[Intubating laryngeal tube suction disposable: Initial clinical experiences with a novel device for endotracheal intubation]. / Intubationslarynxtubus Suction Disposable: Erste klinische Erfahrungen mit einem neuen Hilfsmittel zur endotrachealen Intubation.

BACKGROUND: According to the recent guidelines supraglottic airways, such as laryngeal tubes are recommended to ensure oxygenation in patients with unexpected difficult airways. The novel Intubating Laryngeal Tube Suction Disposable (iLTS-D) is a modified laryngeal tube designed for secondary tracheal intubation. This pilot study evaluated the use of the iLTS-D in clinical practice with respect to practicality and efficacy. METHODS: In this study the airways of 30 consecutive adult patients with no evidence of a difficult airway undergoing elective ear, nose and throat (ENT) surgery were managed with the iLTS-D. After induction of anesthesia the iLTS-D was placed in position and checked for correct ventilation. Following muscle relaxation, endotracheal intubation through the iLTS-D was performed under continuous visualization using a flexible bronchoscope. Finally, the iLTS-D was removed leaving the endotracheal tube in place. Data were collected anonymously as part of a quality assurance program. Publication of the data was approved by the institutional review board. RESULTS: Initial iLTS-D placement took a median of 17 s (range 12-90 s) and provided sufficient ventilation in all patients; however, the position of the iLTS-D needed to be adjusted in four patients. Endotracheal intubation through the iLTS-D was achieved in 29 out of 30 patients at the first attempt (n = 23) or after 2 attempts (n = 6) and the median time required for intubation was 32 s (range 18-187 s). In five patients no laryngeal structures could initially be identified by bronchoscopy. Blind endotracheal intubation through the iLTS-D was performed in two cases and in two other patients the endotracheal tube was also blindly advanced but into the esophagus. After removal of the endotracheal tube and repositioning of the iLTS-D, successful tracheal intubation was subsequently achieved under bronchoscopic vision. The procedure was aborted and uneventful conventional intubation using direct laryngoscopy was carried out in one patient. The median time for removal of the iLTS-D after successful intubation was 20 s (range 15-80 s). Minor blood stains on the iLTS-D were observed in three patients. With one exception, all problems and adverse events occurred during the first 10 patients. CONCLUSION: This first clinical study demonstrated that in patients with apparently normal airways and in the hands of users without previous experience, the iLTS-D allowed sufficient ventilation in all patients and had a high success rate for subsequent endotracheal intubation. The results are, however, preliminary until confirmed by further studies, particularly in patients with difficult airways.

Two cases of buttock claudication caused by isolated internal iliac artery stenosis.

We present two cases of buttock claudication caused by severe stenosis of the internal iliac artery which disappeared totally after percutaneous transluminal angioplasty (PTA). Isolated stenoses of internal iliac arteries are rare. It is often difficult to distinguish between vascular buttock claudication and neurological or orthopaedic symptoms. Conventional or MR-angiography is necessary to secure the diagnosis. PTA of internal iliac artery stenosis is the adequate treatment.

[Iliac ureteral fistulas. Diagnosis and management of an increasing problem]. / Ureteroiliakale Fisteln. Diagnostik und Management eines zunehmenden Problems.

Iliac-ureteral fistulas (IUF) are a rare but potential life threatening event and an important cause of gross hematuria. We report on three cases of IUF. In all cases, prior chronic ureteral stenting, extended pelvic surgery or pelvic irradiation had been performed. Diagnosis was confirmed with angiography in one case, in the others a CT scan revealed the IUF. Treatment included surgical exploration with local reconstruction, extra-anatomical bypass and nephrectomy with arterial patch repair. The increasing incidence of IUF is a consequence of an increasing number of advanced and extended pelvic operations, radiation therapy and long-term ureteral stenting. Diagnosis should be made by provocative angiography or CT. Treatment options vary depending on the site and morphology of the local situation, but morbidity and mortality is still high due to delayed adequate diagnosis and treatment. A conclusive algorithm should be followed for the successful management of IUF.

Bird blood as bioindicator for mercury in the environment.

Mercury concentrations were studied in blood, down and feathers of Common Gull (Larus canus L.) to investigate the suitability of bird blood as a matrix for biomonitoring of mercury in the marine environment. Chicks were collected in 1996 on the Elbe river and the Jade Bay. Like the side feathers, blood indicated site differences in mercury contamination. Correlational analyses showed that mercury concentrations in blood are significantly related to levels in side feathers (p < 0.001; Pearson), but not to those in down (p > 0.05; Pearson). Therefore, blood can be considered as a suitable matrix to indicate the current mercury burden in wild birds.

Toward ultrafast time-resolved Debye-Scherrer x-ray diffraction using a laser-plasma source.

An elliptical glass capillary has been used to focus ultrashort Cu K alpha x-ray pulses emitted from a femtosecond laser-produced plasma. Due to its high magnification (7x), the optic transforms the divergent x-ray emission of the plasma into a quasicollimated x-ray beam with a divergence of only 0.18 degrees. As an application we demonstrate the possibility to perform Debye-Scherrer diffraction experiments with the simultaneous detection of several diffraction orders. This will allow one to extend time-resolved x-ray diffraction with femtosecond laser-plasma x-ray sources to a much wider range of materials, which are not easily available as single crystals.

A comparison of relaxation processes in structurally related van der Waals glass formers: the role of internal degrees of freedom.

Depolarized dynamic light scattering (DLS), dielectric relaxation (DS), and deuterium NMR studies of fragile van der Waals glass forming liquids phenylphthalein-dimethylether (PDE) and cresolphthalein-dimethylether (KDE) are presented. In PDE a new dielectric loss process was found, which can be attributed to the 180 degrees flip of the phenyl rings. The previous finding that the distribution of the structural relaxation times measured for PDE and KDE by DS is substantially narrower than that measured by DLS is explained by partial decoupling of the dynamics of the dipole moment from the structural relaxation of the sample. The dynamics of PDE and KDE is compared with the previous studies of two other structurally similar liquids: 1,1'-di(4-methoxy-5-methylphenyl)cyclohexane (BMMPC) and 1,1'-bis(p-methoxyphenyl)cyclohexane (BMPC) in order to relate dynamical features with the chemical structure of the material. The evidence for the intramolecular character of the secondary relaxations observed in BMPC and PDE is presented.

Comment on "Merging of the alpha and beta relaxations in polybutadiene: a neutron spin echo and dielectric study".

The evaluation method of dielectric data based on a Williams product ansatz [A. Arbe, D. Richter, J. Colmenero, and B. Farago, Phys. Rev. E 54, 3853 (1996)] is not suited to the crossover region of the dynamic glass transition. This method is insensitive to the shape, position, or even existence of at least one of the relaxation functions if, in the extrapolation from below to above the crossover region, the two processes cross or approach one another. Since a crossover region without any particular change in the relaxation mechanism of these processes can in fact be adjusted by this method, better dielectric data for polybutadiene in the gigahertz frequency region are needed to determine whether or not there are peculiarities in the dielectric function. It would be an odd assumption that the many particularities in the crossover region in other instances are not reflected in the dielectric response.

Oral immunotherapy with grass pollen in enterosoluble capsules. A prospective study of the clinical and immunological response.

In a prospective study spanning 2 years, 60 patients with grass pollen allergy were treated with either a low dose oral, a high dose oral or a subcutaneous hyposensitization regime. No significant improvement was seen in the orally treated patients whereas those on the subcutaneous hyposensitization regime demonstrated a decreased specific cutaneous reactivity, a rise in specific IgG antibodies and a reduction in symptoms. This study suggests that oral hyposensitization, even with enterosoluble grass pollen capsules, is ineffective.