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Hypercalcemia is a common feature of malignancy, bone metabolic conditions and granulomatous disorders. In the latter, hypercalcemia is usually calcitriol-related. As eventual association of silicone and polymethylmethacrylate (PMMA) injections with granulomatous disease and hypercalcemia the condition has become an issue of recent interest. Authors report on two cases of calcitriol-related hypercalcemia where PMMA injections had been previously administered. The association, even though intriguing, requires additional confirmation by follow-up studies.

Zusammenfassung 1 Neugeborene Ferkel kommen ohne Gamma-Globulin auf die Welt und erwerben entsprechend ihrer Kolostrumaufnahme in den ersten Stunden p.n. einen hohen Gamma-Globulingehalt. Innerhalb der ersten 5 Wochen sinkt der Gamma-Globulingehalt verhaltnismasig rasch ab, um anschliesend wieder langsam anzusteigen. Etwa mit der 15. Woche erreicht er den Normalstand. 2 Bei ausschlieslich bzw. nur in den ersten 3 Tagen kunstlich (globulinfrei) aufgezogenen Ferkeln, die zunachst kein Gamma-Globulin in ihrem Serum enthalten, sind von der 2. Lebenswoche an allmahlich zunehmende Mengen an Gamma-Globulin zu finden. In der 8. Woche erreichen sie die gleiche Hohe wie bei den naturlich ernahrten Ferkeln. 3 Bei Ferkeln, die Kolostrum nach Belieben oder auch nur einen halben Tag lang aufgenommen haben, konnen nach parenteraler Zufuhr eines bakteriellen Antigens erstmalig in der 5. bzw. 6. Woche Antikorper nachgewiesen werden. 4 Im Serum der ganzlich ohne Muttermilch ernahrten Ferkel lassen sich nach entsprechender Antigenzufuhr erst in der 10. Lebenswoche Antikorper nachweisen; bei den Ferkeln, die nur in den ersten 3 Tagen kunstlich (globulinfrei) und danach vom Muttertier ernahrt worden sind, konnen Antikorper aber schon in der 5. Woche festgestellt werden, also ebenso zeitig wie bei den standig mit Muttermilch ernahrten Tieren. 5 Das sofort nach der Geburt in groser Menge passiv ubernommene Gamma-Globulin wirkt sich nicht unmittelbar auf die Antikorperbildung aus. Diese ist erst nach Einsetzen der Gamma-Globulinsynthese im jungen Organismus festzustellen und wird scheinbar durch bestimmte Stoffe in der Muttermilch in zeitlicher Hinsicht gefordert. Summary Production of gamma-globulin and antibodies in the suckling pig 1 Newborn pigs are born without gamma-globulin and acquire it within a few hours after birth, the amount depending on colostrum intake. The level falls relatively steeply in the first 5 weeks and then rises again slowly, reaching the normal level at about 15 weeks. 2 Piglets reared artificially for the first 3 days on a diet free from globulin show at first no gamma-globulin in their serum, but an increasing amount appears from the second week. At 8 weeks the level is the same as in naturally reared piglets. 3 Piglets given free access to colostrum and those given it for only half a day first show antibodies in their serum 5 to 6 weeks after parenteral introduction of a bacterial antigen. 4 In the serum of piglets reared entirely without sow's milk, antibodies are first demonstrable in the 10th week. Piglets receiving no colostrum for 3 days after birth and then suckled by the sow show antibodies at 5 weeks, the same time as those which suckled the sow from birth. 5 The large quantities of gamma-globulin passively transferred immediately after birth to the piglet are not used immediately for antibody formation. This process first occurs after the onset of gamma-globulin synthesis in the young animal and appears to be caused by certain substances in the milk. Resume La formation d'anticorps et de Gamma-globulines chez les porcelets 1 Les porcelets nouveau-nes sont depourvus de Gamma-globulines. En buvant le colostrum, ils acquierent dans les premieres heures qui suivent la naissance une grande teneur en Gamma-globulines dans le serum. Au cours des premieres semaines, la teneur du serum en Gamma-globulines diminue assez rapidement pour remonter lentement par la suite. C'est a la 15eme semaine environ qu'elle atteint des valeurs normales. 2 Les porcelets, denues de Gamma-globulines a la naissance, et nourris artificiellement (sans globulines), soit totalement, soit pendant les trois premiers presentent dans leur serum des la deuxieme semaine des Gamma-globulines dont la teneur monte peu a peu. Des la 8eme semaine, la quantite de Gammaglobulines est egale a celle des porcelets nourris naturellement. 3 Chez les porcelets qui ont recu du colostrum a volonte ou seulement pendant une demi journee, on ne peut deceler des anticorps apres administration parenterale d'un antigene bacterien, qu'au cours de la cinquieme ou de la sixieme semaine. 4 Dans le serum des porcelets nourris totalement sans lait maternel on ne peut deceler des anticorps, apres incorporation des antigenes correspondants, qu'au cours de la 10eme semaine; chez les porcelets qui n'ont ete nourris artificiellement (sans globulines) que pendant les trois premiers jours et a qui l'on redonna par la suite le lait de leur mere, des anticorps peuvent etre deceles au cours de la 5eme semaine deja, soit a la meme epoque que chez les porcelets qui ont ete nourris par leur mere sans interruption. 5 Les Gamma-globulines recues passivement en grande quantite tout de suite apres la naissance, n'ont aucune action directe sur la production des anticorps. Celle-ci ne peut etre constatee qu'apres le debut de la synthese des Gamma-globulines par la jeune organisme et elle est vraisemblablement acceleree par certaines substances contenues dans le lait des truies. Resumen La formacion de la globulina gamma y de los anticuerpos en el cerdo lactante 1 Los lechones nacen sin tener globulina gamma y en las primeras horas de su existencia adquieren un contenido elevado de globulina gamma, correspondiente a la ingestion de calostro. Durante las primeras semanas desciende el contenido en globulina gamma de una forma relativamente rapida para volver a ascender lentamente. A las 15 semanas, aproximadamente, alcanza el nivel normal. 2 En los lechones criados de una forma artificial (libre de globulinas) exclusivamente o bien solo durante los tres primeros dias, que por lo pronto no contienen globulina gamma en su suero, a partir de la segunda semana se hallan cantidades de globulina gamma gradualmente ascendente. En la octava semana alcanzan el mismo nivel que los cerdos alimentados de una forma natural. 3 En los lechones que han ingerido calostro “ad libitum” o bien solo durante medio dia, tras la administracion parenteral de un antigeno bacteriano, por primera vez se pueden demostrar los anticuerpos durante la quinta o sexta semana. 4 En el suero de los lechones alimentados totalmente sin leche materna, se pueden identificar los anticuerpos en la decima semana de edad, despues de la administracion correspondiente de antigeno; en los lechones que solamente recibieron alimentacion artificial (libre de globulinas) durante los tres primeros dias y a continuacion los alimento la madre, los anticuerposya se pudieron detectar durante la quinta semana, o sea igual de temprano que en los animales alimentados constantemente con leche materna. 5 La globulina gamma adquirida pasivamente en gran cantidad inmediatamente despues del nacimiento, no se refleja en seguida en la formacion de los anticuerpos. Esto solo se puede comprobar despues de iniciarse en el organismo joven la sintesis de la globulina gamma y al parecer se ve favorecido en el sentido temporal mediante ciertas substancias que se encuentran en la leche materna.

Resume Le principe de la readaptation a l’effort par la reeducation de l’effort s’est progressivement impose depuis une trentaine d’annees en s’opposant aux principes anciens et nocifs du repos therapeutique chez les personnes ayant fait un episode cardiaque aigu. La peur de la mort et le danger de l’effort dominaient les esprits. Promoteurs de cette reeducation et ayant rencontre de nombreux obstacles de la part des milieux cardiologiques, nous avons voulu montrer les benefices d’une reeducation prolongee sur 15 ans de facon hebdomadaire ou bihebdomadaire en service de medecine de reeducation d’un groupe de 16 personnes. Aucun de ces patients n’est decede. Leur etat lesionnel cardiaque est stable. Leurs capacites fonctionnelles leur permettent de mener une vie sans contrainte hors de la peur de mourir.

Resume II y a incontestablement un changement dans la facon d'etablir les relations entre medecins et malades. Sous l'influence, principalement des medias, le malade ne laisse qu'une seule alternative a son medecin : le guerir. Parallelement a la confiance aveugle en son medecin qui etait souvent la regle, naguere, s'est substituee une exigence critique qui conduit a demander plusieurs avis et a ≪exiger≫ le recours etendu aux examens complementaires. Decue, la personne malade ou handicapee se considere comme une victime et demande reparation avec ou sans punition du coupable. La medecine de reeducation qui a longtemps echappe a cette evolution n'est plus, aujourd'hui, epargnee. La responsabilite du medecin reeducateur doit tenir compte des particularites de son mode d'exercice : souvent au sein d'une equipe polyvalente aux structures complexes avec, parfois, une dominante medicosociale. On observe au niveau de la jurisprudence de nombreuses evolutions : la notion de risque sanitaire, qui concerne plus largement tout le systeme de sante, tend a se developper a cote du risque medical plus restrictif. Des distinctions entre risque diagnostic, risque therapeutique, risque paramedical, risque medical, sont parfois evoquees. Par ailleurs, l'alea therapeutique, sans faute, tend a etre pris en compte de facon de plus en plus systematique a l'hopital public. Trois types de risque peuvent survenir en medecine physique et de readaptation: - lesionnel et vital dans certains cas severes ; - fonctionnel par insuffisance ou mauvaise application de la reeducation; - situationnel du fait d'une reinsertion non reussie entrant dans ≪la perte de chance≫. Les cas concrets rencontres concernent les manipulations cervicales mais aussi des plaintes concernant l'organisation de la reeducation et l'insuffisance des echanges entre medecin et kinesitherapeute.

PURPOSE Left ventricular ejection fraction (EF) is a powerful predictor of prognosis in coronary artery disease. The purpose of the present study was to measure interobserver differences for gated SPECT (GSPECT) software and echocardiography, and to compare these modalities regarding left ventricular volumes and EF. MATERIALS AND METHODS Eighty-four patients scheduled for nuclear imaging underwent a 1-day GSPECT with Tc-99m-tetrofosmin. Images were processed by 2 raters who calculated volumes and EF using Cedar-Sinai quantitative gated-SPECT (QGS), Emory Cardiac Toolbox (ECT), and 4D-MSPECT of the University of Michigan. Echocardiographic volumes were measured by 2 raters. Interobserver reliability was assessed by intraclass correlation coefficient (ICC). Differences in volumes and EF between echocardiography and GSPECT were compared with t-tests. RESULTS ICC was 0.61 for echocardiography, 0.94 for QGS, 0.88 for ECT, and 0.91 for 4D-MSPECT (P < 0.0001 compared with echocardiography). For small ventricles (ESV ≤30 mL), ICC was 0.58 for echocardiography and 0.90 for QGS (P = 0.008 compared with echocardiography); 0.77 and 0.73 for ECT and 4D-MSPECT, respectively (P = ns). End-diastolic and end-systolic volumes were significantly larger with GSPECT than with echocardiography, also echocardiographic ejection fraction was significantly different from GSPECT. CONCLUSIONS There is better interobserver reliability in GSPECT as compared with echocardiography, and QGS seems more robust in this study especially when it comes to small ventricles.

Current product development showing an ever shrinking physical volume is asking for new, reliable joining technologies. Laser beam technologies conceal innovative solutions to overcome limitations of conventional joining technologies. Laser beam welding of thermoplastics offers several process technical advantages. The joining energy is fed contact-less into the joining area, avoiding mechanical stress and thermal load to the joining partners. The energy is supplied spatially (seam width on the order of 100 μm) and timely (interaction time on the order of ms) very well defined. Different process strategies are possible leading to flexibility, product adapted irradiation, short process times and high quality weld seams as well as to high integration abilities and automation potentials. During the joining process no vibration, no thermal stress, no particle release takes place. Therefore, destruction of mechanically and electronically highly sensitive components, such as microelectronics, is avoided. The work place pollution is neglectable compared to other joining technologies, such as gluing (fume) or ultrasonic welding (noise, pieces of fluff). Not only micro-components can be welded in a reproducible way but also macro-components while obtaining a hermetic sealing with good optical appearance. In this publication firstly, an overview concerning process technical basis, aspects and challenges is given. Next, results concerning laser penetration welding of polymers using high power diode lasers are presented, while comparing contour and simultaneous welding by experimental results and the on-line process monitoring.

The compact and modular set up of high power diode lasers permits simultaneous laser beam welding. The entire weld seam is irradiated as a whole and welded with one single laser pulse (sequence). Apart from short process times, which are of interest for big lot production, simultaneous welding allows a more moderate irradiation (inter-action). Additionally, it promises wider process windows, a marked gap bridging capability as well as an enhanced weld strength compared to contour welding. By means of appropriate beam forming and guiding a homogeneous intensity distribution fitting to the entire weld seam geometry has to be generated, which represents the challenge of the simultaneous process. There are different strategies possible to accomplish simultaneous welding. Some strategies will be illustrated in brief. Furthermore, results of systematic investigation concerning weldability, gap bridging capability, hermetic sealing as well as reachable burst pressure of sample boxes are presented. Finally, an opportunity for on-line process monitoring (control) will be depicted.The compact and modular set up of high power diode lasers permits simultaneous laser beam welding. The entire weld seam is irradiated as a whole and welded with one single laser pulse (sequence). Apart from short process times, which are of interest for big lot production, simultaneous welding allows a more moderate irradiation (inter-action). Additionally, it promises wider process windows, a marked gap bridging capability as well as an enhanced weld strength compared to contour welding. By means of appropriate beam forming and guiding a homogeneous intensity distribution fitting to the entire weld seam geometry has to be generated, which represents the challenge of the simultaneous process. There are different strategies possible to accomplish simultaneous welding. Some strategies will be illustrated in brief. Furthermore, results of systematic investigation concerning weldability, gap bridging capability, hermetic sealing as well as reachable burst pressure of sample boxes are presented. Finally, an op...

The author gives his perspective on the challenges that medical practices will face over the next ten years. Systems of health-care delivery within the practice setting will have to accommodate to a more complex medical agenda, a trend to earlier diagnosis and intervention, and the need to preserve the patient-doctor relationship. In facing these challenges, physicians will need to accept leadership responsibility and be prepared to engage in a more organized, collective approach if we hope to come up with pragmatic solutions that truly work in practice. The guiding principle in all of these changes must be the actual improvement of patient care.

Resume La ceinture lombaire souple apparait aujourd’hui comme le moyen le plus efficace de guerir et de prevenir le mal de dos. Son cout, compare a celui des medications, de la kinesitherapie et de la chirurgie, est tres modeste. Par contre, l’ensemble du corps medical la classe encore dans les therapies « mineures » du mal de dos. De plus, un prejuge injustifie lui attribue faussement des effets nefastes (demusculation en particulier). Une enquete telephonique aupres de 108 personnes utilisant une ceinture depuis plus de 30 jours a permis de montrer son efficacite dans 92 % des cas. Les inconforts et genes etant signales dans 11 % des cas.

Serum samples from 22 patients with infective endocarditis were analysed for the presence of antibodies to cardiolipin, false positive Venereal Disease Research Laboratory (VDRL) test, and rheumatoid factor in order to determine the prevalence of anticardiolipin antibodies, their level, and to ascertain whether there was any correlation with the presence of rheumatoid factor. Although the latex test was positive in 10/22 (45%) patients, anticardiolipin antibodies, usually of a low level, were raised in only four (18%), and the VDRL test was positive in two patients in whom other antibodies were negative. These results show a clear discordance between these three tests, indicating that B cell production of these antibodies is separate and distinct. As with other infections which result in anticardiolipin antibody production, no thrombotic events were encountered.

A method is described which allows to determine the enthalpy of vaporization by a simple DTA experiment. The measurements are performed in a commercially available quantitative DTA instrument. Experimental results of measurements with several organic and inorganic liquids are presented which have vapor pressures at room temperature varying from 150 Torr to less than 1 Torr. The typical accuracy of such measurement is ± 2%.

— 15 patients with acute post-infective polyneuropathy of the Guillain-Barre type have been treated by means of plasma exchange. The clinical course and outcome of these patients is compared to that in a retrospectively matched control series who were treated with supportive therapy only. All patients had severe rapidly evolving muscle weakness and approximately half the patients in each group required ventilatory assistance. Both the duration of muscle weakness and the hospitalisation time was significantly shorter in the patients treated by means of plasma exchange. These results suggest that plasma exchange is of significant benefit in the treatment of patients with the Guillain-Barre syndrome.

Beschreibung einer Austauschdialyse mit dem neuen Dialysator vonKolff u.Watschinger („Spulenniere“, „Twin Coil Kidney“ oder „Disposable Kidney“) zwischen zwei neurologischen Patienten. Es wird auf den Wert von Austauschdialysen in der Behandlung des Leberkomas hingewiesen.

Es wird eine kunstliche Lunge, ein Durchstrommesser und eine Apparatur beschrieben, die gestattet, den Gaswechsel isoliert durchstromter Organe fortlaufend im geschlossenen System zu bestimmen.

A precision determination of the ratio of the magnetic moments of neutron and proton is presented. The method consists in determining the Larmor precession frequencies of neutrons and protons simultaneously in the same extremely homogeneous magnetic field. In this manner the ratio of the two Larmor frequencies gives directly the ratio of the two magnetic moments. The precession frequency of the neutrons is obtained by the occurrence of non-adiabatic transitions of a polarized neutron beam, the precession frequency of the protons by nuclear induction. Measurements are made so that only small differences in frequency have to be measured in terms of a constant but otherwise unknown standard. The value of the ratio of the two moments is found to be $\frac{|{\ensuremath{\mu}}_{N}|}{{\ensuremath{\mu}}_{P}}=0.685001\ifmmode\pm\else\textpm\fi{}0.00003$. By use of this value in connection with the recent determination of the ratio of the moments of proton and deuteron by Bloch, Levinthal, and Packard, the deviation of the deuteron moment from additivity is found to be 0.02230\ifmmode\pm\else\textpm\fi{}0.00009 nuclear magnetons.