of parathyroid adenomas is feasible using the freehand SPECT technology, thus allowing an image-guided parathyroidectomy

Polymorphism of alpha-1-antitrypsin in hematological malignancies

Alpha-1-antitrypsin (AAT) or serine protease inhibitor A1 (SERPINA1) is an important serine protease inhibitor in humans. The main physiological role of AAT is to inhibit neutrophil elastase (NE) released from triggered neutrophils, with an additional lesser role in the defense against damage inflicted by other serine proteases, such as cathepsin G and proteinase 3. Although there is a reported association between AAT polymorphism and different types of cancer, this association with hematological malignancies (HM) is, as yet, unknown. We identified AAT phenotypes by isoelectric focusing (in the pH 4.2-4.9 range) in 151 serum samples from patients with HM (Hodgkins lymphomas, non-Hodgkins lymphomas and malignant monoclonal gammopathies). Healthy blood-donors constituted the control group (n = 272). The evaluated population of patients as well as the control group, were at Hardy-Weinberg equilibrium for the AAT gene (χ2 = 4.42, d.f.11, p = 0.96 and χ2 = 4.71, d.f.11, p = 0.97, respectively). There was no difference in the frequency of deficient AAT alleles (Pi Z and Pi S) between patients and control. However, we found a significantly higher frequency of PiM1M1 homozygote and PiM1 allele in HM patients than in control (for phenotype: f = 0.5166 and 0.4118 respectively, p = 0.037; for allele: f = 0.7020 and 0.6360 respectively, p = 0.05). In addition, PiM homozygotes in HM-patients were more numerous than in controls (59% and 48%, respectively, p = 0.044). PiM1 alleles and PiM1 homozygotes are both associated with hematological malignancies, although this is considered a functionally normal AAT variant

Individual remediation and cooperative learning in inclusive education

Die Entwicklung des Gemeinsamen Unterrichts von Kindern und Jugendlichen mit und ohne besonderen Förderbedarf wird von einer über drei Jahrzehnte anhaltenden pädagogischen Diskussion und von bildungspolitischen Verlautbarungen seit Mitte der 1990er Jahre im In- und Ausland gefordert. Bisher bleibt jedoch die Quote der Schüler an Sonderschulen in Deutschland, verglichen mit den Quoten anderer Länder, sehr hoch. Folgender Beitrag sieht eine Ursache in unserem viergliedrigen Schulsystem, das die Vorstellung von Leistungshomogenität in den Schularten vortäuscht und die Aufrechterhaltung des Frontalunterrichts begünstigt. Gemeinsamer Unterricht geht prinzipiell von Heterogenität aus und empfiehlt reformpädagogische Unterrichtskonzepte mit einem hohen Maß an selbstgesteuertem individualisierten Lernen. U.S.-amerikanische Forschungen zeigen nun, dass sich eine durch die Lehrkraft, also fremdgesteuerte, direkte Förderung als wirksames Verfahren für den Erwerb klassischer schulischer Fertigkeiten bei Kindern mit besonderem Förderbedarf im Lernen erwiesen hat. Daher plädieren wir für den kombinierten Einsatz von direkter individueller Förderung und selbstgesteuertem kooperativen Lernen im Gemeinsamen Unterricht. (DIPF/Orig.)In Germany as well as in foreign countries an educational discussion for more than three decades and political statements since the mid-nineties have demanded an inclusive education for students with special educational needs. The rate of students attending special schools in Germany is still very high compared to the rates of other countries. The German four-track school system is identified being one reason, because it underlines the fiction of homogeneity of classes favoring class teaching. In contrast, inclusive education takes into account heterogeneity recommending a reformpedagogical teaching with a high degree of self-regulatory individualized learning. Research in the U.S., however, shows that direct instructions by teachers are an effective method for educating students with learning disabilities in reading, writing and arithmetic. Therefore, we prefer a combination of direct individualized instruction and self-regulatory cooperative learning in inclusive education. (DIPF/Orig.

Christoph Butterwegge / Michael Klundt (Hrsg.): Kinderarmut und Generationengerechtigkeit. Familien- und Sozialpolitik im demografischen Wandel. Opladen: Leske und Budrich 2003 (244 S.) [Rezension]

Rezension von: Christoph Butterwegge / Michael Klundt (Hrsg.): Kinderarmut und Generationengerechtigkeit. Familien- und Sozialpolitik im demografischen Wandel. Opladen: Leske und Budrich 2003 (244 S,; ISBN 3-8100-3731-1; 18,50 EUR)