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Los tratamientos combinados de ortodoncia y cirugía ortognática proveen solución a aquellos pacientes con severas alteraciones dentomaxilomandi-bulares. La planificación del tratamiento debe ser detallada, a fin de maximizar eléxito de los resultados faciales y oclusales. Los objetivos de tratamiento se ven beneficiados por el uso de métodos de planificación tridimensionales y la generación de guías quirúrgicas, producto de simulaciones quirúrgicas virtuales. El apoyo tecnológico pronostica los cambios en la posición de huesos, la mordida, la vía respiratoria y los tejidos blandos, optimizando los resultados de estética y función.

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Charter Medical Corporation's computerized Clinical Information System is described. The computerized system helps clinicians formulate and document individualized patient treatment plans along the continuum of care and to improve internal medical record keeping. The system can also help improve the efficient collecting, storing, retrieving, and reporting of clinical information, both for internal use and for external utilization review and case management. In the future, the system will be linked to Charter's continuous quality improvement efforts and to its new Clinical Outcome Monitoring System.

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O presente estudo aborda o planejamento da assistência de enfermagem na verificaçäo da temperatura, na escolha do instrumento de medida; no atendimento ao paciente com febre e com hipertermia maligna.

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Limiting conditions for the planning of the installation of an electron linear accelerator in an operating theatre are described taking into account the radiotherapeutical and surgical requirements based on the example of the Essen facility for intraoperative radiotherapy (IORT) with electrons. Special features of the facility like a non-contact electron applicator system with television monitoring, table-top trolley, which is used also during irradiation, are explained in detail. Measured isodose curves for all tubes and all electron energies serve for the radiotherapist as criteria for decision on tube size and electron energy selection during surgical operation. The influence of misalignments of the tube on dose distributions is investigated. Limit values of alignment tolerances are deduced. Daily constancy tests for monitor calibration, electron energy, and tube alignment system are to be performed for quality assurance. Tables of the planned and realized treatments and of a representative time schedule of an IORT give a survey on the indications and the necessary time effort and staff. Completion of the set of tubes as well as optimization of the tube fixation accessory and of the table-top trolley are main subjects for future developments.

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Individuals with cancer should be assisted to achieve optimal levels of functioning before, during, and after cancer treatment. However, to reach optimal functioning a well-defined plan of action is required. This article presents an Optimal Functioning Plan (OFP) aimed at attaining the best possible outcomes for all individuals treated for cancer. The OFP centers on physical functioning, nutritional adequacy, a practical level of independence in activities of daily living, self-care competence, a realistic optimistic outlook, and effective management of side effects. The OFP is a key element of cancer rehabilitation. It represents a way of packaging cancer care in a health-oriented framework.

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Every prescription of a radiograph should be based on an evaluation of the individual patient benefit. An algorithm developed to make it possible to individualize the frequency of bitewing radiographs was applied on a group of young patients in order to evaluate if its application could increase the time intervals between bitewing examinations. The time intervals between bitewing examinations actually performed on 221 patients from exfoliation of all primary teeth up to and including 18 yr of age were determined. The number of surfaces with carious lesions as well as restorations in the posterior approximal surfaces were diagnosed from the radiographs. The intervals between bitewing examinations according to the algorithm were estimated and compared to the actual ones. For most patients the time intervals between examinations increased when the algorithm was applied, without a concomitant risk of missing lesions developing into the deeper parts of the dentin. The results render support to an individualized scheduling of bitewing radiographs based on number of and extent of approximal lesions in baseline radiographs.

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Electron beams from an accelerator appear to originate from a point away from the vacuum window designated as virtual source. Virtual source to isocenter distances are determined experimentally by measurements in a polystyrene phantom with inverse square law method. Corrections required for percentage depth dose are also determined. Results of our study are compared with that of other investigators.

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"Radiosurgery" is the term for a special concept in radiotherapy. It describes a percutaneous, stereotactically guided irradiation delivering a single high dose with collimated narrow beams. The precise stereotactic localization of the target point and a steep dose gradient outside the target volume allow the administration of high doses to a lesion without damage to adjacent normal tissue. Risk of necrosis, due to a dose volume relationship represents the limits of radiosurgery. Units for radiosurgery were designed at Stockholm using multiple external cobalt-60-gamma sources, at Boston operating with protons of a cyclotron, at Berkeley operating with helium ions accelerated by a synchrocyclotron. An attractive alternative to these complicated and expensive facilities is the use of a modified linear accelerator. At the German Cancer Research Center in Heidelberg such a system was developed and has been available for the treatment of patients since 1984. Though, data of over 100,000 patients with vascular malformations and cancer disease are available worldwide, the indication for this therapy is validated only for a minority of entities. In cases of inoperable arteriovenous malformations favourable results in achieving obliteration range between 60% and 100% were obtained. Median survival for solitary brain metastases with controlled, extracerebral tumor diseases were between nine and twelve months. Up to now, advantages of stereotactic irradiation for benign tumor masses could not be proven. Therefore, randomized trials should be initiated in this field, considering decisive improvements in local tumor control with techniques of microsurgery and fractionated, postoperative radiotherapy during the last few years.

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The large mobility of head and neck requires, when irradiating in this area, positioning and fastening aids, which go beyond simple head bolsters or head moulds. This paper presented describes a positioning system developed by us for irradiating the neck-nose-throat area, which, due to its construction, consists of a non-slipping positioning ground plate and an individually adjustable masking system, which is physiological safe, can be proceeded quickly and exactly, is relatively inexpensive, and is accepted by patients without objections, furthermore since skin markings by drawing field limits onto the face mask are no longer necessary. Various technical aids allow the placement of satellites to spare those body parts which are not irradiated and to install compensators for the direction of radiation. An integrated cartridge mount enables in a simple way easy production of field control documentation photos.

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In evaluating the progress made during one year, it is clear that the position of assessment nurse has been an extremely valuable, effective role. The staff nurses' perception is that they not only understand the importance of the nursing process more thoroughly, but they also view the role of nursing administration as that of trying to help the registered professional nurse at the bedside. It is key in today's health care climate that the nursing administrator be visible. One method to assure visibility is for staff to actually see a role model serving as an extension of the nurse administrator. If nurse administrators truly value the importance of the nursing process, then they need to ensure that this message is being communicated throughout the entire nursing service organization. Such an innovative position can function as a liaison between nursing management and the staff. There is no better method of communicating this than having someone who visibly echoes the values of the nurse administrator. It also should be noted here that Shore Memorial Hospital's Nursing Division received a perfect Joint Commission survey evaluation in April 1990. The Nursing Division attributes this to the efforts made regarding implementation of the nursing process, and the forward thinking of a systems change with implementation of a computerized nursing information system that incorporates the nursing process with everyday documentation. Nurse administrators must effect change and demonstrate leadership within their respective organizations. Organizational change can be slow and difficult at times; however, the end result is worth the effort. It is important that the values of the nurse administrator be disseminated throughout the organization.(ABSTRACT TRUNCATED AT 250 WORDS)

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Subdiaphragmatic radiation therapy in malignant lymphoma requires complete irradiation of retroperitoneal lymph nodes, spleen and splenic pedicle and optimal shielding of radiosensitive structures. The aim of our study was to develop a new method for individual field definition by using MR tomography and MR angiography. In 38 patients with malignant lymphoma coronal MR tomograms and MR angiograms of the abdominal vessels were obtained and superimposed by a specially created computer program. By using a Subtraskop the MRT/MRA superposition was geometrically projected onto the simulation film in correct scale. The target volume could individually be defined and was compared to standard treatment planning according to the definition by Abbatucci. In all patients an exact irradiation of the spleen, the splenic pedicle and prominent lymphatic masses was possible. Furthermore, this resulted in a 32% reduction of treated kidney volume in the average of patients. Noninvasiveness, acceptable costs and high accuracy support the application of this new method in clinical routine.

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After experiences with fluid filled tubes a gel fitted with an adhesive has been developed, to reproducibly markate treatment ports on the patient's skin. A gel is chosen, that hinders loss of the fluid and smoothly fits to the skin surface due to the adhesive. The clinical use of the gel hopefully will help with the use of NMR image information in radiotherapy treatment planning.

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The success of dental implantologic measures depends considerably on the correct positioning of the endosseous implants. A sufficient amount of bony substance is mandatory to provide overall covering of the implant with at least 1 mm of cortical bone. By the aid of a custom-developed software system, computed tomography image data can be handled on a conventional MS-DOS personal computer. The user is enabled to simulate size and positioning of the implant by interactive graphic animation. Quick and exact presentation is achieved by optimizing the computation algorithms. Storage needs are minimized by a segmentation procedure and additional compression of the image. Integrated patient data management and user friendly self-documenting program surfaces provide easy application.

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