Einführung: Schreibkrampf ist durch Hyperaktivität der antagonistischen Muskulatur beim Schreiben mit der Hand charakterisiert. Die Schriftproduktion ist verlangsamt und unflüssig, das Schriftbild schlecht lesbar und die Aktivität führt zu schneller Ermüdung und oft zu Schmerzen. Obwohl vor allem Handschrift betroffen ist, kommt es oft zu einer Beeinträchtigung anderer feinmotorischer Leistungen. Von Mai und Mitarbeitern wurde ein motorisches Training zur Behandlung von Schreibkrampf entwickelt, das auf dem Abbau von Fehlstrategien und dem Einsatz alternativer Techniken basiert.

Bei Patienten mit Schreibkrampf ist das Schreiben mit der Hand erheblich beeintrachtigt, was meist ein massives Handicap im (beruflichen) Alltag bedeutet. Das Schreibtraining nach Mai und Kollegen zielt auf eine langfristige Verbesserung der Schreibleistung. Das Training basiert auf der Grundannahme, dass die Schreibstorung durch erworbene motorische Fehlstrategien bedingt ist. Im Trainingsverlauf sollen solche Fehlstrategien identifiziert und mithilfe spezieller motorischer Ubungen abgebaut werden (vereinfachtes Beispiel: Fehlstragie „Ellenbogen auf den Tisch drucken“ wird abgebaut mit der Ubung „lange Striche ziehen von links nach rechts“ zur Forderung des Armtransports). Weiterhin empfehlen wir haufig eine alternative Stifthaltung (zwischen Zeige- und Mittelfinger), mit dem Ziel der Entkopplung von Halten und Bewegen des Stifts. Die Wirksamkeit des Behandlungsansatzes haben wir bisher in zwei Evaluationsstudien uberpruft: Bei 50 Patienten mit Schreibkrampf fanden sich nach dem Schreibtraining bedeutsame Verbesserungen der Bewegungsflussigkeit und Schreibgeschwindigkeit, die auch uber einen Followup-Zeitraum fortbestanden.* Die Wirksamkeit der veranderten Stifthaltung zur Reduktion des Schreibdrucks konnten wir in einer Studie an 10 Patienten demonstrieren. Eine aktuelle Studie soll nun klaren, inwieweit weitere Trainingskomponenten (z.B. Trainingsintensitat, Druck-Feedback) zur Verbesserung der Schreibleistung bei Patienten mit Schreibkrampf beitragen. Wir berichten uber Daten aus der Registrierung der Schreibbewegungen mittels Digitalisiertablett sowie erstmalig der differenzierten Erfassung der Fingerkrafte auf den Stift. Unsere Ergebnisse sprechen dafur, dass motorisches Training bei Patienten mit Schreibkrampf eine bedeutsame Verbesserung der Schreibleistung bewirkt. * Schenk T, Baur B, Steidle B, Marquardt C. Does Training Improve Writer's Cramp? An Evaluation of a Behavioral Treatment Approach Using Kinematic Analysis. J Hand Ther. 2004; 17: 349–363

PURPOSE AND BACKGROUND:Interventional radiologic procedures play an important role in the management of peripheral arterial occlusive disease. Percutaneous transluminal interventions as angioplasty (PTA) and implantations of metal-stents injure the wall of the blood vessels resulting in hyperplasia of the intima and media. In spite of adequate anticoagulation therapy restenosis and reocclusion frequently occur. Our study was designed to prevent hyperplasia of the intima by percutaneous radiation therapy.PATIENTS AND METHODS:A total of 24 patients had a stent implanted in their superficial femoral artery from 1990 to 1992. Eleven patients received percutaneous radiation therapy of the enlarged stent area on five consecutive days with a single dose of 2.5 Gy thus resulting in a total dose of 12.5 Gy. Both patients groups were compared. None of the patients in the radiation group suffered from complications.RESULTS:In the seven months following stent implantation and radiation only two of eleven patients in the radiation group suffered from occlusion of the stent that had to be treated by vascular surgery. In comparison five of 13 patients treated with stent implantation alone suffered from occlusion of the stent within the first eight to nine months.CONCLUSION:In spite of a small case number our study shows a positive influence of percutaneous radiation therapy on the extent of hyperplasia of the intima after stent implantation leading to lower reocclusion rates. Whether these results can be improved by alternative dose-fractionation schedules has to be addressed by further studies.

Intussusceptions in adults are rare. With the increasing use of sonography, CT and improved methods for examining the small bowel, they are now diagnosed more frequently before operation. If one considers the possibility, acute invaginations can be readily diagnosed by sonography or barium examination; the CT appearances are pathognomonic. In long-standing cases it may be difficult to separate the oedematous small bowel walls from each other. The "duck bill" narrowing is a sign of chronic invagination.

Intussusceptions in adults are rare. With the increasing use of sonography, CT and improved methods for examining the small bowel, they are now diagnosed more frequently before operation. If one considers the possibility, acute invaginations can be readily diagnosed by sonography or barium examination; the CT appearances are pathognomonic. In long-standing cases it may be difficult to separate the oedematous small bowel walls from each other. The ''duck bill'' narrowing is a sign of chronic invagination.

The treatment planning system is key for the success of external beam radiotherapy, directly impacting the quality of treatment plans and accuracy of dose calculation in the plans. In this article, we provided an overview of the Pinnacle treatment planning system for external beam planning, including 3-dimensional (3D) conformal plans, step-shoot intensity modulated radiotherapy (IMRT) plans, and volumetric modulated arc therapy (VMAT) plans. We discussed dose calculation algorithm and other utilities, including image fusion, plan documentation, and adaptive planning. Based on our many years of clinical experience with the system, the aim of this article is to provide readers with a summary of this particular planning system.

In eight patients with stones in the bile duct, the concretions were removed percutaneously; in six, they were pushed into the duodenum following dilatation of the papilla and in two patients they were removed percutaneously by a transhepatic route using a Dormier basket. In two patients a stenosis at a choledocho-jejunostomy was successfully dilated by a percutaneously introduced balloon catheter. In five patients stenoses due to tumours of the bile duct were dilated percutaneously and an endoprosthesis introduced. There were no serious complications. The percutaneous transhepatic approach for the treatment of bile duct stones and of malignant obstruction is a valuable alternative to endoscopic and surgical treatment.

In eight patients with stones in the bile duct, the concretions were removed percutaneously; in six, they were pushed into the duodenum following dilatation of the papilla and in two patients they were removed percutaneously by a transhepatic route using a Dormier basket. In two patients a stenosis at a choledocho-jejunostomy was successfully dilated by a percutaneously introduced balloon catheter. In five patients stenoses due to tumours of the bile duct were dilated percutaneously and an endoprosthesis introduced. There were no serious complications. The percutaneous transhepatic approach for the treatment of bile duct stones and of malignant obstruction is a valuable alternative to endoscopic and surgical treatment.