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Eight of the patients had been operated upon previously Pat. The diagnoses of the tumours are depicted in Table 2. The Local Ethics and the Radiation Protection Committees approved the study.
List of patients subjected to 11 CHTP PET before surgery, short notes for the PET and intraoperative findings, and commented outcome. The surgical procedures were performed according to standard protocols at the Department of Surgery, University Hospital, Uppsala, Sweden.
In two patients concomitant liver resections were performed. Two small intestinal NET patients had been previously operated on, and now underwent resection of mesenteric lymph node metastases without intestinal resection, and a left-sided hemihepatectomy together with resections of several liver metastases on the right side.
One patient was subjected to two operations within a short time interval with an 11 CHTP PET examination performed before the first operation.
This patient underwent ileocecal resection and mesenteric lymph node clearance and subsequently right hemihepatectomy and a local tumour excision in the left liver lobe.
Of the 13 sporadic patients with functioning pancreatic NETs, six had insulinomas. Two underwent pylorus-preserving pancreaticoduodenectomy, in one of them combined with distal pancreatectomy because of multiple tumours; three others were subjected to distal pancreatectomy, and one enucleation of the tumour.
Three patients were operated on for gastrinoma, one with duodenectomy and resection of duodenal gastrinoma as well as resection of regional lymph node and liver metastases.
Two patients underwent exploratory laparotomy without resection of tumour. Two patients previously operated with pancreatic resection for glucagonoma were reoperated with resection of lymph node metastases and resection of liver metastases.
Two patients had ectopic ACTH-production; one in a pancreatic NET resected by distal pancreatectomy and another with pancreatic NET and concomitant multiple liver metastases who were subjected to bilateral adrenalectomy.
The six patients with non-functioning pancreatic NETs underwent distal pancreatectomy with splenectomy, re-resection of the pancreatic rim after previous distal pancreatectomy, enucleation, and only laparotomy inoperable tumour.
Of seven patients with MEN-1, five with pancreatic tumours underwent subtotal pancreatectomy and splenectomy in two combined with enucleations of pancreatic head tumours.
Another MEN-1 patient previously subjected to pancreatic resection underwent extirpation of regional lymph node metastases, and one patient was subjected to duodenotomy and resection of multiple duodenal gastrinomas together with near total gastric resection due to a Zollinger-Ellison syndrome with extensive type II gastric NET.
One patient in this series had a sporadic pheochromocytoma and underwent a laparoscopic left-sided adrenalectomy. One patient previously operated for type III gastric NET, now underwent exploratory laparotomy due to suspicion of lymph node metastasis according to a somatostatin receptor scintigraphy.
However no pathological findings were found, implying a false positive somatostatin receptor scintigraphy, but a true negative HTP-PET. During each operation a thorough evaluation was performed of the area described by 5-HTP PET and CT as being positive for tumour, and surgical findings were documented and compared to the radiological findings.
Extirpated tumours were analyzed by histopathology for confirmation of endocrine differentiation. This was performed by chromogranin A and synaptophysin immunostaining, combined with staining for the various pancreatic hormones.
One hour before PET examination carbidopa mg was administered orally in order to block the enzyme aromatic amino acid decarboxylase [ 24 ].
In each bed position a 5 minutes emission was acquired together with a 10 mm transmission scan with an external rotating 68 Germanium pin for attenuation correction.
A low-dose CT kV, 80 mA examination was used for attenuation correction and anatomical correlation of the PET findings. The PET examination typically comprised 5—6 bed positions and the images were reconstructed using Ordered Subset Expectation Maximization OSEM with standard software delivered together with the respective scanners.
CT of the abdomen and chest was performed on a Siemens Somatom Volume Zoom 4 detector row CT scanner Erlangen, Germany using a standard clinical examination protocol.
The liver and pancreas were examined before and during intravenous contrast enhancement in the portal venous inflow phase and the venous phase.
The chest and the rest of the abdomen were examined in the venous contrast enhancement phase. In conclusion, we have proven that tumours diagnosed by 5-HTP PET are NETs as assessed by histopathology and immunostaining.
Our results indicate that 5-HTP PET accurately describes the extent of the disease, which is crucial in the preoperative decision-making, and is a useful tool to guide the surgeon pre- and peroperatively.
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Journal List Cancers Basel v. Cancers Basel. Published online Feb 8. PMCID: PMC Anders Sundin 2 Department of Radiology, Karolinska Hospital, Institution of Molecular Medicine and Surgery, Karolinska Institute, Stockholm SE 77, Sweden; E-Mail: es.
Barbro Eriksson 1 Departments of Medical Sciences, Uppsala University, Uppsala SE 85, Sweden; E-Mails: es. Find articles by Barbro Eriksson.
Britt Skogseid 1 Departments of Medical Sciences, Uppsala University, Uppsala SE 85, Sweden; E-Mails: es. Find articles by Britt Skogseid.
Kjell Öberg 1 Departments of Medical Sciences, Uppsala University, Uppsala SE 85, Sweden; E-Mails: es. Find articles by Kjell Öberg.
Per Hellman 4 Department of Surgical Sciences, Uppsala University, Uppsala SE 85, Sweden; E-Mail: es.
Author information Article notes Copyright and License information Disclaimer. Received Nov 29; Revised Jan 29; Accepted Jan This article has been cited by other articles in PMC.
The number of damages with escaping fragments uncontained failures has reached a relatively low level. A clear maximum can be recognized around , which was caused by the introduction of the first generation of large fan engines, which took many years to reach the current levels of technological maturity.
The lower diagram shows how rapidly designers learned from their experiences. Later generations of engines had considerably lower shut-down rates.
This improvement is even more pronounced with longer operating times. Figure "Engine-related accidents and incidents" This diagram is based on values given in Refs.
Escaping disk and spacer ring fragments: The main cause of these damages is most likely fatigue, which sets in after long operating times. Under the high intended loads, unforeseen operation-conditional changes or special material weaknesses can lead to crack initiation and expansion.
Malfunction of the engine and improper reactions by the crew: These damages should be seen in connection with problems with the indicators of the sensor systems.
These indicators may have malfunctioned Example "Faulty connectors" , been misinterpreted, or the action taken by the crew may have been the wrong one Example "Engine shutdown mistake I" and Example "Engine shutdown mistake II".
These problems can occur after a compressor stall or regulator malfunction, for example. Environmental conditions: These act upon engines primarily as foreign object damage caused by fragments, particles, ice, or birds being sucked into the engine also see Chapter 5.
Uncontained rotor blades: A noteworthy factor is proportion of uncontained rotor blade fragments, even though observation of available acceptance standards and verifications is intended to prevent exactly this type of damage.
One explanation may be that constructive measures and verifications were not possible for older engines, or that factors were involved that had not been foreseen when the engine type was accepted.
In the past few years, great efforts have been made to guarantee safe containment of fan blades. Thrust reversers: In this case, the thrust reverser is considered part of the engine.
This is not self-evident. The greatest problems occur, when the thrust reverser opens during flight Ref. This poses an immediate risk of the aircraft crashing.
Even not opening thrust reversers can be dangerous, if they unacceptably increase braking distance or steer two-engine aircraft off of the runway.
Fires: Fires can ignite and sustain burning in the outer engine in various ways. The engine nacelles are equipped with sensors that detect fires and extinguishing systems that ensure a high level of safety.
Fuel lack, mismanagement : Fuel shortages in flight were a problem especially in the s and 60s due to contamination icing and less advanced fuel management systems.
This problem is evidently still relevant today. Housing failure: Housings of the engine core are highly stressed pressure cookers that are subject to fatigue and can fail due to crack initiation.
Failure of internal components such as the combustion chamber can lead to weakening and cracking of the housing wall followed by the escape of combustion chamber fragments.
Separation of the engine nacelle: Engine nacelles are also not necessarily considered a part of the engine. The nacelle and its equipment are not usually delivered by the engine manufacturer.
In certain aircraft types, the engine can separate due to dangerously high vibrations Ref. There are two primary causes for unintended separation of the nacelle Ref.
A fatigue crack then progresses into the bolt from this damage Chapter 4. Another known cause for failure of engine suspensions is extreme overstress in flight, such as that caused by turbulence in rare cases Fig.
Figure "Rotor damages" The data at left were taken from FAA values given in Ref. Unfortunately, they are already somewhat aged.
However, they still have relevancy with regard to the trends they show. Rotor damage is always especially interesting, since it is usually in connection with uncontained high-energy fragments with correspondingly extensive damage to the aircraft and immediate danger to the passengers.
When considering the fact that targeted and sufficiently successful preventive measures necessitate an understanding of the damage causes, this is especially alarming.
Experience has shown that a lack of effective remedies will usually result in more incidents of the same type occurring. It is also surprising that the number of life span-conditional damages is relatively small.
The question must be asked, whether some of the cases with unknown causes are related to the life span of the failed parts. In order to promote further understanding, it must be mentioned that a number of the damages in the reference works occurred during start-up and take-off.
This number is roughly the same as that of uncontained rotor blade failures, disk damage, and ring damage. In the vast majority of cases, this damage was in the fan or compressor and involved the blading.
The turbine was rarely affected. It must be asked, whether the continually increasing gas temperatures in new engine types have changed the focal point of damage over time.
A positive note is the small number of rotor damages that can be traced back to problems with quality control. With regard to flight situations, a surprisingly large number of damages occur during cruising flight, despite the fact that start-up and take-off presents the greatest amount of disk stress, when thermal strain combines with centrifugally-induced stress in highly-stressed engine areas and the high engine output is accompanied by correspondingly high gas and blade tempera tures.
Figure "Risk analysis" Ref. This method is used, when for a high number in the 10 3 range safety relevant parts during operation the first failures occur.
Thereby the approach is analogous the following steps: 1. Identification of the failure relevant operation time, respectively cycles of every aeroengine respectively the triggering component of the concerned fleet at the time of failure diagram above left.
Calculation of the failure probability and registration in a weibull diagram above the operation time respectively cycles.
This permits hints at the failure mechanism e. To this belongs the knowledge of the following influences:.
Concerned is a simple, fast and powerful computer-aided process. For this a computer model of the failing mode is established and ots influence at the component lifetime evaluated.
The application of this process can be applied to the most different scenarios of the aeroengine engineering like production, deviations, test planning, aging and repair.
Thereby the prediction quality rises with the number of the considered random influences. The lower frame shows an example which serves the forecast of the spare parts supply.
This method can also be used at the behaviour of the aeroengines. So risks respectively safety aspects of flight missions get accessible.
Useful examples are shown in Ref. Thereby inspection periods to be planned and unpredicted and overhauls can be forecast. Figure "Issues during takeoff I" and Figure "Issues during takeoff II" Ref.
It then reaches at least 35 ft ca. V1 see later , VR and V2 are depending from the airplane type. A drop out of an aeroengine demands from the crew very short-term decisions if the start should be continued or aborted.
Thereby especially aggravating affects the usually increased attention of the crew the start process and not the aeroengines. Differently the layman could suppose at the first glance, necessary actions don't comply with markings at the runway, but depend from the speed of the airplane.
These terms suggest, that not before the reaching of V1 action is needed. So this period of time before V1 is the definition and of special importance for the start abort Fig.
In respect of the NO GO criteria : V1 means the maximum speed in the takeoff at which the pilot must take the first action e.
In respect of the GO criteria : V1 also means the maximum speed in the take off, following a failureof the critical engine at VEF, at which the Pilot can continue the takeoff to achieve a screen hight of 35 ft at the end of the runway.
So the necessary procedures must occur between EF and V1. It must be considered, that from experience the identification of an aeroengine drop-out needs at lest one second see middle and lower sketch in Fig.
Thereby it is supposed, that the flight speed of the airliner increases 3 knots. In the time period between and , 81 of starts had to be aborted.
The experience shows, that already a seemingly minor exceeding of V1 by about few knots can lead to the destruction of the airplane.
The most frequent cause is the drop-out of an aeroengine diagram above. Thereby it is not clear if e.
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I knew that he had had no intention of going there to pay homage to Heidegger. Gerhart Baumann describes all the elements of the strategy in his account of the visit.
One can infer nothing, neither from the poem nor from the half-unconscious account, which unveils and masks. Baumann was not ready to understand.
The narrator Baumann reduces the content to a dialogue that could have developed but that did not occur, between two geniuses whose contradictions, and particularly those of the Freiburg professor, should be respected.
Such contradictions belonged to them and testified to their greatness. The event has no effect on this dialectic of the mind. When it is well thought out, philosophical nihilism embraces the history of Nazism and situates it as a necessary, inevitable event.
Moreover, one can plead that it is hard to understand today what it must have been like at the time when German professors made their regrettable decisions and the Jews were dismissed from their academic chairs.
We judge from a distance. That is a bit much. The account mentions all the explicit and public manifestations of the distance that Celan intended to keep.
Celan also resented that he had once placed his trust in Heidegger, reading him without any background knowledge. Baumann cannot understand him.
History could not have this weight. And afterwards, everything had been said. Celan felt free. He had liberated himself. But at the same time, as if to situate his decision, he immediately expressed remorse for it.
He was crossing a divide and made it known. He might have had some doubts about the outcome of his action. There is a perfect logic in the contradiction of the two successive gestures of saying yes while meaning no, and then a definitive no.
He expressed the fundamental duality of his task. Should one not explore the psychology of the victims? Baumann could not explain the fleeting moments of good humor other than by feeling their effect, even though he himself revealed its limits.
The poet, he believed, had been thrust back in time to his old ordeals, being no longer confronted with the hardness of granite.
Wandering and failure were the lot of the Jewish poet; they had nothing to do with the Germans, who had been chosen for another destiny. This is the conviction to which Celan, in fact, succumbed.
The poet expressed his desire to see the marshes close to the cottage. His companions suggested the Horbach area. We know that Celan settled on this itinerary ahead of time.
He knew where he was going and where he was going to take Heidegger; nothing was unexpected. Baumann was not present during the discussion in the cottage.
He rejoined the group later in the morning, for the visit to the marshes: he had come in his own car, which explains why he did not hear the second, more decisive conversation between Celan and Heidegger, in the car Neumann was driving.
However, thanks to him, we have the story of the interrupted walk on the log trail. The script was programmed. Germanic mists and grey skies accompany it, as if by magic.
He was visibly satisfied with the way things had worked out. His success was such that it dispelled his usual melancholy.
She did not recognize him; he seemed so reinvigorated. In the first of the letters he sent to Celan more than two months after the meeting, Gerhard Neumann recalls, in a rather conventional way, the conversations that took place in his presence in the car letter of October 17, In the meantime, Celan had spoken with him on the telephone.
He apparently mentioned the poem he had written, and thus indirectly the role he had made Neumann play in the infernal scenario; it was a distinction the meaning of which the young Neumann could not have understood.
I beg your indulgence; please continue to think kindly of me. We can understand how Celan, later in the evening, flew into a towering rage when he found out about it.
He learned that the metaphorical decomposition in his poetry did not succeed in capturing the real. The author was thinking about such a depraved reality that it evaded the possibility of any meaningful apprehension.
The verbal explosion translated the decomposition of the world. Relations between Celan and Neumann were thus irreparably damaged. The lack of comprehension revealed a lack of solidarity.
Baumann, in recounting the incident, sides implicitly with his young assistant: in his study, he had put his finger on the unintelligible character of an art to which the poor poet remained attached.
The decomposition that he re-translated was the expression of his absurd destiny. He had tried to utter the unutterable with more or less success.
His illness bears witness to a transgression. The mystery cannot be denied. With Sten , which he had written without the r , the choice remained to be made.
The process led, through the integration of the crime, to the advent of a word for the future, and was made explicit in the first version by the addition of a parenthesis: kommendes un- gesäumt kommendes Wort [ 52 ].
He knew what he was going to do and obtain. What he was considering was endless and unfettered. July 25, , Paul Celan.
The poetic writing is transferred into the sphere of economic poverty, repression, and insurrection. The gaze then moves outside towards the vertical, which rises from the shadows of the well and looms up to its other pole stemming from the night.
This is already the site of the conversation that will follow, and the glow of the star under which it will be placed.
The poet makes sure that this prerequisite is present, the actual object, which is there and which serves the transposition. Memory takes care of the rest.
The heart remembers. It has the strength for it. Hope rests on it; it cannot cut itself off from continuity.
If one confines oneself to this logic, it cannot be the case of awaiting a declaration, or of some kind of justification on the part of the host.
Rather it anticipates the confession that will be wrung out of the host. The survival of the past, of the initial act, evokes an implicit contradiction, by the mere fact of being uttered.
Nothing is merely described. Everything is transferred. The descriptions involve a passage to the interior of language, preventing the negation of the values that are associated with it at this site.
The cottage and its well are spoken again like the book, the heart that remembers. In the poem, the phases are apportioned, distinct: first the well, outside, then the indoor space of the cottage, which is organized around the book, to the extent of being confused with it, and with the line of writing traced in this book.
The inscription written in it now gives way, with the narrative distance of the poem, to the gesture of a presentation and a doubling.
The book, still his, is written from one poem to another, from one note to another; but it is enriched once more, in enemy territory, with the names and the language of the adversary, on the tracks of an incursion, always already programmed.
To slip under the skin of the beast; the book will be that book, with all the names of the Nazis. The repetition of the sentence from the guest book—a form of auto-interpretive intertextuality—introduces the present tense of a recollection.
The more he rejects, the less he renounces, and the more his thought is led to draw from itself the power to turn against itself. Nihilism has changed into memory of the annihilation.
The future will open up if it is the depositary of that history. Beda Allemann methodically ruled out any political or factual references. The publisher Robert Altmann reintroduced the political dimension, but he failed to see that the hope for an explanation still expressed a reaction that was too positive, respectful, and almost beseeching.
Otherwise, what meaning did the thing have, in such beautiful attire? Would the example of the bottle cast into the ocean, dear to so many readers and interpreters, not be the in-depth decoding, still to come?
Each recipient would do as he liked with it. My friend Kostas Axelos, whose thought was greatly influenced by Heidegger he was one of the recipients of the Vaduz edition , was at the Austrian Institute in when the interpretation proposed here was presented.
He admitted to me that it was extremely coherent, but he still wondered if others just as coherent might exist.
The future is open. One should maintain the possibility in principle. Herein lies the problem. Reading opens up; it is in search of a meaning that can always be made more precise and profound, but not exchanged for another, unless it is an erroneous one.
Otherwise, this would just be a game; it is conceivable that some play it. That at the appointed time you would hear the language in which the poetry to be written would be addressed to you.
Celan had got his revenge in advance. Celan, in their conversation, made him speak the inhuman, before a representative of the human species.An Anthropological Fiction 8. Southwest Giga Android. However, in well-differentiated NETs, the FDG uptake is generally low, making this technique of Katie Walder value [ 45 ]. Archived from the original on 26 October Justice beyond Borders: A Global Political Theory. This is perhaps the right moment to point out that Heidegger, according to his Thereafter, was unaware that Netflix Geräte was Jewish. Expanded Edition. Goethes Werke. The verses of Franck's hymn Manuel Zuri the order of the words nichtig and flüchtig in their opening lines. Kyrie eleison! Citizenship and National Identity.