ASSESSMENT OF THE LOCAL EXPOSURE OF SKIN ON HANDS OF NUCLEAR MEDICINE WORKERS HANDLING 18F-LABELLED RADIOPHARMACEUTICALS: PRELIMINARY CZECH STUDY

The article summarises some preliminary results of the assessment of the exposure of hands of workers manipulating ¹⁸F-labelled radiopharmaceuticals based on personal monitoring at two nuclear medicine clinics in the Czech Republic. The measurements were carried out using special thermoluminescence dosemeters the readings of which could be interpreted in terms of the personal dose equivalent H_p(0.07) approximating the equivalent dose to the skin at various locations on the surface of both hands. The results have shown that out of 21 workers monitored, ∼43 % (preparation and applications of radiopharmaceuticals) may reach an exposure equal to three-tenth of the annual dose limit to the skin. At the same time, it can also be concluded that in ∼10 % cases of workers, the relevant dose limit may be exceeded.

Possibilities of the exposure reduction of hands during the preparation and application of radiopharmaceuticals

BACKGROUND

The current routinely used methods of estimating the skin equivalent dose relies on the finger dosimetry which usually largely underestimates the real maximum exposure and thus appropriate correction factors have to be used.

METHODS

The group under the investigation consisted of 10 workers preparing and 5 workers administering radiopharmaceuticals labelled with 18F. The monitoring was carried out using 12 pairs of thermoluminiscent dosimeters (TLDs) placed on each hand of the worker. A total of 46 measurements were completed. The maximum exposure of the skin of hands, defined in terms of the quantity of the personal dose equivalent Hp(0.07), was related to the unit activity of radiopharmaceutical with which the worker came into the contact during the measurement.

RESULTS

The exposure of the hands of workers handling 18F-labelled radiopharmaceuticals showed significant inhomogeneity. Out of 15 workers, in 53 % of cases, the maximum skin exposure was observed on the tip of their index finger. It was estimated that in about 60 % of the cases (during the preparation and administration of radiopharmaceuticals), the exposure may exceed the 3/10 of the annual dose limit. Moreover, in 40 % of all cases, the exposure may even be higher than this dose limit. The established relevant correction factors reached the values up to 8 (as for preparations) and 13 (as for administrations).

CONCLUSIONS

The study resulted in the establishment of the appropriate correction factors and in the recommendations of procedures aimed at the further reduction of the exposure of extremities (Tab. 3, Fig. 2, Ref. 17).

32nd International Austrian Winter Symposium : Zell am See, the Netherlands. 20-23 January 2016

A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CT

W Langsteger, A Rezaee, W Loidl, HS Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M Beheshti

A2 F18 Choline PET – CT: an accurate diagnostic tool for the detection of parathyroid adenoma?

L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W Langsteger

A3 [18F]Fluoro-DOPA-PET/CT in the primary diagnosis of medullary thyroid carcinoma

A Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M Hartenbach

A4 Variations of clinical PET/MR operations: An international survey on the clinical utilization of PET/MRI

T Beyer, K Herrmann, J Czernin

A5 Standard Dixon-based attenuation correction in combined PET/MRI: Reproducibility and the possibility of Lean body mass estimation

I Rausch, P Rust, MD DiFranco, M Lassen, A Stadlbauer, ME Mayerhöfer, M Hartenbach, M Hacker, T Beyer

A6 High resolution digital FDG PET/MRI imaging for assessment of ACL graft viability

K Binzel, R Magnussen, W Wei, MU Knopp, DC Flanigan, C Kaeding, MV Knopp

A7 Using pre-existing hematotoxicity as predictor for severe side effects and number of treatment cycles of Xofigo therapy

A Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A Haug

A8 QDOSE – comprehensive software solution for internal dose assessment

Wencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas Kluge

A9 Clinical impact of Time-of-Flight on next-generation digital PET imaging of Yttrium-90 radioactivity following liver radioembolization

CL Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, MV Knopp

A10 Snakes in patients! Lessons learned from programming active contours for automated organ segmentation

M Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, RP Baum, B Knäusl, D Georg

A11 Influence of a genetic polymorphism on brain uptake of the dual ABCB1/ABCG2 substrate [11C]tariquidar

M Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O Langer

A12 Outcome prediction of temporal lobe epilepsy surgery from P-glycoprotein activity. Pooled analysis of (R)-[11C]-verapamil PET data from two European centres

M Bauer, M Feldmann, R Karch, W Wadsak, M Zeitlinger, MJ Koepp, M-C Asselin, E Pataraia, O Langer

A13 In-vitro and in-vivo characterization of [18F]FE@SNAP and derivatives for the visualization of the melanin concentrating hormone receptor 1

M Zeilinger, C Philippe, M Dumanic, F Pichler, J Pilz, M Hacker, W Wadsak, M Mitterhauser

A14 Reducing time in quality control leads to higher specific radioactivity of short-lived radiotracers

L Nics, B Steiner, M Hacker, M Mitterhauser, W Wadsak

A15 In vitro 11C-erlotinib binding experiments in cancer cell lines with epidermal growth factor receptor mutations

A Traxl, Thomas Wanek, Kushtrim Kryeziu, Severin Mairinger, Johann Stanek, Walter Berger, Claudia Kuntner, Oliver Langer

A16 7-[11C]methyl-6-bromopurine, a PET tracer to measure brain Mrp1 function: radiosynthesis and first PET evaluation in mice

S Mairinger, T Wanek, A Traxl, M Krohn, J Stanek, T Filip, M Sauberer, C Kuntner, J Pahnke, O Langer

A17 18F labeled azidoglucose derivatives as “click” agents for pretargeted PET imaging

D Svatunek, C Denk, M Wilkovitsch, T Wanek, T Filip, C Kuntner-Hannes, J Fröhlich, H Mikula

A18 Bioorthogonal tools for PET imaging: development of radiolabeled 1,2,4,5-Tetrazines

C Denk, D Svatunek, T Wanek, S Mairinger, J Stanek, T Filip, J Fröhlich, H Mikula, C Kuntner-Hannes

A19 Preclinical evaluation of [18F]FE@SUPPY- a new PET-tracer for oncology

T Balber, J Singer, J Fazekas, C Rami-Mark, N Berroterán-Infante, E Jensen-Jarolim, W Wadsak, M Hacker, H Viernstein, M Mitterhauser

A20 Investigation of Small [18F]-Fluoroalkylazides for Rapid Radiolabeling and In Vivo Click Chemistry

C Denk, D Svatunek, B Sohr, H Mikula, J Fröhlich, T Wanek, C Kuntner-Hannes, T Filip

A21 Microfluidic 68Ga-radiolabeling of PSMA-HBED-CC using a flow-through reactor

S Pfaff, C Philippe, M Mitterhauser, M Hartenbach, M Hacker, W Wadsak

A22 Influence of 24-nor-ursodeoxycholic acid on hepatic disposition of [18F]ciprofloxacin measured with positron emission tomography

T Wanek, E Halilbasic, M Visentin, S Mairinger, B Stieger, C Kuntner, M Trauner, O Langer

A23 Automated 18F-flumazenil production using chemically resistant disposable cassettes

P Lam, M Aistleitner, R Eichinger, C Artner

A24 Similarities and differences in the synthesis and quality control of 177Lu-DOTA-TATE, 177Lu -HA-DOTA-TATE and 177Lu-DOTA-PSMA (PSMA-617)

H Eidherr, C Vraka, A Haug, M Mitterhauser, L Nics, M Hartenbach, M Hacker, W Wadsak

A25 68Ga- and 177Lu-labelling of PSMA-617

H Kvaternik, R Müller, D Hausberger, C Zink, RM Aigner

A26 Radiolabelling of liposomes with 67Ga and biodistribution studies after administration by an aerosol inhalation system

U Cossío, M Asensio, A Montes, S Akhtar, Y te Welscher, R van Nostrum, V Gómez-Vallejo, J Llop

A27 Fully automated quantification of DaTscan SPECT: Integration of age and gender differences

F VandeVyver, T Barclay, N Lippens, M Troch

A28 Lesion-to-background ratio in co-registered 18F-FET PET/MR imaging – is it a valuable tool to differentiate between low grade and high grade brain tumor?

L Hehenwarter, B Egger, J Holzmannhofer, M Rodrigues-Radischat, C Pirich

A29 [11C]-methionine PET in gliomas - a retrospective data analysis of 166 patients

N Pötsch, I Rausch, D Wilhelm, M Weber, J Furtner, G Karanikas, A Wöhrer, M Mitterhauser, M Hacker, T Traub-Weidinger

A30 18F-Fluorocholine versus 18F-Fluorodeoxyglucose for PET/CT imaging in patients with relapsed or progressive multiple myeloma: a pilot study

T Cassou-Mounat, S Balogova, V Nataf, M Calzada, V Huchet, K Kerrou, J-Y Devaux, M Mohty, L Garderet, J-N Talbot

A31 Prognostic benefit of additional SPECT/CT in sentinel lymph node mapping of breast cancer patients

S Stanzel, G Pregartner, T Schwarz, V Bjelic-Radisic, B Liegl-Atzwanger, R Aigner

A32 Evaluation of diagnostic value of TOF-18F-FDG PET/CT in patients with suspected pancreatic cancer

S Stanzel, F Quehenberger, RM Aigner

A33 New quantification method for diagnosis of primary hyperpatahyroidism lesions and differential diagnosis vs thyropid nodular disease in dynamic scintigraphy

A Koljević Marković, Milica Janković, V Miler Jerković, M Paskaš, G Pupić, R Džodić, D Popović

A34 A rare case of diffuse pancreatic involvement in patient with merkel cell carcinoma detected by 18F-FDG

MC Fornito, D Familiari

A35 TSH-stimulated 18F-FDG PET/CT in the diagnosis of recurrent/metastatic radioiodine-negative differentiated thyroid carcinomas in patients with various thyroglobuline levels

P Koranda, H Polzerová, I Metelková, L Henzlová, R Formánek, E Buriánková, M Kamínek

A36 Breast Dose from lactation following I131 treatment

WH Thomson, C Lewis

A37 A new concept for performing SeHCAT studies with the gamma camera

WH Thomson, J O’Brien, G James, A Notghi

A38 Whole body F-18-FDG-PET and tuberculosis: sensitivity compared to x-ray-CT

H Huber, I Stelzmüller, R Wunn, M Mandl, F Fellner, B Lamprecht, M Gabriel

A39 Emerging role 18F-FDG PET-CT in the diagnosis and follow-up of the infection in heartware ventricular assist system (HVAD)

MC Fornito, G Leonardi

A40 Validation of Poisson resampling software

WH Thomson, J O’Brien, G James

A41 Protection of PET nuclear medicine personnel: problems in satisfying dose limit requirements

J Hudzietzová, J Sabol, M Fülöp

Occupational exposure control: the problem of quantities in radiation protection

The paper explores the quantities and units used in radiation protection with special emphasis on their applications in occupational exposure control. An overview of the current situation reveals that there seem to be too many different quantities associated with the same unit. Some of these quantities are defined in a quite complicated manner and, therefore, may cause some confusion in their interpretation and practical use in the field. Some suggestions towards the simplification of the present system are also proposed.

Assessment of the total effective dose of miners in the underground Rožná Uranium Mine in the Czech Republic during the period 2004-2009

The paper discusses the situation in the Czech Republic regarding past and present uranium mining activities with emphasis on the evaluation of the exposure of underground miners in the Rožná Uranium Mine, which is currently the only active mine in the country and practically in the entire European Union. The total effective dose has been summarised taking into account all three major components, namely radon short-lived decay products, long-lived alpha emitters in ore dust and penetrating external gamma radiation. The average and maximum values of the effective dose as well as the collective effective dose of underground miners are also presented. The purpose of the paper is to document the miners' exposures during a period of 6 years in a uranium mine where conditions including the ore grade and methods of mining showed recently some changes that may affect the individual components of the total effective dose.

Attitudes and Concerns of Pre-Pubescent and Pubescent Girls about Breast Health and Breast Cancer: An Unmet Need

Background: Prior research has indicated that girls have unaddressed fears about breast health and breast cancer. In a Breastcancer.org online survey (SABCS 2008 Abstract#5078), 26% of girls have already worried they may have breast cancer and 73% reported that a relative or close acquaintance had already been diagnosed. Their fears are magnified by the current trend of early onset of breast development and their sensitivity to high media coverage of breast cancer. We hypothesize that girls have limited opportunities and are without the emotional capacity and communication skills necessary to gather and process this information at home, in school, and in the doctor's office.Methods: Breastcancer.org, the Taking Care of Your “Girls” book project, and the Lankenau Hospital Health Education Center conducted an online survey of girls in middle and high schools prior to the delivery of its in-school Basic Breast Health Assembly Program in 13 Philadelphia, Atlanta, Washington, and Los Angeles area schools. 4246 girls attended an assembly, of which 3397 participated in the student survey. 1067 adult female family members (AFFM)—mostly mothers—completed the family member survey.Results: In total, 33% of girls had already learned about breast health and breast cancer in school. 48% of girls wanted to attend the Assembly Program; 93% of AFFMs wanted their girls to participate in the Assembly Program. 50% of girls said they felt uneasy starting the conversation about these topics with their AFFM, 97% of AFFMs said they felt comfortable starting the conversation with their girls, but only 43% of the girls report having the conversation. Of the girls who talked to a parent, 91% talked to their mothers and only 1% talked with their fathers. Girls and AFFMs offered many tips on how to start and sustain a healthy dialogue on these topics: listen, be open, make it fun, pick a private place and time, share experiences, provide facts, and call in experts when you need more information.42%, 18%, and 23% of girls, respectively, have talked to a doctor, sister, or friend about these topics. 50% of girls want to learn breast self-exams from their doctors.Discussion: This survey indicates that girls have unmet informational needs on breast health and breast cancer. This was a source of anxiety for both girls and their AFFMs. There was a willingness to engage in educational activities by both girls and AFFMs, but the dialogue opportunities and communication skills were seen as lacking. Girls identified AFFMs, schools, and doctors as their preferred sources of this information.Girls' ability to express their anxiety, replace fears with facts, learn breast healthy behaviors, and deal with a loved ones' diagnosis requires education, modeling, and an ongoing dialogue. This survey provides guidance for educators and healthcare professionals regarding research into interventions seeking to correct this previously underappreciated gap in public health education.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1037.

Breast cancer fear in girls: a major “side effect” of breast cancer in loved ones and a backlash of ubiquitous media coverage

Abstract #5078

Background: Breast cancer significantly impacts girls' lives: it affects 1:8 women and directly impacts those most influential in girls' lives (e.g. mothers, friends' mothers, teachers, coaches). Plus, girls are often exposed to powerful media messages meant to raise breast cancer awareness. Our hypothesis is that these factors could generate significant fear and misunderstanding in adolescent and pre-adolescent girls.
 Methods: To better understand the impact of breast cancer fear in girls, the nonprofit organization Breastcancer.org and the Taking Care of Your “Girls” book project, together with the Lankenau Hospital Health Education Center, conducted an in-school online survey in girls ages 8 to 18 years (median 15), prior to the delivery of a Breast Health Assembly in 7 Philadelphia and Atlanta areas schools. 2450 girls attended the assemblies, of which 1709 participated in the survey (about 70% question completion rate).
 Results: In total, 73% of girls had a relative or close acquaintance who had had breast cancer (most often: a friend's mother [49% n=580/1201]). Although only 3.34% (n=40/1196) of girls' mothers had had breast cancer, girls were most fearful of breast cancer affecting their mothers. While only 46% (n=768/1573) thought breast cancer was common in grandmothers, 76% (n=1192/1572) reported it was most common in mothers. Although only 3.35 % (n=53/1580) believed that breast cancer was common in teens, 26% (477/1554) said that they've already feared having breast cancer themselves. The most common triggers for this fear were a misinterpretation of a normal breast finding, a news report on breast cancer, or a new breast cancer diagnosis in someone they knew. Over 20% believed that infection, drug use, stress, and tanning could cause breast cancer; and 10-20% reported their belief that caffeine, getting bumped or bruised in the breast, and antiperspirants could cause it. In addition, 8.5% thought that breast-feeding increased breast cancer risk.
 Discussion: 73% of the girls in this study have one or more women close to them who've had breast cancer and all girls are sensitive to the media. These factors seem to contribute to their fear of the disease and their tendency to overestimate breast cancer risk (in themselves and their mothers). Furthermore, they were un- or misinformed about true breast cancer risk factors and effective breast health measures. The impact of a girl's unrealistic fear of breast cancer is unknown. We are concerned that it may deter rather than motivate healthy behaviors. Breast health programs are necessary to replace fear and inaccurate information with facts and reassurance. These results might be useful in the design of education and intervention strategies to improve psychological wellbeing and the achievement of long-term public health goals.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5078.

Estrogen replacement therapy after breast cancer: a 12-year follow-up

BACKGROUND

In the United States, estrogen replacement therapy (ERT) is discouraged in breast cancer survivors because of concerns that hormones may reactivate the disease. Because ERT can improve quality of life and decrease morbidity from osteoporosis and cardiovascular disease, however, this policy is increasingly being challenged.

METHODS

From February to August 1995, 607 breast cancer survivors were interviewed concerning ERT usage. Sixty-four patients indicated they received some form of ERT after their breast cancer diagnosis. Medical records for these patients were analyzed for disease stage, surgical treatment, adjuvant treatment, estrogen and progesterone receptor status, date of initiation of ERT, type of ERT, recurrence, and final outcome. Patients receiving ERT were followed prospectively.

RESULTS

Eight patients were excluded because they had used only vaginal cream ERT. The remaining 56 received ERT as conjugated estrogens, an estradiol patch, estropipate, or birth control pills. The median follow-up from diagnosis was 12.8 years (range, 4.7-38.9 years). The median time on ERT since diagnosis was 6.4 years (range, 1.0-20.9 years); 38% of the patients initiated ERT within 2 years of diagnosis. Estrogen receptors were positive in 28 (74%) of the 38 cases with available information. Pathological disease stage at time of diagnosis and treatment was 0 in 15 cases (27%), I in 27 (48%), and II in 14 (25%). Twenty-six patients (47%) received adjuvant chemotherapy or hormonal therapy. One local recurrence and one contralateral breast cancer occurred during the follow-up period (13.5 and 9.6 years, respectively), with no regional or distant recurrences, for a 15-year actuarial disease-free survival rate of 92.5%. There were no breast cancer deaths.

CONCLUSIONS

Use of ERT in a cohort of breast cancer survivors with tumors of generally good prognosis was not associated with increased breast cancer events compared with non-ERT users, even over a long follow-up period.

Dietary glycotoxins: inhibition of reactive products by aminoguanidine facilitates renal clearance and reduces tissue sequestration

Evidence indicates that the metabolic turnover of food-derived reactive orally absorbed advanced glycation end products (AGEs) or glycotoxins (GTs) is delayed, possibly contributing to the tissue damage induced by endogenous AGEs, especially in patients with diabetes and kidney disease. The aim of this study was to explore whether pharmacologic inhibition of dietary AGE bioreactivity by aminoguanidine (AG) can improve turnover and renal excretion of these substances. Normal Sprague-Dawley rats were fed single-labeled [14C]AGE-ovalbumin, double-labeled [14C-125I]AGE-ovalbumin, or control 125I-labeled ovalbumin diet plus free [14C]glucose, with or without AG (0.2% in water). [14C]AGE- and 125I-labeled peptide-associated radioactivity (RA) were compared with AGE immunoreactivity (by enzyme-linked immunosorbent assay) in tissues, serum, and 72-h urine samples. The effect of AG on dietary AGE bioreactivity was assessed by monitoring the inhibition of covalent complex formation between fibronectin (FN) peptide fragments and serum components, after a meal of labeled dietary AGE with or without AG. The radiolabeled AGE diet produced serum absorption and urinary excretion peaks kinetically distinct from those of free [14C]glucose or [125I]ovalbumin. Some 26% of the orally absorbed AGE-ovalbumin was excreted in the urine, whereas after AG treatment, urinary excre-tion of dietary AGEs increased markedly (to >50% of absorbed). More than 60% of tissue-bound RA was found covalently deposited in kidneys and liver, whereas after treatment with AG, tissue AGE deposits were reduced to <15% of the amount found in untreated AGE-fed controls. Sera enriched for dietary GTs formed covalently linked complexes with FN, a process completely inhibitable by AG cotreatment. Amelioration of dietary GT bioreactivity by AG improves renal elimination and prevents tissue deposition of food GTs. This may afford a novel and potentially protective use of AG against excessive tissue AGE toxicity in diabetic patients with renal disease.

Concurrent administration of vinorelbine with recombinant human granulocyte colony-stimulating factor: an effective method of increasing dose intensity

Thirty-three patients with incurable neoplasms resistant to standard therapy received vinorelbine 8 mg/m2 to 10 mg/m2 per day by continuous infusion with concurrent administration of recombinant human granulocyte colony-stimulating factor 5 microm/m2 per day. The duration of the vinorelbine infusion was individualized; the infusion was continued until early evidence of hematopoietic toxicity was noted. The concurrent administration of recombinant human granulocyte colony-stimulating factor permitted a substantial increase in dose intensity of the anticancer agent without a corresponding increase in drug toxicity. There was no evidence that the antitumor effect of vinorelbine was compromised by the concurrent administration of recombinant human granulocyte colony-stimulating factor.

Autostrangulation of the vermiform appendix. An unusual mechanism of acute appendicitis

A 23-year-old woman presented with acute appendicitis. At laparoscopy the appendix appeared to be strangulating itself. The pathologic evaluation demonstrated mucosal coagulation necrosis, confirming the early ischemic changes of the infarctive process visualized laparoscopically.

Long-term effects of instilled mineral dusts on pulmonary surfactant isolated from monkeys

Experiments were carried out to determine the long-term effect of instillation of 500 mg of generic bituminous, anthracite, quartz, or titanium dioxide (TiO2) dust on the composition of pulmonary surfactant. Dust was instilled in the caudal lobe of the right lungs of female pigtailed macaque monkeys (Macaca nemestrina). The composition of surfactant isolated from cell-free bronchoalveolar lavage (CF-BAL) samples obtained from right lungs (dust exposed) at various times over the following year was compared with that of surfactant isolated from CF-BAL from left lungs (dust free). Little change was seen in the amount of surfactant-associated lipid phosphorus as a result of exposure to dust. Exposure to quartz, anthracite, or TiO2 dust induced a significant increase in the total amount of protein in the surfactant-enriched fraction. The relative amount of specific proteins was also altered: surfactant-associated protein A decreased, and the amount of the heavy and light chains of immunoglobulin molecules (identified by NH2-terminal amino acid sequence analysis) increased. These changes were visible more than a year after instillation of quartz and at least 3 months after instillation of anthracite dust. Despite variation in the responses of the individual animals, the changes observed might serve as an indicator of the severity of the effect of exposure of the lung to mineral dust and/or to pathogens.

Monitoring of 222Rn in Taiwanese hot spring spa waters using a modified electret ion chamber method

222Rn concentrations in some Taiwanese hot spring spa waters have been monitored using commercially available electret ion chambers (EIC). The use of two EIC units for measuring radon concentrations in the air phase and voltage dependent correction factors for subtracting gamma contributions resulted in improved accuracy.

[Ipsilateral fractures of the diaphysis and upper femur.]

Ipsilateral segmental fractures of the diaphysis and the upper end of the femur are relatively rare. They are encountered more frequently in patients with multiple injuries. The basic prerequisite of treatment is an early and accurate diagnosis which may prove difficult in particular in patients with multiple injuries. Conservative treatment is associated with a high incidence of complications, therefore the authors recommend urgent or early surgical stabilization of both fractures. As a rule the method of open reposition and stabilization by plates according to principles of the AO school with the known advantages and shortcomings of this method is used. The authors found intramedullary osteosynthesis by a combination of interlocking nailing and the use of screws useful in intracapsular fractures or else Ender's method in case of the localization of the proximal fracture in the trochanteric area. In both types of fractures new types of nails are useful (long Gamma nail, reconstruction nail of the second or third generation) which before now were not available. Key words: ipsilateral femoral fractures, surgical treatment.

An innovative approach to telemetry monitoring

To use staff more effectively on a medical telemetry unit, nurses collaborated with clinical engineers to incorporate a commercially available pocket pager with a dysrhythmia detection system. Nurses carry a pocket pager which beeps and displays the patient's room number when a dysrhythmia is detected. This system eliminates the need for a telemetry monitor watcher and provides nurses with ongoing information about their patients. It also created an annual savings of approximately $130,000.

[Injuries of the inferior vena cava--prerequisites of successful treatment]

The authors submit a report on the successful treatment of an uncommon injury--a blunt injury of the infrahepatic portion of the vena cava inferior which was part of a multiple injury. In the conclusion the authors formulate general prerequisites of a successful solution of similar injuries and express the demand that as reserve strategic, tactical and technical knowledge should be assembled on the above problem by a large number of surgeons.

Alpha activity measurement of cigarettes in Kuwait

A semiconductor surface barrier detector with an active area of 450 mm2 and depletion layer thickness of 300 microns has been used to measure the alpha activity of cigarette tobacco. The performance parameters of the counting system, the calibration and the results of alpha-activity in some cigarettes are presented.