[Aspiration in a specialised weaning unit--an underestimated problem]. / Aspiration auf der Weaningstation--ein unterschätztes Problem.

This retrospective case series shows that 45 % of patients aspirated straight after removal of the tracheal cannula. The present case series includes 82 patients with long-term mechanical ventilation (LTMV) admitted to a specialised weaning unit. Aspiration was proven after patients sipped water coloured with patent blue V. Colour was detected with a bronchoscope after passing through the tracheostoma and directed toward the VC. The aspiration rate in this study is in good agreement with other reports in the literature.We could find no significant statistical differences concerning age (p = 0.97), gender (47 % vs. 49), number of bronchoscopies (p = 0.91) and comorbidities (p = 0.326) between patients with and without aspiration. The duration of the stay at the ward and the duration of ventilation as well as the parameter Hb at the time of admission (p = 0.566), CO2(p = 0.288/p = 0.716), HCO3 (p = 0.915/p = 0.612) and CRP (p = 0.402/p = 0.523) at the time of admission and discharge also showed no significant differences.The Kaplan Meier curves show a considerable divergence between patients with and without aspiration. However, the Log Rank Test (p = 0.348) and the univariate Cox Regression (HR 1.4, 95 % CI 0.689 - 2.849) were not significant. We believe that this can be attributed to the event rate, which was too low in our collective. This trend to a higher mortality of patients with aspiration might be due to weakness of the respiratory muscles when there is reduced coughing. Proof of aspiration in these patients is only one aspect of a multidimensional problem. Larger, prospective cohort studies are needed to show whether aspiration can serve as a prognostic marker.

Detection of the linear carbon cluster C10: rotationally resolved diode-laser spectroscopy.

Detected in interstellar space and as intermediates in soot formation, molecules of pure carbon in the form of linear chains or ring structures have interested researchers for several decades, who attempt to elucidate their physical properties and the processes govering their formation. A high-resolution infrared spectrometer housing a tunable diode laser and combined with an effective laser ablation source for the cluster production has been used to study the molecular properties of small carbon clusters; reported herein is the first gas-phase spectrum of linear C10.

The Cologne Carbon Cluster experiment: ro-vibrational spectroscopy on C8 and other small carbon clusters.

We report on our ongoing efforts in obtaining the IR-spectra of the linear carbon cluster molecules Cn with n=8-13. So far C8, C9, C10, and C13 have been recorded at Cologne. With the exception of C8 all assignments have been secured. For C8 a tentative assignment could be derived with the bandcenter of the sigmau antisymmetric stretching mode located at nu0=2067.9779 cm(-1) and a preliminary rotational constant in the vibrational ground state of B"=0.02068 cm(-1). The measured signal to noise ratio of the ro-vibrational band is fairly weak and thus the lower J ro-vibrational transitions can not be assigned with certainty. As a consequence the band center remains uncertain by 4 J or 0.17 cm(-1). For a more reliable assignment the sensitivity of the system has to be increased by at least one order of magnitude. The envisaged sensitivity increase of our experiment will be discussed along with the intention to perform terahertz observations of the low energetic bending ro-vibrational spectra. These sub-mm wave measurements will be carried out simultaneously with the IR measurements.

Cephalometric investigations concerning the geometry of the viscerocranium of human anencephalic fetuses.

Cephalometric investigations were carried out on 16 macerated skulls of anencephalic fetuses aged around 6 months and compared with the values obtained from a group of 18 normally developed specimens. The skull geometry of the anencephalic fetuses was different from normal proportions: anencephalic fetuses showed a clear mandibular prognathism, and a maxilla tilted in anterior direction. The values describing length of maxilla and length of the anterior cranial base, and NS-Ba angle were found to be within the normal range. From the results it can be concluded that the defective development of the forebrain seems to have no effects on the length development of the anterior cranial base although it does influence the form of the surrounding bony structures. The formation of the mandibular prognathism cannot be brought into direct connection with the defective brain development.

[Metatarsal osteotomies for the correction of hallux valgus and metatarsus primus varus congenitus]. / Metatarsalosteotomien zur Korrektur des Hallux valgus und Metatarsus primus varus congenitus.

It is reported about the combined use of different methods for metatarsal osteotomy and in conclusion we recommend a differentiation of these corrective techniques and their indications. The differentiation is based on the consideration of the valgus angle, the grade of secondary arthrosis and the functional load of the joints.

Hand eczema in metalworker trainees--an analysis of risk factors.

The present study, as part of PROMETES (Swiss Prospective Metal Worker Eczema Study), was performed to examine risk factors for the development of occupational hand dermatitis in metal-worker trainees. Since this disease is very common, a high standard of preventive measures is necessary, especially for persons with an endogenous disposition for the development of eczema, e.g., atopics. Within the cohort of 201 healthy young men, 47 (23%) showed at least mild signs of hand eczema at 1 point of the 2.5 year observation period. Various occupational and domestic exposures, skin protection behaviour, regeneration time, and smoking habits, as well as atopic disposition, were studied with regard to their influence on the skin condition of the metalworker trainees. By multivariate analysis, we determined 3 important risk factors for the development of hand eczema in the cohort. (i) We showed once more the important influence of an atopic disposition as a major risk factor for occupational contact dermatitis. (ii) Furthermore, the results suggest that, apart from chemical irritants, mechanical factors should not be underestimated in their role as irritants to the epidermal barrier. (iii) Additionally, an insufficient amount of skin recovery time seems to support a cumulative sub-irritant effect on the skin, which may lead to irritant contact dermatitis.

Role of the atopy score and of single atopic features as risk factors for the development of hand eczema in trainee metal workers.

This study was performed as part of PROMETES (Swiss Prospective Metal Worker Eczema Study) to examine the role of atopy as a possible risk factor for the development of hand eczema in trainee metal workers. In a cohort of 201 young men without any skin problems at the start of their apprenticeship, 9.5% developed signs of dermatitis on their hands within a period of 6 months. The 2. 5-year incidence was 23%. We did not find a significantly increased risk for hand eczema in those participants with an atopic skin diathesis according to the atopy score of Diepgen et al. (Dermatosen 1991; 39: 79-83) Analysis of individual atopic signs and symptoms showed reported metal reactivity to have a significant influence on the onset of early skin damage within 6 months, whereas a history of flexural eczema appeared to be significantly related to the overall incidence over 2.5 years.

Is occupational irritant contact dermatitis predictable by cutaneous bioengineering methods? Results of the Swiss Metalworkers' Eczema Study (PROMETES).

BACKGROUND: Since identification of subjects with high eczema risk by screening tests is desirable, different skin bioengineering methods were studied for their validity as predictive measures for the development of hand eczema. METHODS: 205 metalworker trainees were followed up over 2.5 years from the beginning of their apprenticeship to observe the occurrence of hand eczema. Within the first weeks of their training they underwent a number of noninvasive biophysical tests. Transepidermal water loss, skin moisture and skin roughness were measured, and irritation tests with dimethyl sulfoxide (DMSO), sodium hydroxide (NaOH) and sodium lauryl sulfate were conducted. Sensitivity, specificity and predictive values of the performed tests and test combinations were calculated. RESULTS: None of the observed single biophysical methods can be considered a valid screening test. CONCLUSION: A combination of short irritation tests (DMSO and NaOH tests) and the measurement of skin moisture, however, allows to identify individuals at high risk for hand dermatitis with a high sensitivity, though low specificity.

Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis.

The actual advantage of barrier creams over bland emollients for skin protection is still hotly debated. In a randomized, double-blinded study, a newly-introduced barrier cream and its moisturizing vehicle were compared regarding their skin compatibility, efficacy and resulting acceptance. Thus, 2 panels of 25 hospital nurses with mild signs of skin irritation were asked to use 1 of the test products provided (verum or vehicle) over a period of 4 weeks. Effects of both types of preparations were studied weekly by clinical examination and the instrumental assessment of bioengineering parameters. Results showed no significant differences between barrier cream and vehicle. In both groups, clinical skin status improved and stratum corneum hydration increased significantly during the study period. Both preparations were tolerated and accepted well, thus showing both skin protection and skin care. These results contribute to the debate as to whether a strict distinction between "skin care" and "skin protection" products is justified. The vehicle alone is capable of positively influencing skin status. Emphasis must be laid on regular, frequent, and correct application of a product for it to be effective.