[Legal conditions for telemedicine in Germany].
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Delivery of Health Care↗
Biomedical subjects
E T Peuker
Publications and source records attributed to E T Peuker.
Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder?
The success of arthroscopic capsular release of the glenohumeral joint depends on complete incision of the inferior capsule. This study determined the distance between capsule and the axillary nerve in different joint positions. In 14 human shoulder specimens the anterior joint capsule and axillary nerve were dissected, and the anterior joint capsule was incised between the 1 and 5 o'clock positions. The shortest distance between the insertion of the inferior capsule and the axillary nerve was measured at the glenoid and humeral insertions in abduction, adduction, internal, and external rotation. The axillary nerve is surrounded from soft connective tissue and is closer to the humeral than to the glenoidal attachment of the joint capsule. During abduction and external rotation the nerve stays in its position while the glenohumeral capsule tightens, which increases the distance between the two structures. This results in the following distances: to the glenoidal/humeral capsule insertion: in adduction and neutral rotation, 21.2+/-4.2/14.2+/-2.6 mm; in abduction and neutral rotation, 24.0+/-4.9/15.0+/-5.0 mm; in abduction and internal rotation, 21.1+/-6.6/14.6+/-3.7 mm; and in abduction and external rotation, 24.9+/-3.8/16.4+/-4.4 mm. Thus, when performing arthroscopic capsular release the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and externally rotated shoulder.
Aged↗
[Thiel method fixed cadaver ears. A new procedure for graduate and continuing education in middle ear surgery].
BACKGROUND AND OBJECTIVE: An efficient training program in ear surgery needs suitable models to learn the specific preparation techniques. However, conventionally fixed or fresh frozen ears of human corpses do not meet all demands. Therefore we investigated the feasibility of ears fixed according to Thiel for surgical training in the temporal bone lab. METHODS: Various surgical techniques on external and middle ears were evaluated on ears from cadavers fixed according to Thiel. Structure and consistency of the tissues were compared to vital conditions by means of a standardized questionnaire. RESULTS: Structure and consistency of the tissues of the auditory canal, the tympanic cavity and the mastoid were comparable to vital conditions. Merely the cartilage of the auricle was considerable softened. This enabled a surgical preparation under conditions close to the intravital situation. CONCLUSIONS: Under the aspects of quality assurance and efficiency of continuous medical education in middle ear surgery, the Thiel fixation technique provides an excellent prerequisite.
Cadaver↗
Entrapment of the lingual nerve due to an ossified pterygospinous ligament.
During a routine dissection course at the University of Muenster (Germany) an unusual course of the lingual nerve was found with entrapment of the nerve between a widely ossified pterygospinous ligament and the medial pterygoid muscle. Furthermore, the nerve's mobility was restricted by a more distal anastomosis with the inferior alveolar nerve. Although incomplete or complete ossification of the pterygospinous ligament is not uncommon, the combination with a medial course of the lingual nerve has not been described before. Besides practical importance for surgeons and anesthetists, the entrapment of the lingual nerve may lead to lingual numbness and pain associated with speech impairment.
Aged↗
[Surgical procedures in mouth, jaw and facial surgery in Thiel embalmed body donors].
METHODS: This study investigates whether human cadavers embalmed according to Thiel can be used for research and education in oral-maxillo-facial surgery. Different surgical approaches were tested on such cadavers. The usability of the specimen was judged jointly by anatomists and surgeons. Color, structure, and consistency of the different tissues were comparable to vital conditions. Thiel's embalming technique applied to human cadavers provides an optimal basis for research and for basic and postgraduate medical education.
Curriculum↗
[Pathomorphology of laser-induced interstitial tumor thermotherapy of the liver].
The aim of this study was to analyse pathomorphological findings after treatment with laser induced tumor thermotherapy (LITT) on liver tissue and to correlate the results with magnetic resonance imaging. LITT was performed ex vivo and in vivo using a Neodym-YAG-Laser. Lesions were monitored by MR-thermometry ex vivo and by contrast-enhanced MRI in vivo. After LITT the lesions were examined macroscopically, histologically, and electronmicroscopically. LITT-induced tissue damage was qualitatively evaluated, classified, and quantified by means of digital image analysis. Four different zones of tissue damage were identified within the lesions. Adjacent to the applicator the tissue was completely ablated while more peripheral lesions exhibited only sublethal cell damages seen by EM. In vivo the pattern of tissue injury followed the lobular architecture of the liver tissue. Ultrastructural examination revealed only in areas of minor tissue injury intact sinusoidal patterns. MRI overestimated the diameter of the core zone of complete tissue ablation both ex vivo and to a lesser extent in vivo.
Animals↗
Facial vein terminating in the superficial temporal vein: a case report.
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Aged↗
Risk information and informed consent in acupuncture--a proposal from Germany.
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Acupuncture Therapy↗
Reflection contrast microscopy (RCM): a forgotten technique?
Reflection contrast microscopy (RCM), which utilizes the optical phenomena caused by oblique epi-illumination in combination with a specific optical apparatus, provides an approach for exploring biological phenomena in greater detail. The lack of stray reflection makes it superior to other microscopes. It bridges light and electron microscopic capabilities by allowing the analysis of ultrathin sections beyond the usual light microscopic magnification. By using consecutive image analysis, quantitation can be achieved. The wide range of applications of RCM can be combined with most microscopical techniques, so extending the spectrum of information that can be gathered. Twenty-five years after the development of RCM, there is still scope for its application in modern cell biology.
Animals↗
[Virtual simulation for optimizing the range of motion in hip alloarthroplasty using an adapted thrust-plate prosthesis model].
The purpose of the present study was to increase the free range of motion in conventional trust-plate prosthesis design and to optimize the trust-plate contact as well as the osteointegration area below the trust-plate. For the first part of the study, the two-dimensional geometry of the osteotomy plane was demonstrated in 25 CT-reconstructed femora after performing a virtual cut at a CCD angle of 135 degrees. In the second part, we constructed a prototype of an anatomic adapted trust-plate prosthesis (A-TPP) with an optimized trust-plate and corpus geometry based on the three-dimensional data of three human cadaveric femurs (age 67-75 years). In the final step, we documented the range of motion with computer-aided movement-mapping and compared the conventional TPP with the A-TPP. The results showed a wide variance in osteotomy geometry in the 12 femurs. With the A-TPP, we were able to obtain a much better fit in the trust plate surface. The movement-mapping showed a much higher range of motion in the A-TPP implant. With the A-TPP, the implant surface area for osteointegration could also be significantly increased.
Adolescent↗
Live interdisciplinary teaching via the internet.
The independence of teachers and students is one of the main advantages of teleteaching. Specialties considered unsuitable for combined lessons are manageable using the internet. This study outlines simultaneous communication with students and lecturers over long distances between the anatomical dissection laboratory, the operating theatre, and the lecture hall. In several three-directional on-line lectures, different equipment was used. Students could also participate using personal computers from other locations. During the presentations, the participants have the opportunity to discuss problems with any lecturer. It was possible to demonstrate sufficient transmission capability for real-time application with the use of the new internet technology. No important qualitative differences can be reported between: hardware and software based solutions; or commercial and free offers. Although it is often difficult to reconcile the timetable of surgeries and lectures, multimedia on-line teaching via the internet provides new potential for interdisciplinary medical education.
Computer-Assisted Instruction↗
[Precision and comparison of CT-, MRI- and DL-controlled interventions exemplified by lumbar facet infiltration--an experimental study].
We evaluated the accuracy of the needle tip representation by different imaging techniques for the guidance of facet infiltrations. For visualisation of the lumbar facet joints we used a high-field magnetic resonance tomograph (MRT) with a 2.0 Tesla field and 3.5 mm slice thickness, an open low-field magnetic resonance tomography (MRT) with an 0.064 Tesla field and 9 mm slice thickness, and IMATRON electron beam computed tomograph (EBCT) with a slice thickness of 6 mm, and a mobile C-arm fluoroscope. The study was performed on 4 human cadaveric lumber spine preparations, each of which had 8 facet joints. Under imaging control, special injection needles were placed as close as possible to the facet joint space. Following placement of he needle, all specimens were scanned with the electron beam tomograph using a slice thickness of 1.5 mm. The thin-slice study served as the gold standard. The distance between the tip of the needle and the facet joint was measured in all the images. Comparison of the different modalities with the gold standard revealed the following results: 1) median values of the absolute differences were 1.25 mm for high-field MRI, 1.35 mm for 6 mm EBCT, 2.05 mm for low-field MRI, and 2.30 mm for X-ray fluoroscopy. 2) While there was no statistically significant difference in the accuracy of tip localization between high-field MRI and 6" EBCT (p = 0.293), both systems were more precise than low-field MRI (p = 0.04) and X-ray fluoroscopy (p = 0.009). When choosing the best imaging technique, such additional factors as radiation, costs and time, must also be considered. Provided necessary radiological precautions are taken, and assuming careful pre-interventional planning, CT. EBCT and X-ray fluoroscopy are currently more effective than the expensive, time-consuming and costly magnetic resonance tomography.
Equipment Design↗
[New paths for Internet generated learning in anatomy].
For the purposes of a functioning information and knowledge based medicine the conditions for the medical education are crucial. Although multimedia based courses and tutorials via the Internet seem to serve best for a more effective teaching and new didactics, respective anatomical offers in Germany are scarce and thus practice and experience are limited. Only simple digital equivalents of conventional contents and methods can be found, whereas the potencies of the new media are not realized in didactic concepts. Substantial advantages of web based tutorial systems are an intensive use of the feedback possibilities, the opportunity for continuous updating of the contents, the favourable distribution, and faster utilization of improved techniques. This paper introduces the adaptation of different techniques and the development of concepts and notions of modern Internet based teaching by the way of three different events in anatomical education for medical students and doctors. HistoNet 2000 was developed as an interface of lectures, seminars and practical courses in microscopy. The online transmission of a microscopical course as an interactive practical teleteaching was performed by the way of asymmetric data transfer via the ADSL-technology. Multicasting was used as well and has also been applied for the third project. In this multimedial online teaching different specialties were joined together for interdisciplinary courses via the Internet. These new technologies lead to enhanced efficiency in teaching and enlarge the educational offer. Specific Internet adapted teaching and learning projects have to be developed.
Anatomy↗
[Design features of an individual thrust plate prosthesis].
The purpose of the present study was to document the osteotomy plane for the thrust plate prosthesis, and to evaluate the question whether the geometry of the thrust plate itself correlates with the range of motion after implantation and whether the osteointegration area can be optimised. For the first part of the study, the two-dimensional geometry of the osteotomy was demonstrated in 12 computer-reconstructed femurs after performing a virtual cut at a CCD angle of 135 degrees. In the second part we constructed a prototype of an I-TPP with an optimised thrust plate and corpus geometry. In a final step, we documented the range of motion with computer-aided movement mapping. The results showed a wide variance in osteotomy geometry in the 12 femurs. With the I-TAP we were able to obtain a much better surface adaptation of the thrust plate. Movement mapping showed a much lower range of motion in the I-TPP implant.
Bone Plates↗
[Possibilities of spinal endoscopy within the scope of minimal invasive intervention--an experimental study].
The purpose of the present study was to evaluate, in vitro, a newly designed spinaloscope with a diameter of 1.8 mm, with integrated portals for instruments and irrigation. The 0 degree optical system has a resolution of 6,000 pixels. The instrument portals can be used for surgical lasers, biopsy forceps or burrs. We carried out our evaluations on fresh (unfixed) human lumbar spine specimens. The position of the endoscope was documented by CT scans. The endoscope was introduced into the spinal canal via the hiatus sacralis using a blunt trocar. The various structures and tissues were clearly identifiable and included the dura, the lig. flavum, the lig. long. posterior, spinal nerves, small pieces of disc material and various fibrous bands. The usefulness of the biopsy forceps was also shown.
Biopsy↗
[Clinical anatomy as an integrating element in teaching surgical subjects].
Different conceptions to revise the licensing regulations for physicians (Approbationsordnung für Arzte) aim to interlock preclinical and clinical subjects. Therefore a more practice-oriented anatomy has to be taught in basic and postgraduate medical education. At the Westfalian Wilhelms University of Münster we established an interdisciplinary anatomical education, executed by clinical lecturers in cooperation with the educational staff of the Department of Anatomy. The intergral element is the comprehensive constitution of clinical anatomy: clinical practitioners of different specialties together with anatomists give lessons in applied anatomy accompanying the dissection course. Clinically experienced lecturers of anatomy guide senior medical students in practical courses, refreshing their anatomical knowledge using particular prosections. These courses correlate with the topics of the distinct clinical tutorials. Conjointly clinical practitioners and anatomists plan, and perform meetings in postgraduate medical education.
Anatomy↗
[Possibilities of multimedia online teaching in medical education].
The local independence of students and teachers is accepted to be one of the main advantages of teleteaching. New techniques allow to use the Internet protocol similar to video conferences, thus giving premises to link specialties which have to operate in different environments. Synchronous communication can be established with students even over long-distances. In a pilot study a three-directional lecture between an operating theatre, the dissection laboratory of the institute of anatomy, and a lecture hall was given. During the lesson students discussed problems with any lecturer. We were able to demonstrate a sufficient transmission capability for this real-time application provided by the available internet technology. On the other hand, great technical and personnel effort for this computer aided MOT is necessary. However, although it is often difficult to reconcile the timetable of surgeries and lectures MOT provides new potentialities in interdisciplinary medical education.
Computer-Assisted Instruction↗
A new distinctive variation of renal arterial vascularization.
In addition to the usual renal arteries, a bilateral artery branching from the aorta was found connecting the aorta to both kidneys in an 82 year-old Caucasian man. By creating an additional blood supply to the kidneys this artery may have had an effect on renal perfusion.
Aged↗