[Differential Treatment Strategy of Pleural Empyema in a Post-Pneumonectomy Cavity]

INTRODUCTION

Pleural empyema in a post-pneumonectomy cavity (PEC) occurs with a frequency of 2% -15% and a mortality of more than 10%. It can occur with or without bronchopleural fistula (BPF). The treatment of empyema in the PEC requires a strict algorithm: drainage, bronchoscopy, closure of the fistula, thorough cleaning of the PEC, filling the cavity, thoracoplasty.

METHODS

39 cases with an empyema in the PEC were analysed retrospectively (men: n = 38; women: n = 1; mean age: 60.3 ± 7.6 years). In 32 (82.1%) of the patients, a BPF was detected (right: n = 26, left: n = 6). The average length of stay in hospital was 125 days (22 - 293 days). Cleaning of the PEC was achieved in all surviving patients (n = 23, 65.1%). All patients (n = 39) underwent bronchoscopy with placement of a chest tube for drainage. The BPF was closed in three cases (7.7%) with a stent while in 12 cases (30.8%) a vascularized flap was used. In 14 patients (35.9%) the bronchial stump was either reclosed with sutures or resected. In three cases (7.7%) a re-anastomosis was performed.

RESULTS

The PEC became sterile by regular flushing with antibiotic solution in three patients (7.7%). In 35.9% of the patients (n = 14), aggressive surgical debridement (Weder procedure) was necessary. A thoracic window was applied in 22 patients (56.4%), followed by negative pressure wound therapy (NPWT) and change of dressing every three to four days or a tamponade of the thoracic cavity with simple dressings. In 19 patients (48.7%) the thoracic cavity was sealed with an antibiotic solution. In 5 cases an Alexander thoracoplasty took place.

CONCLUSIONS

Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Thus, two problems arise at the same time – fistula and infection in the pleural cavity. Through a strict algorithm, both problems can be dealt with in stages. After sealing the fistula, the thoracic cavity is thoroughly cleaned and finally the thorax is closed. Only in a small number of patients (1.3%) in whom these measures remain ineffective (persistent MRSA, aspergillus colonization) should the cavity be obliterated by thoracoplasty.

[Differential diagnosis of nasal obstruction]

Nasal obstruction can have a variety of different causes. The following text describes important diseases of the nose and paranasal sinuses, which are associated with the symptom of nasal obstruction and discusses specifics of diagnosis and therapy.

[Diagnosis and therapy of bleeding in ENT]

Bleeding in the oral cavity, nose or ear are common events in the daily routine of ENT specialists. Apart from trivial cases that often get outpatient treatment, there are numerous cases of serious bleeding that require stationary treatment and if necessary, an operative or interventional therapy. In the following section the most frequent types of bleeding, their diagnosis and therapy will be explained.

Early warning against airborne radioactivity in Bavaria: Measuring network for radioactive immissions

During the Chernobyl accident it became evident that there was no up to date information of the radiological situation in Bavaria as a whole. Therefore an online measuring network was implemented, which provides radioactivity data around the clock from all over Bavaria. It comprises measuring devices for gamma-dose rate, airborne aerosol and iodine activity and precipitation. The data are processed in accessory computers and transferred to the main network computers in Augsburg by means of a subcenter computer at the site of the IfR-station. Alarm levels are low in order to have an early warning against airborne radioactivity. New techniques for remote maintenance of the measuring devices and nuclide identification are being planned and tested.

Blocking growth by an electrically active subsurface layer: the effect of Si as an antisurfactant in the growth of GaN

Combining aberration corrected high resolution transmission electron microscopy and density functional theory calculations we propose an explanation of the antisurfactant effect of Si in GaN growth. We identify the atomic structure of a Si delta-doped layer (commonly called SiN(x) mask) as a SiGaN(3) monolayer that resembles a √3×√3 R30° surface reconstruction containing one Si atom, one Ga atom, and a Ga vacancy (V(Ga)) in its unit cell. Our density functional theory calculations show that GaN growth on top of this SiGaN(3) layer is inhibited by forming an energetically unfavorable electrical dipole moment that increases with layer thickness and that is caused by charge transfer between cation dangling bonds at the surface to V(Ga) bound at subsurface sites.

Competitive reporter monitored amplification (CMA)--quantification of molecular targets by real time monitoring of competitive reporter hybridization

Background

State of the art molecular diagnostic tests are based on the sensitive detection and quantification of nucleic acids. However, currently established diagnostic tests are characterized by elaborate and expensive technical solutions hindering the development of simple, affordable and compact point-of-care molecular tests.

Methodology and Principal Findings

The described competitive reporter monitored amplification allows the simultaneous amplification and quantification of multiple nucleic acid targets by polymerase chain reaction. Target quantification is accomplished by real-time detection of amplified nucleic acids utilizing a capture probe array and specific reporter probes. The reporter probes are fluorescently labeled oligonucleotides that are complementary to the respective capture probes on the array and to the respective sites of the target nucleic acids in solution. Capture probes and amplified target compete for reporter probes. Increasing amplicon concentration leads to decreased fluorescence signal at the respective capture probe position on the array which is measured after each cycle of amplification. In order to observe reporter probe hybridization in real-time without any additional washing steps, we have developed a mechanical fluorescence background displacement technique.

Conclusions and Significance

The system presented in this paper enables simultaneous detection and quantification of multiple targets. Moreover, the presented fluorescence background displacement technique provides a generic solution for real time monitoring of binding events of fluorescently labelled ligands to surface immobilized probes. With the model assay for the detection of human immunodeficiency virus type 1 and 2 (HIV 1/2), we have been able to observe the amplification kinetics of five targets simultaneously and accommodate two additional hybridization controls with a simple instrument set-up. The ability to accommodate multiple controls and targets into a single assay and to perform the assay on simple and robust instrumentation is a prerequisite for the development of novel molecular point of care tests.

Imaging of the sinuses for functional sinus surgery using navigational guidance

Advances in the understanding of mucociliary activity and pathophysiology of the nasal cavity and paranasal sinuses have revolutionized the surgical management of chronic and recurrent sinusitis. The development of functional endoscopic sinus surgery (FESS) can also be seen as the pioneer task in endoscopic surgery. Today, in more than 50% of all sinus surgeries FESS is being used. Inflammatory causes are the most common indication for surgery, which can be evaluated best preoperatively using (multi-detector) computed tomography. Even today there are further relevant developments of FESS that result in alleviation of the surgeon due to different degrees of automation. Using a preoperatively acquired navigational dataset helps choosing the optimal surgical strategy. Intraoperatively the navigational dataset is at present mainly used for localization of surgical tools. These newer operation methods demand for high-quality radiological imaging and evaluation, consisting of delineation of the local (inflammatory) process, detection of disease related complications and description of anatomical variations that may be important to the surgeon. Since patients with chronic recurrent sinusitis are relatively young on average and recurrent disease or further CT examinations are not uncommon, there should always be a focus on reduction of radiation exposure as much as possible. Technical advances like cone-beam tomography seem promising to further improve dose reduction as well as spatial resolution.

Microfabricated atomic vapor cell arrays for magnetic field measurements

We describe a method for charging atomic vapor cells with cesium and buffer gas. By this, it is possible to adjust the buffer gas pressure in the cells with good accuracy. Furthermore, we present a new design of microfabricated vapor cell arrays, which combine silicon wafer based microfabrication and ultrasonic machining to achieve the arrays of thermally separated cells with 50 mm(3) volume. With cells fabricated in the outlined way, intrinsic magnetic field sensitivities down to 300 fT∕Hz(1∕2) are reached.

Physical activity and gestational weight gain: a meta-analysis of intervention trials

BACKGROUND

high gestational weight gain (GWG) has been found to be associated with a number of adverse perinatal and long-term outcomes.

OBJECTIVES

we aimed to perform a systematic review and meta-analysis to find out whether physical activity in pregnancy might help avoid high GWG.

SEARCH STRATEGY

a literature search in relevant databases and an additional search by hand through bibliographies of various publications were performed.

SELECTION CRITERIA

we included randomised controlled trials on healthy women, with increased physical activity as the only intervention. GWG had to be documented for the intervention and control group separately.

DATA COLLECTION AND ANALYSIS

two reviewers independently extracted data and performed quality assessment. Data from the included trials were combined using a random-effects model. The effect size was expressed as mean difference (MD).

MAIN RESULTS

of 1380 studies identified, 12 trials met the inclusion criteria. In seven trials, GWG was lower in the exercise group compared with the control group, whereas five trials showed a lower GWG in the control groups. The meta-analysis resulted in an MD of GWG of -0.61 (95% CI: -1.17, -0.06), suggesting less GWG in the intervention groups compared with the control groups. We found no indication for publication bias or dose effects.

AUTHOR'S CONCLUSIONS

in summary, our analyses suggest that physical activity during pregnancy might be successful in restricting GWG.

[Cervical giant tumor in a 56-year-old female patient]

We report the case of a 56-year-old female patient with a giant tumor on the left side of the neck, which appeared to be localised outside the large salivary glands. Due to the extensive vascularisation seen on MRI, digital subtraction angiography was performed. To reduce intraoperative bleeding, the vasculature was embolized. The tumor was resected together with the submandibular gland, since a connection between gland and tumor could not be excluded intraoperatively. Histology showed a pleomorphic adenoma with an intact capsule and no indication of malignancy. Pleomorphic adenomas are typical tumors of the salivary glands; however, they can also occur outside the gland. The tumor and its pseudocapsule must be fully resected to prevent recurrence.