1
|
3145Empagliflozin potently reduces sarcoplasmic Ca leak and increases Ca transient amplitude of human failing ventricular cardiomyocytes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
2
|
[Analysis and options for optimization of preoperative assessment for anesthesia at a university hospital]. Anaesthesist 2017; 67:93-108. [PMID: 29230500 DOI: 10.1007/s00101-017-0392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Risk assessment prior to elective surgery is an important tool in the context of perioperative patient care; however, only a few studies have been carried out to address the processes and problems during preoperative assessment for anesthesia. AIM Over a period of several weeks all preoperative anesthesia evaluations prior to elective surgery were prospectively recorded in order to generate a data pool with a view to identifying options for process optimization. MATERIAL AND METHODS All preoperative evaluations over a period of 38 working days at the University Medical Center Regensburg were recorded and analyzed with respect to waiting time for the patient and the duration of the preoperative consultation on medication. Also documented were the patient age, ASA score, the faculty carrying out the operation, type and risk of surgery, planned time of surgery, professional experience of the anesthesiologist and the approval status for surgery. In addition, all problems which occurred during the preoperative anesthesia evaluation were documented using a questionnaire. RESULTS Overall 2233 preoperative assessments for anesthesia were recorded and analyzed. The number of patients attending the preoperative assessment clinic differed markedly in the course of a day and was lower at the end of the week. Approval for surgery with no reservations was given more frequently by anesthesiologists with more than 5 years professional experience and consultants compared to younger colleagues. The main reason for approval with reservations or no approval was the lack of patient records and test results, which should have been presented according to the in-house standard for preoperative assessment for anesthesia. The mean waiting time was 58.6 ± 30.3 min, the mean duration of the patient documentation review and physician-patient consultation together was 33.6 ± 16.3 min. Anesthesiologists with 2-5 years professional experience needed significantly less time for patient documentation reviews and physician-patient consultations than younger and more experienced colleagues. The duration of the preoperative assessment for anesthesia correlated with the ASA score and risks of surgery. CONCLUSION The analysis of processes and problems in the context of preoperative assessment for anesthesia revealed several options for optimization. Major efforts should be the implementation of an appointment system for the preoperative assessment clinic in order to generate a homogeneous distribution of patients during the course of a day. Furthermore, surgeons and case managers should be requested to refer patients to the preoperative assessment clinic only with complete records and test results according to the in-house standard.
Collapse
|
3
|
Anti-Aspergillusimmunoglobulin-G testing in serum of hematopoietic stem cell transplant recipients. Transpl Infect Dis 2016; 18:354-60. [DOI: 10.1111/tid.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/02/2016] [Accepted: 01/20/2016] [Indexed: 11/28/2022]
|
4
|
The Temporal Atrial Fibrillation Pattern during the Blanking Period after Atrial Fibrillation Ablation Is Associated with Later AF Recurrence. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
5
|
Predictors of AF Recurrence after Surgical Ablation: Insights from Continuous Heart Rhythm Monitoring. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
6
|
Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial. Br J Dermatol 2015; 173:192-200. [DOI: 10.1111/bjd.13547] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2014] [Indexed: 01/02/2023]
|
7
|
[Not Available]. Anaesthesist 2014; 63:700-702. [PMID: 25401186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
8
|
[Placement of a central venous catheter in cases of persistent left superior vena cava]. Anaesthesist 2014; 63:231-3. [PMID: 24566941 DOI: 10.1007/s00101-014-2304-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/20/2014] [Accepted: 01/26/2014] [Indexed: 11/25/2022]
Abstract
This article presents a case report on the placement of a central venous catheter (CVC) in a patient with an unknown persistent left superior vena cava (PLSVC). Normally, PLSVCs remain asymptomatic but can be associated with disastrous consequences for the patient during placement of a CVC particularly due to vascular perforation and pulmonary injury. A PLSCV is particularly common in association with congenital heart defects; however, otherwise healthy patients can also be affected. As the presence of a PLSCV is normally unknown special attention must be paid in every patient during placement of a CVC.
Collapse
|
9
|
Atrial fibrillation burden estimates derived from intermittent rhythm monitoring should not be used for patient follow-up or as endpoints in clinical trials. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
10
|
Hospitalized but not admitted: characteristics of patients with "observation status" at an academic medical center. JAMA Intern Med 2013; 173:1991-8. [PMID: 23835927 PMCID: PMC3942156 DOI: 10.1001/jamainternmed.2013.8185] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The Centers for Medicare & Medicaid Services (CMS) defines observation status for hospitalized patients as a "well-defined set of specific, clinically appropriate services," usually lasting less than 24 hours, and that in "only rare and exceptional cases" should last more than 48 hours. Although an increasing proportion of observation care occurs on hospital wards, studies of patients with observation status have focused on the efficiency of dedicated units. OBJECTIVE To describe inpatient and observation care. DESIGN AND SETTING Descriptive study of all inpatient and observation stays between July 1, 2010, and December 31, 2011, at the University of Wisconsin Hospital and Clinics, a 566-bed tertiary academic medical center. PARTICIPANTS All patients with observation or inpatient stays during the study period. MAIN OUTCOMES AND MEASURES Patient demographics, length of stay, difference between cost and reimbursement per stay, and percentage of patients discharged to skilled nursing facilities. RESULTS Of 43,853 stays, 4578 (10.4%) were for observation, with 1141 distinct diagnosis codes. Mean observation length of stay was 33.3 hours, with 44.4% of stay durations less than 24 hours and 16.5% more than 48 hours. Observation care had a negative margin per stay (-$331); the inpatient margin per stay was positive (+$2163). Adult general medicine patients accounted for 2404 (52.5%) of all observation stays; 25.4% of the 9453 adult general medicine stays were for observation. The mean length of stay for general medicine observation patients was 41.1 hours, with 32.6% of stay durations less than 24 hours and 26.4% more than 48 hours. Compared with observation patients on other clinical services, adult general medicine had the highest percentage of patients older than 65 years (40.9%), highest percentage female patients (57.9%), highest percentage of patients discharged to skilled nursing facilities (11.6%), and the most negative margin per stay (-$1378). CONCLUSIONS AND RELEVANCE In an academic medical center, observation status for hospitalized patients differed markedly from the CMS definition. Patients had a wide variety of diagnoses; lengths of stay were typically more than 24 hours and often more than 48 hours. The hospital lost money, primarily because reimbursement for general medicine patients was inadequate to cover the costs. It is uncertain what role, if any, observation status for hospitalized patients should have in the era of health care reform.
Collapse
|
11
|
Successful isavuconazole salvage therapy in a patient with invasive mucormycosis. Infection 2013; 42:429-32. [PMID: 24217961 DOI: 10.1007/s15010-013-0552-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
A 45-year-old male with rhinocerebral mucormycosis (Rhizopus oryzae), refractory to liposomal amphotericin B and posaconazole, received isavuconazole salvage therapy. Initial isavuconazole plasma and tissue levels were 0.76-0.86 μg/mL and 1.09-1.38 μg/g. Plasma levels increased to 1.3-3.24 μg/mL with reduced comedication. Isavuconazole was well tolerated, and the patient has remained disease-free 24 months post-antifungal therapy.
Collapse
|
12
|
[Secondary sclerosing cholangitis after multiple trauma and long-term intensive care treatment: case report of a characteristic course]. Anaesthesist 2013; 62:121-4. [PMID: 23340951 DOI: 10.1007/s00101-012-2133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/16/2012] [Accepted: 12/17/2012] [Indexed: 12/01/2022]
Abstract
This article reports on a patient who needed intensive care treatment because of multiple trauma. The patient had no preexisting liver disease but developed secondary sclerosing cholangitis and finally died. The etiology, diagnosis and therapeutic options of this clinical picture are discussed and a review of the literature is presented.
Collapse
|
13
|
Pre-hospital cardiopulmonary resuscitation supported by ECMO – a case series of 6 patients. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
The surgical Cox Maze III procedure for the treatment of atrial fibrillation: Results from continuously monitored patients. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Extracorporeal life support during PCI and TAVI procedures using Mini-ECMO systems. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
16
|
Is the alpine divide becoming more permeable to biological invasions? - Insights on the invasion and establishment of the Walnut Husk Fly, Rhagoletis completa (Diptera: Tephritidae) in Switzerland. BULLETIN OF ENTOMOLOGICAL RESEARCH 2011; 101:451-465. [PMID: 21320363 DOI: 10.1017/s0007485311000010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Walnut Husk Fly, Rhagoletis completa Cresson (Diptera: Tephritidae), is native to North America (Midwestern US and north-eastern Mexico) and has invaded several European countries in the past decades by likely crossing the alpine divide separating most parts of Switzerland from Italy. Here, we determined its current distribution in Switzerland by sampling walnuts (Juglans regia L.) in ecologically and climatically distinct regions along potential invasion corridors. R. completa was found to be firmly established in most low altitude areas of Switzerland where walnuts thrive, but notably not a single parasitoid was recovered from any of the samples. Infested fruit was recovered in 42 of the 71 localities that were surveyed, with mean fruit infestation rate varying greatly among sites. The incidence of R. completa in Switzerland is closely related to meteorological mean spring temperature patterns influencing growing season length, but not to winter temperatures, reflecting survival potential during hibernation. Importantly, areas in which the fly is absent correspond with localities where the mean spring temperatures fall below 7°C. Historical data records show that the natural cold barrier around the Alpine divide in the central Swiss Alps corresponding to such minimal temperatures has shrunk significantly from a width of more than 40 km before 1990 to around 20 km after 2000. We hypothesize on possible invasion/expansion routes along alpine valleys, dwell on distribution patterns in relation to climate, and outline future research needs as the incursion of R. completa into Switzerland; and, more recently, other European countries, such as Germany, Austria, France and Slovenia, represent an example of alien species that settle first in the Mediterranean Basin and from there become invasive by crossing the Alps.
Collapse
|
17
|
Abstract
Athletic traumatic hip subluxations are rare. Classic radiographic features have been well described. This case highlights the potential pitfalls of immediate magnetic resonance imaging. Femoral head contusions and acetabular rim fractures are common associated findings usually apparent with magnetic resonance imaging (MRI). However, in this case an MRI done 3 hours post injury failed to show any edema in either location, making the appearance of these findings on subsequent MRIs difficult to interpret. An acute MRI more than 48 hours post injury may have been more helpful.
Collapse
|
18
|
Arthroscopy on Anticoagulated Patients: A Retrospective Evaluation of Postoperative Complications. Orthopedics 2010. [DOI: 10.3928/01477447-20100104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
19
|
Abstract
Anticoagulation is commonly needed for multiple medical conditions. The indications to discontinue anticoagulation for a simple procedure are controversial. Other surgical subspecialties have shown that keeping patients on warfarin during a simple procedure is safe. The purpose of this retrospective study was to evaluate the postoperative complications encountered for patients undergoing simple arthroscopic procedures while on warfarin. We hypothesized that anticoagulated patients undergoing simple arthroscopic procedures would have few surgical bleeding complications.Arthroscopic procedures performed over a 10-year period on warfarin-anticoagulated patients were retrospectively evaluated. Data collected included the procedure and orthopedic problem, the type of anesthesia, the medical condition requiring anticoagulation, the international normalized ratio (INR) at surgery, and all postoperative complications (bleeding, hematoma, delayed healing, prolonged postoperative course, infection, and medical complication). Twenty-four patients met the inclusion criteria. All had abnormal INR levels at time of surgery. Four patients were operated on emergently for septic joints, and 20 patients had elective arthroscopic procedures (10 knees, 10 shoulders). There were no major intraoperative bleeding problems. Seven patients had minor postoperative surgical complications: 2 prolonged effusions and 5 prolonged ecchymosis. No medical complications were seen. Oral warfarin appeared to be a safe alternative to manipulating anticoagulation during the preoperative period for simple arthroscopic procedures. Minor bleeding complications consisting of ecchymosis were seen, but no medical complications were identified.
Collapse
|
20
|
|
21
|
Therapeutische Kommunikation statt Narkose oder Analgosedierung bei THS. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Life table statistics of three apple aphids, Dysaphis plantaginea, Rhopalosiphum insertum, and Aphis pomi (Homoptera, Aphididae), at constant temperatures. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1439-0418.1985.tb01990.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Comparison of single- versus double-tunnel tendon-to-bone healing in an ovine model: a biomechanical and histological analysis. Am J Sports Med 2009; 37:512-7. [PMID: 19168807 DOI: 10.1177/0363546508327543] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The double-bundle technique has recently gained much interest in ligament reconstruction. In addition to potential kinematic advantages, perhaps double tunnels have the potential for faster and more secure tendon-to-bone healing. HYPOTHESIS Placement of tendons in 2 osseous tunnels, as opposed to 1, will enhance tendon fixation as determined biomechanically and histologically. STUDY DESIGN Controlled laboratory study. METHODS Fourteen sheep were used, and an extra-articular tendon graft reconstruction was performed on both knees of each sheep. In 1 randomly selected knee, the long digital extensor tendon was released from the femur and placed into a single tunnel in the proximal tibia. In the contralateral knee, the tendon was split and placed into 2 tibial tunnels. Ten sheep were analyzed by mechanical testing, and the remaining 4 were subjected to histologic evaluation at 6 weeks after surgery. Paired t tests were used for statistical analysis. RESULTS Mechanical testing demonstrated that the peak load (981.8 +/- 143.2 N, mean +/- SD) and stiffness (570.9 +/- 114.6 N/mm) at 6 weeks after surgery in the double-tunnel group were significantly greater than for the single-tunnel group (714.8 +/- 94.2 N and 432.2 +/- 56.7 N/mm, respectively; load, P = .007; stiffness, P = .03). Histologic analysis suggested similar tendon-to-bone healing for both groups. CONCLUSION This study demonstrated enhanced biomechanical fixation of the tendon to the surrounding bone in the double-tunnel compared with the single-tunnel technique in this ovine model. CLINICAL RELEVANCE The double-tunnel technique may provide better fixation and healing in human ligament reconstruction.
Collapse
|
24
|
New insights into surgical atrial fibrillation ablation therapy: Initial experience with a novel permanently implantable heart rhythm monitor device. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
25
|
Cardiac anaesthesia during minimised extracorporeal circulation: Does the anaesthetic matter? Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
26
|
|
27
|
Reoperations on the autograft and homograft after the Ross procedure: A report from the German-Dutch Ross registry. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
|
29
|
Notärztliche Behandlung von Palliativpatienten mit Dyspnoe. ZEITSCHRIFT FUR PALLIATIVMEDIZIN 2008. [DOI: 10.1055/s-0028-1088509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Aspergillus galactomannan testing in patients with long-term neutropenia: implications for clinical management. Ann Oncol 2008; 19:984-9. [DOI: 10.1093/annonc/mdm571] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Soft X-ray spectromicroscopy of phase-change microcapsules. Micron 2008; 39:275-9. [PMID: 17509889 DOI: 10.1016/j.micron.2007.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/03/2007] [Accepted: 04/03/2007] [Indexed: 11/29/2022]
Abstract
A synchrotron-based scanning transmission X-ray microscope (STXM) is used to investigate Micronal phase-change microcapsules. Prolonged X-ray illumination of the specimen leads to the breaking of the microcapsules' protective polymer shell and a partial separation of the core-shell species occurs. The paraffin wax and acrylic polymer components are characterized by carbon K-edge near X-ray edge absorption fine structure (NEXAFS) spectroscopy and components distribution mapping of the beam-damaged specimen is performed.
Collapse
|
32
|
Successful salvage treatment of disseminated cutaneous fusariosis with liposomal amphotericin B and terbinafine after allogeneic stem cell transplantation. Transpl Infect Dis 2008; 10:290-3. [PMID: 18194367 DOI: 10.1111/j.1399-3062.2007.00296.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fusarium infections are associated with high mortality after allogeneic stem cell transplantation. We report on successful treatment of a disseminated cutaneous Fusarium proliferatum infection using liposomal amphotericin B and terbinafine. In vitro susceptibility tests of antifungal drugs suggest that terbinafine is a potent additional antifungal drug for disseminated cutaneous fusariosis.
Collapse
|
33
|
Experience with ritonavir/atazanavir in HIV-positive antiretroviral-naïve individuals commencing therapy. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
34
|
Spinal cord ischemia after endovascular repair of the descending thoracic aorta in a sheep model. Eur J Vasc Endovasc Surg 2007; 34:461-9. [PMID: 17683959 DOI: 10.1016/j.ejvs.2007.04.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 04/01/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Spinal cord ischemia remains a devastating complication after thoracic aortic surgery. The aim of this study was to investigate the pathophysiology of spinal cord ischemia after thoracic aortic endografting and the role of intercostal artery blood supply for the spinal cord in a standardized animal model. METHODS Female merino sheep were randomized to either I, open thoracotomy with cross-clamping of the descending aorta for 50 min (n=7), II, endograft implantation (TAG, WL Gore & Ass.), (n=6) or III open thoracotomy with clipping of all intercostal arteries (n=5) . CT-angiography was used to assess completion of surgical protocol and assess the fate of intercostal arteries. Tarloy score was used for daily neurological examination for up to 7 days post-operatively. Histological cross sections of the lumbar, thoracic and cervical spinal cords were scored for ischemic damage after stained with Hematoxylin-Eosin, Klüver-Barrrera and antibodies. Exact Kruskall-Wallis-Test was used for statistical assessment (p<0.05). RESULTS Incidence of paraplegia was 100% in group I and 0% in group II (p=0.0004). When compared to the endovascular group, there was a higher rate of histological changes associated with spinal cord ischemia in the animals of the control group (p=0.0096). Group III animals showed no permanent neurological deficit and only 20% infarction rate (p=0.0318 compared to group I). CONCLUSIONS In sheep, incidence of histological and clinical ischemic injury of the spinal cord following endografting was very low. Complete thoracic aortic stent-grafting was feasible without permanent neurologic deficit. Following endovascular coverage or clipping of their origins, there is retrograde filling of the intercostal arteries which remain patent.
Collapse
|
35
|
Phenology modelling of major insect pests in fruit orchards from biological basics to decision support: the forecasting tool SOPRA. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1365-2338.2007.01121.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
36
|
Palliativ- und Notfallmedizin: Teamarbeit durch Kommunikation. ZEITSCHRIFT FUR PALLIATIVMEDIZIN 2007. [DOI: 10.1055/s-2006-952017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
The extent of akinesis is predictive of the in-hospital mortality from endoaneurysmorrhaphy. ZEITSCHRIFT FUR KARDIOLOGIE 2005; 94:121-7. [PMID: 15674742 DOI: 10.1007/s00392-005-0194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 10/27/2004] [Indexed: 10/25/2022]
Abstract
Endoaneurysmorrhaphy (EAR) has become an important therapeutic option in the treatment of patients with left ventricular (LV) aneurysm and congestive heart failure. Today, more and more patients are referred for EAR with a dilated akinetic LV rather than a classic dyskinetic LV aneurysm. Little is known about the contribution of the extent of akinesis to perioperative mortality. We reviewed the data of 147 patients with anterior left ventricular aneurysms undergoing EAR. Seventy percent of the patients were male; mean age was 62+/-9 years. Demographic, hemodynamic, angiographic and surgical variables were analyzed using univariate statistic tests in order to determine risk factors for in-hospital mortality.Eighty-two percent of the LV aneurysms had at least some dyskinesia, but 70% were mainly akinetic. 133 patients had additional bypass surgery, one had additional mitral valve replacement. In-hospital mortality was 4.1% (n=6). Risk factors for in-hospital mortality were the total extent of akinetic myocardium (p=0.027) in the 30 degrees RAO view and the duration of cardiopulmonary bypass (CPB, p=0.0068) which was itself dependent on the LV ejection fraction (p=0.001), the number of stenosed coronary arteries (p=0.004), and the extent of akinesis (p=0.023). The extent of dyskinesia was not associated with either perioperative mortality (p=0.36) or CPB duration. EAR can be performed with acceptable perioperative results. Because akinesis increases in many patients with time, and because the duration of ECC was dependent on variables reflecting the severity of the underlying heart disease, our findings underscore the importance of optimal timing for the surgical intervention.
Collapse
|
38
|
Abstract
Nitrous oxide has been used in addition to other volatile anaesthetics to provide general anaesthesia and short time sedation for more than 150 years. However, the exact mechanisms of action remain unclear. For decades nitrous oxide was considered to be the ideal anaesthetic because of his favourable physical properties and low cardiovascular side effects. However, the known side effects of nitrous oxide as well as the implementation of new anaesthetic agents and short acting opiates led to more and more criticism about the administration of this gas. Nitrous oxide is still frequently used for mask induction primarily in paediatric anaesthesia and gynaecology. However, recent studies have shown that omitting nitrous oxide can also be a risk factor because of an increased susceptibility to intraoperative awareness. Careful consideration of the illustrated contraindications and side effects as well as the available alternatives, shows that nitrous oxide is still an option in general anaesthesia.
Collapse
|
39
|
Abstract
The following article summarizes different aspects of local anesthetic effects that cannot be explained purely by a sodium channel blockade. Particularly remarkable is hereby their antiinflammatory activity, e.g. the inhibition of pathological changes such as excessive stimulation of the inflammatory system, without compromising the host defense system. In contrast to other immunosuppressive drugs commonly used for treating such conditions, local anesthetics look promising for the future as a new therapeutic option. Besides general anesthetic activity, local anesthetics exert cerebroprotective effects and are furthermore, in consideration of their cardiovascular stability, of interest during neuroanesthetic procedures. In addition, local anesthetics are known for their potency to minimize bronchial hyperreactivity, although details of the underlying mechanisms are not yet elucidated. These effects of local anesthetics may represent interesting prospects for which their relevance has to be determined.
Collapse
|
40
|
Percutaneous dilatation tracheostomy (PDT) in cardiac surgery patients. Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
41
|
Eitrige Spondylodiszitis bei juveniler chronischer Arthritis: Komplikation unter Etanercept-Therapie. AKTUEL RHEUMATOL 2003. [DOI: 10.1055/s-2003-45044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
42
|
[The Ross procedure (pulmonary autograft) as an alternative for aortic valve replacement]. Dtsch Med Wochenschr 2003; 128:1759-64. [PMID: 12934169 DOI: 10.1055/s-2003-41707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The Ross procedure (pulmonary autograft) has since the 1980s attracted growing interest as an alternative to the widely practised insertion of a prosthetic aortic valve. The 12-year experience of a consecutive series from one centre are reported here. PATIENTS AND METHODS Between February 1990 and January 2002 a Ross procedure, predominantly with the subcoronary technique, was performed in 244 consecutive patients with aortic valve disease (244 men, 54 women, mean age 46 +/- 13.5 years). Annual follow-up clinical examinations (mean postoperative period 32.9 +/- 29.5 months in 99 % of the cohort) were performed. RESULTS Perioperative mortality was 0.8 % (n=2), and there were two late deaths unrelated to the aortic valve disease. Seven patients had to be re-operated for failure of the homograft (n=4) or autograft (n=4). According to clinical criteria, 99 % of the followed-up patients were in New York Heart Association (NYHA) functional class I or II, only two patients, with pulmonary comorbidity, were in class III. Echocardiography demonstrated autografts with nearly normal transvalvular gradient (mean maximal pressure gradient 6.5 +/- 3.3 mmHg), while nine patients had second-degree aortic regurgitation. The mean maximal gradient across the homograft valve in the pulmonary position was 12.0 +/- 6.9 mmHg, while ten patients had second-degree and one had third-degree pulmonary regurgitation. CONCLUSION The technically demanding Ross procedure produced excellent clinical and hemodynamic mid-term results. It is thus an appealing alternative to the widely used replacement by a prosthetic valve. Definitive assessment awaits further long-term follow-up.
Collapse
|
43
|
Mucormycoses. Mycoses 2002; 44:253-60. [PMID: 11714058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Over recent years the clinical importance of mucormycosis has significantly increased. Most frequently mucormycosis occurs in neutropenic patients with haematological diseases. It is caused by fungi of the order Mucorales. The clinical patterns of the disease produced by different genera or species of Mucorales are virtually identical. Rhizopus, Absidia, Rhizomucor and Mucor are the organisms most commonly isolated from patients who suffer from mucormycosis. Diagnosis of mucormycosis is difficult as it is based on culture methods or microscopy of clinical specimens. The diagnosis is often only made after a delay or even post-mortem. Therapy includes surgical intervention if possible and is based on systemic amphotericin B (conventional or liposomal).
Collapse
|
44
|
|
45
|
Abstract
Recent evidence points to a potential role of cyclic GMP (cGMP) in the control of cardiac glucose utilization. The present work examines whether the glucose transport system of cardiac myocyte is a site of this cGMP-dependent regulation. Treatment of isolated rat cardiomyocytes (for 10 min) with the membrane-permeant cGMP analogue 8-(4-chlorophenylthio)-cGMP (8-p-CPT-cGMP, 200 microM) caused a decrease in glucose transport in non-stimulated (basal) myocytes, as well as in cells stimulated with insulin or with the mitochondrial inhibitor oligomycin B by up to 40%. An inhibitory effect was also observed with another cGMP analogue (8-bromo-cGMP), and in cells stimulated by hydrogen peroxide or anoxia. In contrast, 8-p-CPT-cAMP (200 microM), or the beta-adrenergic agonist isoprenaline (which increases cAMP levels) did not depress glucose transport, and even potentiated the effect of insulin. Blockade of endogenous cGMP formation with the guanylate cyclase inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, 10 microM) significantly increased basal and insulin-dependent glucose transport (by 25%), whereas addition of the guanylate cyclase activator 3-(5'-hydroxymethyl-2'furyl)-1-benzylindazol (YC-1, 30 microM) produced a depression of glucose transport (by 20%). Confocal laser scanning microscopic studies revealed that cGMP partially prevents the insulin-induced redistribution of the glucose transporter GLUT4 from intracellular stores to the cell surface. These observations suggest that the glucose transport system of cardiomyocytes represents a metabolic target of inhibition by cGMP, and that this regulation occurs at the level of the trafficking of glucose transporters.
Collapse
|
46
|
Abstract
UNLABELLED This presentation will discuss the benefits and pitfalls of implementing a study status and duplicate-read protection mechanism within a distributed picture archiving and communication system (PACS) architecture. There are many advantages to a distributed PACS network in which image studies are proactively pushed to reading stations before they are required by a radiologist. The absence of a central server, which serves on demand, makes managing study status and protecting against duplicate reads challenging. The system to manage study status and read access must be efficient, robust, and easy to administer. A system is presented that accomplishes these goals while maintaining the advantages of a distributed architecture. METHODS The basic workflow of the system is that image studies acquired at a modality device are automatically sent to an archive server. Using a set of advanced routing rules, the archive automatically routes studies to diagnostic workstations where studies are candidates for diagnostic read. The workstations display a list of all local studies available for reading. A monitor application running on the workstations coordinates access to studies for diagnostic read. Once the status of a study has been changed, the workstations on the networks and the archive are notified, which causes the study to be automatically removed from any list on a workstation where it might be a read candidate. RESULTS Implementation of this system provides a balanced workflow throughout the system while minimizing the need for costly high-speed network hardware. Additionally studies are read as soon as they are available by the next available radiologist. This workflow is enabled without the need for specific interaction by any of the radiologists on the network. By having the images available at the workstation in an organized worklist, this methodology increases the efficiency of the radiologist. CONCLUSION The implementation of this system enables a radiology department, or even a specialty group within a department, to gain the benefit of a distributed system as well as the benefits provided by a central-server architecture. This can be done very cost effectively with minimal configuration overhead and hardware requirements.
Collapse
|
47
|
Hemodynamics of semilunar valves at rest and exercise at an average of more than two years after the Ross procedure. THE JOURNAL OF HEART VALVE DISEASE 2001; 10:166-169; discussion 169-70. [PMID: 11297202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Rest, and especially exercise, hemodynamics are valuable determinants to assess outcome of the Ross procedure. In this study, the degree of insufficiency and pressure gradients at rest across the autograft and homograft, as well as the pressure gradients at exercise, were measured. METHODS Among 115 patients operated on between February 1990 and February 1999, 67 were evaluated echocardiographically at rest and moderate exercise. The mean patient age at subcoronary implantation was 52 +/- 13 years. The mean interval between surgery and investigation was 27.3 +/- 17.4 months. The exercise level was 100 W (n = 47), 75 W (n = 14) or 50 W (n = 6). RESULTS Fifty-two patients had no or trace aortic insufficiency, 23 were grade I/IV, and two were grade II/IV. Pulmonary insufficiency was graded as none (n = 45), mild (n = 21), and moderate (n = 1). Heart rate increased from 70 +/- 12 beats/min at rest to 108 +/- 19 beats/min at exercise. The maximal pressure gradient across the autograft increased from 6.1 +/- 2.3 mmHg at rest to 8.7 +/- 4.1 mmHg at exercise. The maximal pressure gradient across the homograft increased from 11.8 +/- 5.3 mmHg at rest to 17.7 +/- 8.2 mmHg at exercise. A pressure gradient across the homograft >25 mmHg was measured in 13 patients. CONCLUSION In most patients, hemodynamics at rest and moderate exercise at an average of more than two years after the Ross procedure were excellent. Some homografts developed pressure gradients at exercise; this finding will form the target of future surgical and scientific investigations.
Collapse
|
48
|
Abstract
Efficient control of Shigella-induced, rho-dependent cytoskeletal rearrangements seems to be required to shape the delicate cellular structures associated with bacterial invasion of epithelial cells. We therefore studied a class IX myosin and rho antagonist, the GTPase-activating protein (GAP) myr5, for a potential role in the bacterial entry process. We show that myr5 is recruited into bacterial entry spots. The recruitment pattern resembled that of rhoC or ezrin, but not rhoA, rac or CDC42, while in vitro GAP activity of myr5 was similar for rhoA, B or C. Analysis of myr5 mutants suggested that GTPase- or ATP-binding activites are not required for Shigella-induced recruitment of this atypical myosin to the bacterial entry site. Functional studies revealed a potential dual role of the myosin functions and the GAP module of myr5 for bacterial internalization.
Collapse
|
49
|
S04.04 Facial expressions and personality. Eur Psychiatry 2000. [DOI: 10.1016/s0924-9338(00)93926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
50
|
[Intermediate term clinical results after endoaneurysmorrhaphy in left ventricular aneurysm]. ZEITSCHRIFT FUR KARDIOLOGIE 2000; 89:754-60. [PMID: 11077684 DOI: 10.1007/s003920070178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Endoaneurysmorrhaphy (EAR) in postinfarct ventricular aneurysms leads to excellent short-term results. However, the temporal response of EAR is widely unknown. Thus, the indication for surgical treatment of patients with ventricular aneurysms is not well defined. EAR was performed in 157 patients (6/1993-6/1999) with symptomatic ventricular aneurysms (median NYHA III). Factors influencing cardiac mortality and morbidity during follow-up were determined by univariate and multivariate analysis. Perioperative mortality was low: 5%. Mortality during follow-up was 3.3% per year, resulting in a 5-year survival rate of 78%. NYHA classification ameliorated significantly from the preoperative status compared to the follow-up period (median NYHA II; p < 0.001). Multivariate analysis identified preexisting arterial occlusive disease and advanced age (> 70 years) as significant factors influencing medium-term mortality. Implantation of the left internal mammary artery was associated with a better survival rate. Endoaneurysmorrhaphy can be performed with low perioperative mortality, will result in a significant amelioration of the cardiac clinical status and offers low medium-term mortality. Our data indicate that EAR seems to be the procedure of choice for patients with symptomatic ventricular aneurysms.
Collapse
|