Computerized occlusion rating of embolized ruptured intracranial aneurysms: relation to intra- and postinterventional aneurysm rehemorrhage.

Endovascular coil occlusion of ruptured cerebral aneurysms has a higher rate of rebleeding compared to surgical clipping. Initial aneurysm coil occlusion rate (OR) is the strongest available predictor of aneurysm rebleeding. Standard clinical subjective occlusion rating (SOR) is limited by subjective bias. Therefore, computerized occlusion rating (COR) was introduced. Its superiority was established for experimental and human aneurysms. In the present clinical study, we aimed to evaluate COR as a risk factor for postprocedural reruptures (PPRs) and intraprocedural reruptures (IPRs). In our series of 249 consecutive patients treated in our institution, we observed 7 (2.8%) cases with IPR and 7 (2.8%) cases with PPR. These patients were analyzed in the present study. Mean COR value was 85% (range 71-96%). In 12 (85.7%) cases, COR was lower than SOR. In aneurysms with a COR of 95% or higher, no PPR occurred. All patients with IPR harbored multiple aneurysms. In -conclusion, our data showed a distinct tendency of potentially dangerous overestimations when using SOR compared to the objectively measured COR values. IPR was always associated with multiple aneurysms.

Assessment of left ventricular volume and ejection fraction: comparison of QGS and MBGS analyses of ECG-gated myocardial perfusion SPECT imaging.

OBJECTIVES: The purpose of this study was to compare quantitative ECG-gated single-photon emission computed tomography (SPECT) (QGS) and model-based ECG-gated single-photon emission computed tomography (MBGS) for determination of end-diastolic cardiac volume (EDV), end-systolic cardiac volume (ESV), and left ventricular ejection fraction (LVEF). The accuracy of both methods was evaluated by measurements obtained from contrast left ventriculography (LVG). METHODS: Forty-five patients (40 male, age: 55+/-11 years) with coronary artery disease were studied by angiography and ECG-gated SPECT using technetium-99m-sestamibi for the evaluation of myocardial perfusion and LVEF. Short axis SPECT images were analyzed by QGS and MBGS to estimate endocardial and epicardial surfaces and to derive EDV, ESV, and LVEF. RESULTS: EDV by gated SPECT (QGS: 187+/-71 ml; MBGS: 191+/-76 ml) were lower than corresponding values by LVG (203+/-59 ml), whereas ESV by gated SPECT (QGS: 121+/-62 ml; MBGS: 108+/-54 ml) were higher than by LVG (105+/-49 ml). Thus, LVEFs by gated SPECT (QGS: 39+/-12%; MBGS: 45+/-9%) were significantly lower than by LVG (50+/-15%). LVEF by MBGS was significantly higher than by QGS (P<0.05). A significant correlation was observed among QGS, MBGS, and LVG for the calculation of EDV, ESV, and LVEF. CONCLUSION: Measurements of LV volumes and LVEF by QGS and MBGS showed close agreement with each other and with results from LVG. However, both methods measure lower values for EDV and higher values for ESV and thus underestimate LVEF compared with LVG.

Automated assessment of myocardial SPECT perfusion scintigraphy: a comparison of different approaches of case-based reasoning.

OBJECTIVE: This study compared the diagnostic accuracy of different approaches of case-based reasoning (CBR) for the assessment of coronary artery disease (CAD) using thallium-201 myocardial perfusion scintigraphy in comparison with coronary angiography. METHODS AND MATERIAL: For each scintigraphic image set, regional myocardial tracer uptake was obtained by polar map analysis. CBR algorithms based on a similarity measure were employed to identify similar scintigraphic images within the case library, where each case contained the scintigraphic data together with results of coronary angiography. The angiographic data of retrieved cases were then used to determine whether significant CAD was present in one of the major coronary arteries. Three different approaches of CBR were compared: (1) case retrieval based on a global comparison of polar map data (GLOB), (2) case retrieval based on a territorial comparison of polar map data (TER), and (3) case retrieval based on a comparison of a given case with eight sub-libraries classified according to the involvement of the three major coronary vessels using a group similarity measure (GROUP). Two matching algorithms the best-match approach and an adapted retrieving approach were combined with all three case retrieval methods and their influence on the diagnostic accuracy were investigated. RESULTS: For overall detection of significant CAD, the best-match approach of both TER and GROUP retrieval methods showed a higher diagnostic accuracy than the GLOB retrieval method (75% and 77% versus 70%, respectively). ROC analysis for the adapted retrieving approach showed a similar diagnostic accuracy for all three methods with an area under the curve of 0.79, 0.8, and 0.8 for GLOB, TER, and GROUP, respectively. CONCLUSION: The observed improvement in the diagnostic accuracy by the new approaches may lead to further improvements of CBR systems, which have the potential to offer valuable decision support for human readers, especially for less experienced investigators.

Whole blood mercury and selenium concentrations in a selected Austrian population: does gender matter?

BACKGROUND: Data on mercury exposure of the Austrian population were inadequate. This study was performed to determine the causal factors underlying mercury exposure and selenium concentrations, and to estimate the gender-related health impacts. METHODOLOGY: Venous blood samples of 78 women and 81 men were drawn at the Austrian Red Cross, Vienna. Mercury contents in acid-digested whole blood samples were measured after amalgam enrichment by CV-AAS, and selenium by AAS (heated quartz-cell) after hydrid formation. RESULTS: The average total mercury blood content of Austrians was low (2.38+/-1.55 microgL(-1); N=152). Mercury and selenium concentrations were not different between the genders (P>0.05) but we observed discrepancies regarding the causal factors. Mercury levels in men were influenced not only by fish consumption but also by age, education level, and amalgam fillings, whereas in women, only the diet (fish/seafood, red wine consumption) determined blood mercury (P<0.05). Moreover, only the males indicated a depressive effect of dental amalgam on hematocrit (P<0.05). Regarding selenium, age and alcohol consumption led to lower concentrations in men, whereas a high-level education had the opposite effect; no determinant was found for women. For the whole study group, a significant effect of chronic disease on selenium levels could be detected (P<0.05). 18% of women and 13% of men showed marginal selenium deficiency (blood selenium<65 microgL(-1)). Selenium and mercury concentrations were not correlated. CONCLUSIONS: Our results indicate the need to evaluate and integrate gender-related findings in metal toxicology and trace element research, because different causal factors require different preventive measures to reduce mercury exposure and the risk of low selenium concentrations. Future research is needed on the gender- and age-related differences in fish/seafood consumption habits, the modifications of mercury toxicokinetics through sex hormones, the selenium supply in Austria, and the clinical relevance of a low selenium status.

Gated cardiac 13N-NH3 PET for assessment of left ventricular volumes, mass, and ejection fraction: comparison with electrocardiography-gated 18F-FDG PET.

UNLABELLED: The purpose of this study was to evaluate myocardial electrocardiography (ECG)-gated 13N-ammonia (13N-NH3) PET for the assessment of cardiac end-diastolic volume (EDV), cardiac end-systolic volume (ESV), left ventricular (LV) myocardial mass (LVMM), and LV ejection fraction (LVEF) with gated 18F-FDG PET as a reference method. METHODS: ECG-gated 13N-NH3 and 18F-FDG scans were performed for 27 patients (23 men and 4 women; mean+/-SD age, 55+/-15 y) for the evaluation of myocardial perfusion and viability. For both 13N-NH3 and 18F-FDG studies, a model-based image analysis tool was used to estimate endocardial and epicardial borders of the left ventricle on a set of short-axis images and to calculate values for EDV, ESV, LVEF, and LVMM. RESULTS: The LV volumes determined by 13N-NH3 and 18F-FDG were 108+/-60 mL and 106+/-63 mL for ESV and 175+/-71 mL and 169+/-73 mL for EDV, respectively. The LVEFs determined by 13N-NH3 and 18F-FDG were 42%+/-13% and 41%+/-13%, respectively. The LVMMs determined by 13N-NH3 and 18F-FDG were 179+/-40 g and 183+/-43 g, respectively. All P values were not significant, as determined by paired t tests. A significant correlation was observed between 13N-NH3 imaging and 18F-FDG imaging for the calculation of ESV (r=0.97, SEE=14.1, P<0.0001), EDV (r=0.98, SEE=15.4, P<0.0001), LVEF (r=0.9, SEE=5.6, P<0.0001), and LVMM (r=0.93, SEE=15.5, P<0.0001). CONCLUSION: Model-based analysis of ECG-gated 13N-NH3 PET images is accurate in determining LV volumes, LVMM, and LVEF. Therefore, ECG-gated 13N-NH3 can be used for the simultaneous assessment of myocardial perfusion, LV geometry, and contractile function.

Influence of potassium dichromate on tracheal secretions in critically ill patients.

BACKGROUND: Stringy, tenacious tracheal secretions may prevent extubation in patients weaned from the respirator. This prospective, randomized, double-blind, placebo-controlled study with parallel assignment was performed to assess the influence of sublingually administered potassium dichromate C30 on the amount of tenacious, stringy tracheal secretions in critically ill patients with a history of tobacco use and COPD. METHODS: In this study, 50 patients breathing spontaneously with continuous positive airway pressure were receiving either potassium dichromate C30 globules (group 1) [Deutsche Homoopathie-Union, Pharmaceutical Company; Karlsruhe, Germany] or placebo (group 2). Five globules were administered twice daily at intervals of 12 h. The amount of tracheal secretions on day 2 after the start of the study as well as the time for successful extubation and length of stay in the ICU were recorded. RESULTS: The amount of tracheal secretions was reduced significantly in group 1 (p < 0.0001). Extubation could be performed significantly earlier in group 1 (p < 0.0001). Similarly, length of stay was significantly shorter in group 1 (4.20 +/- 1.61 days vs 7.68 +/- 3.60 days, p < 0.0001 [mean +/- SD]). CONCLUSION: These data suggest that potentized (diluted and vigorously shaken) potassium dichromate may help to decrease the amount of stringy tracheal secretions in COPD patients.

The JAVA-based DICOM query interface DicoSE.

DICOM 3 is a very elaborate standard for the communication between medical image devices. It is published in several parts by the National Electrical Manufacturers Association (NEMA). To adequately visualize the data structure defined in parts 3, 5 and 6 of the DICOM standard, we implemented the web based Dicom Search Engine (DicoSE). It allows for querying the DICOM standard data dictionary for defined data fields and visualizes the topology of the data which is inherently present in DICOM datasets. For the administration of the underlying data a web based administration interface is provided. The service is entirely based on freely available software.

Comparison of mouth-to-mouth resuscitation and Combitube ventilation in a bench model.

CONTEXT: In addition to heart massage, the primary goal of cardiopulmonary resuscitation is efficient oxygenation and ventilation. OBJECTIVE: To compare the ease of learning and handling of standard mouth-to-mouth resuscitation with the Combitube (Tyco Healthcare Nellcor, Pleasanton, CA) ventilation. METHODS: After a 30 minute theoretical introduction and demonstration of mouth-to-mouth resuscitation and use of the Combitube in mannequins, following American Heart Association guidelines, 26 adolescent school children (15 of them 14 years old, 11 of them 10 years old) undertook two ventilation trials, each consisting of five single ventilations, with each technique. Only the second trial with each technique was evaluated. Qualitative implementation (grades: very good, good, failed) was evaluated, several procedure-related time points were recorded, and tidal volumes (ml) were measured. RESULTS: With mouth-to-mouth resuscitation, the time interval until start of first ventilation was 36.5 seconds shorter than with the Combitube (P < 0.001). With the Combitube, the time needed for five single ventilations was 6.4 seconds less than with mouth-to-mouth resuscitation (P < 0.001) and mean tidal volumes were higher (mouth-to-mouth resuscitation, 450 +/- 384 ml, versus Combitube, 735 +/- 358 ml; P < 0.05). CONCLUSION: Most of the school children performed both techniques to a high qualitative level. The study shows that mouth-to-mouth resuscitation and use of the Combitube have equal ease of learning, a precondition for proficient retention of skills. Tidal volumes were significantly higher with the Combitube and, not surprisingly, the time interval until the start of first ventilation was significantly shorter with mouth-to-mouth resuscitation. Regardless of the ventilation technique or device, we believe that subsequent retraining of ventilation skills is very important.

Influence of adjunctive classical homeopathy on global health status and subjective wellbeing in cancer patients - A pragmatic randomized controlled trial.

OBJECTIVES: The use of complementary and alternative medicine has increased over the past decade. The aim of this study was to evaluate whether homeopathy influenced global health status and subjective wellbeing when used as an adjunct to conventional cancer therapy. DESIGN: In this pragmatic randomized controlled trial, 410 patients, who were treated by standard anti-neoplastic therapy, were randomized to receive or not receive classical homeopathic adjunctive therapy in addition to standard therapy. The study took place at the Medical University Vienna, Department of Medicine I, Clinical Division of Oncology. MAIN OUTCOME MEASURES: The main outcome measures were global health status and subjective wellbeing as assessed by the patients. At each of three visits (one baseline, two follow-up visits), patients filled in two different questionnaires. RESULTS: 373 patients yielded at least one of three measurements. The improvement of global health status between visits 1 and 3 was significantly stronger in the homeopathy group by 7.7 (95% CI 2.3-13.0, p=0.005) when compared with the control group. A significant group difference was also observed with respect to subjective wellbeing by 14.7 (95% CI 8.5-21.0, p<0.001) in favor of the homeopathic as compared with the control group. Control patients showed a significant improvement only in subjective wellbeing between their first and third visits. CONCLUSION: Results suggest that the global health status and subjective wellbeing of cancer patients improve significantly when adjunct classical homeopathic treatment is administered in addition to conventional therapy.

Model-based analysis of electrocardiography-gated cardiac (18)F-FDG PET images to assess left ventricular geometry and contractile function.

UNLABELLED: This study presents and evaluates a model-based image analysis method to calculate from gated cardiac (18)F-FDG PET images diastolic and systolic volumes, ejection fraction, and myocardial mass of the left ventricle. The accuracy of these estimates was delineated using measurements obtained by MRI, which was considered the reference standard because of its high spatial resolution. METHODS: Twenty patients (18 men, 2 women; mean age +/- SD, 59 +/- 12 y) underwent electrocardiography-gated cardiac PET and MRI to acquire a set of systolic and diastolic short-axis images covering the heart from apex to base. For PET images, left ventricular radius and wall thickness were estimated by model-based nonlinear regression analysis applied to the observed tracer concentration along radial rays. Endocardial and epicardial contours were derived from these estimates, and left ventricular volumes, ejection fraction, and myocardial mass were calculated. For MR images, an expert manually drew contours. RESULTS: Left ventricular volumes by PET and MRI were 101 +/- 60 mL and 112 +/- 93 mL, respectively, for end-systolic volume and 170 +/- 68 mL and 189 +/- 99 mL, respectively, for end-diastolic volume. Ejection fraction was 44% +/- 13% by PET and 46% +/- 18% by MRI. The left ventricular mass by PET and MRI was 196 +/- 44 g and 200 +/- 46 g, respectively. PET and MRI measurements were not statistically significant. A significant correlation was observed between PET and MRI for calculation of end-systolic volumes (r = 0.93, SEE = 23.4, P < 0.0001), end-diastolic volumes (r = 0.92, SEE = 26.7, P < 0.0001), ejection fraction (r = 0.85, SEE = 7.4, P < 0.0001), and left ventricular mass (r = 0.75, SEE = 29.6, P < 0.001). CONCLUSION: Model-based analysis of gated cardiac PET images permits an accurate assessment of left ventricular volumes, ejection fraction, and myocardial mass. Cardiac PET may thus offer a near-simultaneous assessment of myocardial perfusion, metabolism, and contractile function.

Comparison of a conventional tracheal airway with the Combitube in an urban emergency medical services system run by physicians.

This prospective randomised study was performed to compare the use of the Esophageal-Tracheal Combitube(R) (ETC; Tyco Healthcare, Mansfield, MA; http://www.combitube.org) with a conventional tracheal airway (ETA) for airway management by experienced physicians of the Emergency Medical Services System of the City of Vienna in the prehospital setting. Access to the patient's head, time of arrival of the ambulance, ease of insertion, time of insertion, potential substitution by the alternate airway, efficacy of adrenaline (epinephrine) administered via the airway, survival to the intensive care unit (ICU) ward and survival to discharge from the hospital were evaluated. One hundred and seventy-two non-traumatic cardiac arrest patients (131 males, 41 females) were enrolled in this study during a 12 months period. In 83 patients (48.3%), the conventional ETA (group 1) was used for the initial intubation attempt which was successful in 78 patients (94%). The remaining five patients of group 1 could not be intubated with an ETA, but were successfully managed with the ETC. Eighty-nine patients (51.7%) were intubated with the ETC (group 2) as first choice (79 in oesophageal position (89%); eight in tracheal position: (9%)), which was successful in 87 (98%) patients. The remaining two patients in group 2 (2%) were successfully managed with the ETA. Success of intubation and ventilation with ETC was comparable to the ETA. Recorded time of insertion was shorter with the ETC versus ETA (P<0.05). The Combitube worked well in cases of difficult access to the patient's head and in bleeding and vomiting patients. Both devices served as successful substitutes for each other. Adrenaline (epinephrine) applied via ETC with a 10-fold dosage was as effective as via the conventional ETA. To our knowledge this is the first study using physicians comparing ETC and ETA in the prehospital setting.

Effects of 12 months of recombinant growth hormone therapy on parameters of bone metabolism and bone mineral density in patients on chronic hemodialysis.

BACKGROUND: Renal osteodystrophy is common in patients with chronic renal failure (CRF) on hemodialysis (HD), leading to reduced bone mineral density (BMD) and higher bone fracture incidences. Since growth hormone (GH) and insulin-like growth factor 1 (IGF-1) are known to enhance bone metabolism and BMD, and CRF patients exhibit GH and IGF-1 resistance, recombinant human GH (rhGH) therapy could be beneficial for these patients. METHODS: This study evaluated the effects of a 12-month rhGH therapy on bone metabolism parameters; alkaline phosphatase (AP), osteocalcin (OC), procollagen I carboxyterminal propeptide (PICP), telopeptide ICTP, serum crosslaps, n-terminal propeptide of type III procollagen (PIIINP) and intact parathyroid hormone (iPTH), as well as on BMD of the lumbar spine and the femoral neck in 19 malnourished HD patients (10 females, 9 males) with a mean age of 59.3 +/- 13.4 yrs. Fourteen patients completed the 12-month study. RhGH (0.25 IU/kg) was given subcutaneously 3x/week after each dialysis session. RESULTS: IGF-1 concentrations rose significantly from 169.2 +/- 95.6 to 262.9 +/- 144.4 ng/mL (p<0.01) after 3 months, followed by a slight decline over the next 9 months. PICP as a bone formation marker significantly increased after 3 months from 250.1 +/- 112.6 to 478.5 +/- 235.2 ug/L (p<0.01), as well as PIIINP, whereas OC and bone resorption parameters like ICTP showed only a slight increase (ICTP: 50.3 +/- 18.5 to 70.0 +/- 39.5 ug/L after 3 months (ns)). All bone metabolism parameters slightly declined in the following 9 months, but remained above baseline values after 12 months. PTH rose from 198.0 +/- 139.2 to 456.0 +/- 268.7 ng/ml, p<0.01 after 6 months. BMD of the lumbar spine showed a significant reduction after 3-month rhGH therapy (0.80 +/- 0.17 vs. 0.77 +/- 0.16 g/cm2, p<0.01), but returned to baseline values after 12 months. BMD of the femoral neck remained stable during the entire study. CONCLUSIONS: In summary, 12-month rhGH treatment in patients on chronic HD caused a significant increase in IGF-1, together with an increase in bone turnover. In addition, there was a temporary reduction in BMD of the lumbar spine seen, which returned to baseline values after 12 months.

One-year growth hormone therapy improves granulocyte function without major effects on nutritional and anthropometric parameters in malnourished hemodialysis patients.

BACKGROUND/AIMS: Growth hormone (GH) resistance leads to enhanced protein catabolism and contributes to the malnutrition of patients with chronic renal failure (CRF). In short-term trials anabolic effects of rhGH therapy have been demonstrated in patients on chronic hemodialysis. METHODS: This study was initiated to determine the effects of 12 months of rhGH therapy on polymorphonuclear leukocyte (PMNL) function as well as on nutritional and anthropometric parameters. 0.125 IU/kg rhGH was given 3 times a week during the first 4 weeks and 0.25 IU/kg thereafter to 19 malnourished hemodialysis patients with a mean age of 59.3 +/- 13.4 years. RESULTS: Insulin-like growth factor I (IGF-I) concentrations rose significantly from 169.2 +/- 95.6 to 262.9 +/- 144.4 ng/ml (p < 0.01) in the first 3 months, but declined thereafter. Phagocytic activity of PMNLs also increased significantly in response to rhGH therapy and this activation remained stable over the whole 12-month period. Other parameters of PMNL function were not influenced by rhGH therapy. In addition, nutritional parameters such as albumin, prealbumin, transferrin, cholesterol, HDL-cholesterol, cholinesterase, predialytic creatinine and blood urea nitrogen were not affected by rhGH therapy. A decline of total body fat (TBF) was observed after 3 and 9 months of rhGH therapy (17.5 +/- 10 vs. 16.7 +/- 10% after 3 months, p < 0.017 and 16.8 +/- 8.7% after 9 months, p < 0.049), whereas lean body mass remained stable. CONCLUSIONS: Twelve months of rhGH therapy caused a significant increase in IGF-I levels, stimulated phagocytic activity of PMNLs and induced a decline of TBF. Other anthropometric and nutritional parameters were not affected, which might be related to the persistence of GH resistance.

DicoSE--a Web-interface based on XML for visualizing and searching the topology of the data structure defined by the DICOM 3 standard.

To adequately visualize and interpret the data fields of DICOM 3 datasets the data structure defined in the DICOM 3 standard has to be applied. The DICOM 3 data structure is very extensive and therefore costly to implement. We are working on an open source system which provides the data structure via a Java-programming interface. The data is held in a freely available XML-database. As a spin-off we are providing the web-based Dicom Search Engine (DicoSE) which will be available via internet soon. DicoSE allows for searching the DICOM standard data dictionary for defined data fields and visualizes the topology of the data which is present in DICOM datasets acquired by various types of modalities. Thus, the interpretation of the meaning of data fields is supported. For maintaining the data stored in the database a web-based administration interface is provided.

Additive homeopathy in cancer patients: Retrospective survival data from a homeopathic outpatient unit at the Medical University of Vienna.

BACKGROUND: Current literature suggests a positive influence of additive classical homeopathy on global health and well-being in cancer patients. Besides encouraging case reports, there is little if any research on long-term survival of patients who obtain homeopathic care during cancer treatment. DESIGN: Data from cancer patients who had undergone homeopathic treatment complementary to conventional anti-cancer treatment at the Outpatient Unit for Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria, were collected, described and a retrospective subgroup-analysis with regard to survival time was performed. Patient inclusion criteria were at least three homeopathic consultations, fatal prognosis of disease, quantitative and qualitative description of patient characteristics, and survival time. RESULTS: In four years, a total of 538 patients were recorded to have visited the Outpatient Unit Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria. 62.8% of them were women, and nearly 20% had breast cancer. From the 53.7% (n=287) who had undergone at least three homeopathic consultations within four years, 18.7% (n=54) fulfilled inclusion criteria for survival analysis. The surveyed neoplasms were glioblastoma, lung, cholangiocellular and pancreatic carcinomas, metastasized sarcoma, and renal cell carcinoma. Median overall survival was compared to expert expectations of survival outcomes by specific cancer type and was prolonged across observed cancer entities (p<0.001). CONCLUSION: Extended survival time in this sample of cancer patients with fatal prognosis but additive homeopathic treatment is interesting. However, findings are based on a small sample, and with only limited data available about patient and treatment characteristics. The relationship between homeopathic treatment and survival time requires prospective investigation in larger samples possibly using matched-pair control analysis or randomized trials.

Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions.

OBJECTIVES: Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions. METHODS: Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs. RESULTS: Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs. CONCLUSION: The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations.

Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers.

BACKGROUND: Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%. In principle, chest tube insertion can be performed by using Trocar or Non-trocar techniques. If using trocar technique, two different chest tubes (equipped with sharp or blunt tip) are currently commercially available. This study was performed to detect any difference with respect to time until tube insertion, to success and to misplacement rate. METHODS: Twenty emergency physicians performed five tube thoracostomies using both blunt and sharp tipped tube kits in 100 fresh human cadavers (100 thoracostomies with each kit). Time until tube insertion served as primary outcome. Complications and success rate were examined by pathological dissection and served as further outcomes parameters. RESULTS: Difference in mean time until tube insertion (63 s vs. 59 s) was statistically not significant. In both groups, time for insertion decreased from the 1st to the 5th attempt and showed dependency on the cadaver's BMI and on the individual physician. Success rate differed between both groups (92% using blunt vs. 86% using sharp tipped kits) and injuries and misplacements occurred significantly more frequently using chest tubes with sharp tips (p = 0.04). CONCLUSION: Data suggest that chest drain insertion with trocars is associated with a 6-14% operator-related complication rate. No difference in average time could be found. However, misplacements and organ injuries occurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is recommended.

Performance and skill retention of intubation by paramedics using seven different airway devices--a manikin study.

INTRODUCTION: Endotracheal intubation (ETI) is the most widespread method for emergency airway management. Several studies reported that ETI requires considerable skill and experience and if performed incorrectly, may result in serious adverse events. Unrecognized tube misplacement or oesophageal intubation is associated with high prehospital morbidity. This study investigates the usability of supraglottic airway devices compared to ETI and the skill retention of 41 previously inexperienced paramedics following training using a manikin model. METHODS: 41 paramedics participated in this study. None had prior experience in airway management, apart from bag-valve ventilation. After a standardised audio-visual lecture lasting 45min, the paramedics participated in a practical demonstration using the advanced patient simulator SimMan(®) (Laerdal Medical, Stavanger, Norway). Afterwards, paramedics were instructed to perform airway-management using seven different techniques to secure the airway (ETI, Laryngeal mask unique [LMA], Proseal, Laryngeal tube disposable [LT-D(®)], I-Gel(®), Combitube(®), and EasyTube(®)) following a randomized sequence. Participants underwent reassessment after 3 months without any further training or practice in airway-management. RESULTS: During the initial training session, ETI was successfully performed in 78% of cases, while 3 months later the success rate was 58%. For the supraglottic airway devices, five out of six were successfully used by all paramedics at both time points, the exception being Proseal(®). Our data show successful skill retention (success rate: 100%) after 3 months for five out of six supraglottic airway devices. Time to ventilation (T3) was significantly less for LMA, LT-D(®) and I-Gel(®) at all time points compared to ETI. CONCLUSION: ETI performed by inexperienced paramedics is associated with a low success rate. In contrast, supraglottic airway devices like LMA, LT-D(®), I-Gel(®), Combitube(®) and EasyTube(®) are fast, safe and easy-to-use. Within the limitations of a manikin-study, this study suggests that inexperienced medical staff might benefit from using supraglottic airway devices for emergency airway management.

[Examination of the prevalence of skin injuries in debeaked fattened turkeys]. / Untersuchungen zur Prävalenz von Hautverletzungen bei schnabelkupierten Mastputen.

Within the framework of a cooperative research project, turkey health as well as numerous aspects of animal welfare were examined in various intensive commercial farms with varying rearing forms. The present study demonstrates the prevalence of skin injuries concerning living animals as well as carcasses of slaughtered turkeys of both sexes. Although all turkeys were debeaked, prevalences of skin injuries at a value of 12.8% with male turkeys and 13.8% with female turkeys could be found at the age of 16 weeks. Within the scope of medically inspections skin injuries were mainly established in the head region, especially the snood as well as in the region of the back. By means of their clinical picture pecking wounds and scratch injuries could be distinguished. Skin lesion produced primary as a result of scratching the skin surface, could be enlarged by the animal itself or by conspecifics by beak pecking, especially after bleeding, in spite of debeaked upper beak. Injuries in the head region, especially of the snood, could be explained mainly as a result of pecking by conspecifics by reason of their clinical picture and were found mainly in male turkeys. Skin injuries in the region of the back, especially at the coxal tuberosity, were identified primarily as scratch marks. They were found mainly in female turkeys. A statistically significant correlation of the injury prevalence to particular husbandry parameters discussed in the literature as "predisposing" or "limiting" factors (e.g., population density, light regime or offer of employment material) could not be established in this study. At the meat inspection fresh scratching injuries at the chest and the hind legs were diagnosed most often. Especially fresh injuries of the carcass point to a misguided behaviour of the staff concerning animal handling during loading and transport which is not conform to animal welfare.

Standard PAH therapy improves long term survival in CTEPH patients.

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH), subsequent to pulmonary embolism is a relatively frequent cause of pulmonary hypertension. Similar to patients with pulmonary arterial hypertension (PAH), CTEPH carries a poor prognosis. There is no hard evidence for any other therapy except pulmonary endarterectomy and none for those patients that are not eligible for this procedure. PATIENTS AND METHODS: Fifty patients with confirmed, inoperable CTEPH receiving specific vasodilative therapy (prostanoids, endothelin receptor antagonists, PDE 5-inhibitors or combination) were included in this retrospective study (mean age 55 years, range 16-76 years; 36 female, 14 male). Kaplan-Meier plots of these patients were compared with Kaplan-Meier plots of two historical CTEPH patient groups without any specific vasodilative treatment by log rank tests. RESULTS: CTEPH patients treated with specific vasodilative compounds as used for therapy of PAH were followed up for 52 +/- 30 months and had a significantly improved survival compared with patients treated without PAH type vasodilators (p < or = 0.0002). CONCLUSION: Our data may generate the hypothesis that specific vasodilative treatment improves outcome in patients with inoperable CTEPH.