Surgical Approach of Synchronous Medullary Thyroid Carcinoma and Pheochromocytoma in MEN 2 Syndrome

In cases with concurrent medullary thyroid carcinoma (MTC) and pheochromocytoma, discussion regarding a one-stage versus two-stage treatment strategy approach remains open. From 1975 to 1990, 11 of 25 multiple endocrine neoplasia type 2 (MEN 2) patients presented with biendocrinopathies or triendocrinopathies synchronously. All patients were treated surgically and followed subsequently in our hospital. Of the group of nine patients with concurrent MTC and pheochromocytoma, five were treated in one-stage and four in two-stage procedures. No patient had major complications intraoperatively. For the two-stage group, the total hospital stay (preoperatively and postoperatively) averaged 35 days. For the one-stage group, the total hospital stay averaged 25 days. In patients with increased operative risks (patients with higher age and impaired physical condition or if neck surgery includes transstemal cervicomediastinal lymphadenectomy), two-stage procedures should be selected. However, in young patients with the MEN 2 syndrome or syndromes with small tumors detected by family screening, thyroidectomy, cervical lymphadenectomy, and adrenalectomy may be performed in a one-stage procedure without increasing surgically related morbidity

Parodontale Erkrankungen bei Schwangeren und ihr Einfluss auf Frühgeburt und fetale Wachstumsrestriktion - State of the Art: eine Literaturauswertung

Die Reduktion perinataler Morbidität und Mortalität ist ein wichtiges medizinisches Ziel. Als wesentlicher Faktor, der für die perinatale Morbidität und Mortalität verantwortlich gemacht wird, ist die Frühgeburtlichkeit zu nennen. Durch die Unreife der Organsysteme Frühgeborener kann es zu zahlreichen akuten Erkrankungen, wie Atemnotsyndrom, intrazerebralen Blutungen und septischen Krankheitsbildern aufgrund der erhöhten Infektdisposition, kommen. Infolge dessen treten chronische, insbesondere pulmonale und neurologische, Folgeschäden auf, die nicht nur für das Frühgeborene und dessen Familie eine Belastungssituation darstellen, sondern auch vom Gesundheits- und Sozialsystem enorme Leistungen erfordern, die mit hohen Kosten verbunden sind. Schätzungen zufolge waren im Jahr 2006 ca. 12,8 % der Geburten Frühgeburten. Ca. 70 % der Frühgeburten ereignen sich spontan, wovon 45 % auf eine vorzeitige Wehentätigkeit und 25 % auf einen vorzeitigen Blasensprung zurückzuführen sind. Zur Reduktion der Frühgeburtsraten ist es entscheidend, insbesondere die Genese der spontanen Frühgeburten besser zu kennen, um sinnvolle Präventionsmaßnahmen ergreifen zu können. Schätzungen zufolge sind 25 % - 50 % der spontanen Frühgeburten auf eine Infektion zurückzuführen. Seit Offenbacher et al. 1996 ihre Arbeit zum möglichen Zusammenhang einer Parodontitis mit Frühgeburt und niedrigem Geburtsgewicht veröffentlichten, wird ein verstärkter Fokus auf die Untersuchung dieser Theorie gelegt. Offenbacher et al. postulierten, dass eine Parodontitis einen unabhängigen Risikofaktor für die Entbindung untergewichtiger Frühgeborener darstellt. Die pathophysiologischen Überlegungen umfassen verschiedene Wege, wie eine Parodontitis eine Frühgeburt auslösen könnte: entweder kann es durch hämatogene Streuung der oralen pathogenen Keime in die Plazenta oder Amnionflüssigkeit zu einer intrauterinen Infektion kommen, oder die chronische parodontale Entzündung selbst führt zu einer systemischen Infektion, die letztlich über erhöhte Zytokin- und Prostaglandinspiegel eine Frühgeburt auslösen kann. Da die Erkrankung mit Scaling und Root planning gut behandelbar ist, wäre es wichtig, sie als Risikofaktor für eine Frühgeburt zu identifizieren und somit zur Senkung der Frühgeburtsraten beizutragen. Die seit 1996 durchgeführten klinischen Studien variieren sehr in ihren Ergebnissen. So können einige Studien einen positiven Zusammenhag zwischen einer mütterlichen Parodontitis und einer Frühgeburt und einem niedrigen Geburtsgewicht nachweisen, andere wiederum können diese These nicht unterstützen. Bis 2007 kann kein einheitlicher Trend definiert werden. Die in dieser Arbeit betrachteten 37 Veröffentlichungen seit 2008 liefern weiterhin unterschiedliche Ergebnisse. Bei den untersuchten Studien handelt es sich um Beobachtungs- und Interventionsstudien. Zusätzlich wurden die Metaanalysen und Reviews seit 2008 berücksichtigt. Ein großes Problem in der Interpretation der Resultate stellen u.a. die verschiedenen Studiendesigns, die unterschiedlichen Probengrößen, die Populationsheterogenität und das Fehlen einer einheitlichen Parodontitisdefinition dar. Die Studien sind daher nur begrenzt miteinander vergleichbar. Zusammenfassend kann zum aktuellen Zeitpunkt keine definitive Aussage getroffen werden, ob eine Parodontitis einen unabhängigen Risikofaktor für eine Frühgeburt und ein niedriges Geburtsgewicht darstellt oder nicht. Es werden weitere randomisierte kontrollierte Studien, eine einheitliche Parodontitisdefinition, definierte Therapiestrategien und deren Erfolgskontrolle sowie weitere Investitionen in die Grundlagenforschung benötigt. Zum jetzigen Stand der Forschung sollte die Untersuchung des Parodontalstatus in die pränatale Routinevorsorge integriert werden und bei entsprechender Erkrankung auch eine Behandlung stattfinden

Surface and depth profile analysis of insulating samples by TOF-SIMS

The functionahty of modern products made of glass, glass-ceramics, organics or other special materials is mainly dominated by the surface quality. Α well defined lateral homogeneity of the surface stoichiometry is an important requirement for following addedvalue procedures, e.g. optical, mechanical or organic functional coatings. As a characterization tool the time-of-flight secondary ion mass spectrometry (TOF-SIMS) provides analytical information about the chemical matrix in the surface near region with a lateral and depth resolution on the nanometer scale. Corrosion, contamination, interaction with the environment or diffusion of material components are typical phenomena, which can be studied in detail. The results lead to a deeper knowledge of the microscopic material behavior which is one of the basics for the understanding of complex processes in the field of development and production. Typical applications demonstrate the variety of operating a TOF-SIMS analytic tool, which is optimized for the investigation of electrically high insulating sample Systems with various geometric appearance

Salient characteristics of non-traditional students: Implications for college student personnel services

This population is not an easy one to identify. The search for a meaningful profile is complicated by the heterogeneity of the group 2 and the multiplicity of sub-groups. Yet, it is obvious that we have seen a dramatic increase in this student population which has received too little attention from professionals in higher education. Currently, student services tend to focus on the college student 17 through 25 years of age, single, male, unemployed, and full-time (Cross, 1974). Student services that have been implemented for the non-traditional student are mainly in the academic areas, with such programs as evening/weekend classes, credit for prior learning, extended office hours and elderhostel (Thon, 1983). If we are to meet the needs of this population, then student development educators need to examine the characteristics of non-traditional students and to develop student services approaches that will meet students\u27 needs and maximize their total educational experience

Paternal kin recognition in the high frequency / ultrasonic range in a solitary foraging mammal

Background Kin selection is a driving force in the evolution of mammalian social complexity. Recognition of paternal kin using vocalizations occurs in taxa with cohesive, complex social groups. This is the first investigation of paternal kin recognition via vocalizations in a small-brained, solitary foraging mammal, the grey mouse lemur (Microcebus murinus), a frequent model for ancestral primates. We analyzed the high frequency/ultrasonic male advertisement (courtship) call and alarm call. Results Multi-parametric analyses of the calls’ acoustic parameters and discriminant function analyses showed that advertisement calls, but not alarm calls, contain patrilineal signatures. Playback experiments controlling for familiarity showed that females paid more attention to advertisement calls from unrelated males than from their fathers. Reactions to alarm calls from unrelated males and fathers did not differ. Conclusions 1) Findings provide the first evidence of paternal kin recognition via vocalizations in a small-brained, solitarily foraging mammal. 2) High predation, small body size, and dispersed social systems may select for acoustic paternal kin recognition in the high frequency/ultrasonic ranges, thus limiting risks of inbreeding and eavesdropping by predators or conspecific competitors. 3) Paternal kin recognition via vocalizations in mammals is not dependent upon a large brain and high social complexity, but may already have been an integral part of the dispersed social networks from which more complex, kin-based sociality emerged

Life cycle sustainability assessment approaches for manufacturing

Sustainability assessments considering the three dimensions environment, economy, and society are needed to evaluate manufacturing processes and products with regard to their sustainability performance. This chapter focuses on Life Cycle Sustainability Assessment (LCSA), which considers all three sustainability dimensions by combining the three methods life cycle assessmentLCA, life cycle costingLCC, and Social Life Cycle Assessment (SLCA). Existing LCSA approaches as well as selected ongoing work are introduced, both regarding the individual approaches as well as the combined LCSA approach. This includes, for instance, the Tiered Approach. This approach facilitates the implementation of LCSA, for instance, within the manufacturing sector, by providing a category hierarchy and guiding practitioners through the various impact and cost categories proposed for the three methods. Furthermore, ongoing developments in LCC and SLCA are presented, such as the definition of first economic and social impact pathways (linking fair wage and level of education to social damage levels) for addressing the current challenges of missing impact pathways for economic and social aspects. In addition, the Sustainability Safeguard Star suggests a new scheme for addressing the inter-linkages between the three sustainability dimensions. These approaches foster the application and implementation of LCSA and thus contribute to developing sustainable processes and products

Sustainable corporate development measured by intangible and tangible resources as well as targeted by safeguard subjects

The needed shift towards sustainable development in existing business processes can be achieved through the combination of the capital based approach and the life cycle sustainability assessment. This contribution performs an analysis and selection of assessment tools and indicators regarding the resources used in organisational processes and the life cycle of the products or services to measure the potential impacts on the environment and society. The relevance of intangible capital to improve the organisational sustainability performance as well as the expansion of the traditional dimensions of sustainability with the target of the six safeguard subjects: human health, social justice, ecosystem quality, financial stability, resource availability and man-made environment are integrated into a conceptual framework. This approach allows the development and implementation of strategies towards sustainable corporate development through a recommendation-based framework

Selection Criteria for Suitable Indicators for Value Creation Starting with a Look at the Environmental Dimension

AbstractThis paper presents a set of selection criteria for identifying indicators for sustainable production of the manufacturing industry. Starting from a condensed overview of over 500 general sustainability indicators, such focussing on sustainable production are discussed, including the three dimensions of sustainability and the indicator qualities. Based on the Collaborative Research Centres (CRC) 1026 Framework and with the understanding that manufacturing industries may differ, the authors suggest to use the ABC judgement method - a semi-quantitative systematic method to prioritize indicators based on expert judgement and supporting evidences - to select core and supplemental indicators. Concise questionnaires considering sustainability targets are used and combined with a scoring system to support the decision process. The method can use either top-down indicators (i.e. on the impact level e.g. acidification, climate change) or bottom-up indicators (i.e. on inventory level e.g. energy consumption, recycling rate, volume or weight of solid waste/hazardous waste). Proof of concept of the proposed approach in a life cycle based case study are presented by three demonstration cases focusing on manufacturing sector i.e. elevator, refrigerator and welding. Based on these cases result, we conclude that this is the first step in the right direction to use the ABC method to identify the suitable impact category sets for conducting LCA studies. The three simple questions that transfer selection criteria, i.e. robustness, relevance, effectiveness, practicality and clear and easy to measure, are found operational and appropriate