A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery.

BACKGROUND AND AIM: The implications of multi-incision (MILS) and hand-assisted (HALS) laparoscopic techniques for minimally invasive liver surgery with regard to perioperative outcomes are not well defined. The purpose of this study was to compare MILS and HALS using propensity score matching. METHODS: 309 patients underwent laparoscopic liver resections (LLR) between January 2013 and June 2018. Perioperative outcomes were analyzed after a 1:1 propensity score match. Subgroup analyses of matched groups, i.e., radical lymphadenectomy (LAD) as well as resections of posterosuperior segments (VII and/or VIII), were performed. RESULTS: MILS was used in 187 (65.2%) and HALS in 100 (34.8%) cases, with a significant decrease of HALS resections over time (p = 0.001). There were no significant differences with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) Score, previous abdominal surgery and cirrhosis between both groups. Patients scheduled for HALS were characterized by a significantly higher rate of malignant tumors (p < 0.001) and major resections (p < 0.001). After propensity score matching (PMS), 70 cases remained in each group and all preoperative variables as well as resection extend were well balanced. A significantly higher rate of radical LAD (p = 0.039) and posterosuperior resections was found in the HALS group (p = 0.021). No significant differences between the matched groups were observed regarding operation time, conversion rate, frequency of major complications, length of intensive care unit (ICU) stay, overall hospital stay and R1 rate. CONCLUSION: Our analysis suggests MILS and HALS to be equivalent regarding postoperative outcomes. HALS might be particularly helpful to accomplish complex surgical procedures during earlier stages of the learning curve.

Flat Bands, Indirect Gaps, and Unconventional Spin-Wave Behavior Induced by a Periodic Dzyaloshinskii-Moriya Interaction.

Periodically patterned metamaterials are known for exhibiting wave properties similar to the ones observed in electronic band structures in crystal lattices. In particular, periodic ferromagnetic materials are characterized by the presence of bands and band gaps in their spin-wave spectrum at tunable GHz frequencies. Recently, the fabrication of magnets hosting Dzyaloshinskii-Moriya interactions has been pursued with high interest since properties, such as the stabilization of chiral spin textures and nonreciprocal spin-wave propagation, emerge from this antisymmetric exchange coupling. In this context, to further engineer the magnon band structure, we propose the implementation of magnonic crystals with periodic Dzyaloshinskii-Moriya interactions, which can be obtained, for instance, via patterning of periodic arrays of heavy metal wires on top of an ultrathin magnetic film. We demonstrate through theoretical calculations and micromagnetic simulations that such systems show an unusual evolution of the standing spin waves around the gaps. We also predict the emergence of indirect gaps and flat bands, effects that depend on the strength of the Dzyaloshinskii-Moriya interaction. Such phenomena, which have been previously observed in different systems, are observed here simultaneously, opening new routes towards engineered metamaterials for spin-wave-based devices.

Neuroimmunology of the female brain across the lifespan: Plasticity to psychopathology.

The female brain is highly dynamic and can fundamentally remodel throughout the normal ovarian cycle as well as in critical life stages including perinatal development, pregnancy and old-age. As such, females are particularly vulnerable to infections, psychological disorders, certain cancers, and cognitive impairments. We will present the latest evidence on the female brain; how it develops through the neonatal period; how it changes through the ovarian cycle in normal individuals; how it adapts to pregnancy and postpartum; how it responds to illness and disease, particularly cancer; and, finally, how it is shaped by old age. Throughout, we will highlight female vulnerability to and resilience against disease and dysfunction in the face of environmental challenges.

Sentinel lymph node biopsy and risk factors for predicting metastasis in cutaneous squamous cell carcinoma.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is a common cancer capable of metastasis. Sentinel lymph node biopsy (SLNB) may be a valuable adjunct for patients with cSCC at high risk for metastasis. However, data on risk factors for metastasis and results of SLNB from patients with cSCC are limited. OBJECTIVES: To evaluate risk factors for metastasis in patients with cSCC in a large cohort study with long-term follow-up and to determine the value of SLNB. METHODS: We retrospectively analysed all records of patients who underwent excision of cSCC between January 2005 and August 2009 at a tertiary referral centre. In total, 143 patients were included in the cohort, including 17 patients with SLNB and a follow-up time of ≥ 24 months. RESULTS: Tumour thickness > 4 mm and recurrent cSCC were strongly associated with metastatic disease. All metastases in this cohort occurred within 24 months of follow-up. SLNB showed a low sensitivity with regard to the development of metastasis. Six of 17 patients developed metastatic disease despite a negative SLNB. CONCLUSIONS: Patients with risk factors (cSCC with a tumour thickness > 4 mm or recurrent disease) may develop metastases within the first 2 years despite a negative SLNB. Therefore these patients should be closely monitored during the follow-up. Based on our data SLNB does not provide diagnostic value for patients with cSCC.

A randomised controlled trial of bilateral dual transversus abdominis plane blockade for laparoscopic appendicectomy.

We investigated the effects of pre-operative ultrasound-guided bilateral dual transversus abdominis plane blocks on pain when sitting up and pain at rest after laparoscopic appendicectomy. We allocated 28 participants to injection with 60 ml ropivacaine 0.375% and 28 participants to 60 ml isotonic saline. The median (IQR [range]) cumulative pain scores during the first 12 postoperative hours were less after ropivacaine than saline (maximum 120): on sitting, 34 (19-46 [0-59]) vs 50 (30-59 [0-97]), respectively, p = 0.009; and at rest, 25 (10-33 [0-49]) vs 31 (24-43 [0-72]), respectively, p = 0.035. There were no differences in morphine consumption, nausea, vomiting, time in recovery or time to walk.

Magnetic properties of granular CoCrPt:SiO 2 thin films deposited on GaSb nanocones.

We report on the effect of microstructure and geometrically induced modifications of the magnetic properties of granular CoCrPt:SiO2 films with weakly interacting magnetic grains deposited on pre-structured GaSb nanocone templates fabricated by an ion erosion technique. By tuning the irradiation conditions, nanocone patterns of different cone sizes were prepared (from 28 to 120 nm in diameter and 32 to 330 nm high, respectively). The influence of the intergranular exchange coupling was also investigated by varying the SiO2 content from 8 to 12 at.%. Deposition of CoCrPt:SiO2 on samples with small nanocones leads to a close magnetic grain packing, which results in the formation of extended magnetic domains larger than the average distance between the GaSb cones. In contrast, on larger nanocones, the magnetic coating grows on the side-walls, with a large separation between neighboring cones, leading to magnetic single-domain regions, which are correlated to the underlying structure. Magnetometry indicates that both remanence and coercivity decrease with increasing cone size and/or SiO2 content due to a combined effect of the angular distribution of the magnetic easy axis of the grains and the intergranular exchange coupling strength.

A randomised controlled trial of ultrasound-guided blockade of the saphenous nerve and the posterior branch of the obturator nerve for postoperative analgesia after day-case knee arthroscopy.

The purpose of this study was to investigate the effects of blockade of the saphenous nerve and the posterior branch of the obturator nerve in addition to a standard analgesic regimen for patients discharged the same day after knee arthroscopy. The primary outcome was knee pain on flexion during the first 24 postoperative hours, calculated as area under the curve. We allocated 60 patients to ultrasound-guided nerve blocks with either ropivacaine or saline, 30 to each. The median (IQR [range]) pain score on knee flexion in the ropivacaine group 2.0 (1.1-3.7 [0.1-7.1]) was not statistically different to that in the saline group (3.3 (1.7-4.6 [0.3-6.8]), p = 0.06). There were no differences in pain at rest, opioid consumption or function.

Successful treatment of partial portal vein thrombosis (PVT) with low dose rivaroxaban.

In a 63-year-old cirrhotic patient, recanalisation of a partial portal vein thrombosis was achieved by a low dose of rivaroxaban (10 mg daily). After anticoagulant therapy was stopped, partial vein thrombosis recurred. Restarting rivaroxaban at a dose of 10 mg led to recanalisation. The patient did not suffer any complications; in particular no bleeding occurred during 8 months of treatment.

Quantification of periarticular demineralization and synovialitis of the hand in rheumatoid arthritis patients.

UNLABELLED: The bone mineral density (BMD) measurement of the hand in rheumatoid arthritis (RA) patients is no standard measurement method as yet. The aim was to contribute to the standardization of the hand BMD measurement, especially of periarticular regions. As results, we found best precision values for the wrist and a significant correlation between hand and spine/femur BMD depending on disease activity and disease duration. INTRODUCTION: This study was conducted to investigate (i) the precision of periarticular hand BMD measuring, (ii) the periarticular demineralization of the hand, (iii) the correlation between periarticular hand BMD and spine/femur BMD, and (iv) the correlation of hand BMD to hand synovitis. METHODS: A number of 52 RA patients were examined by BMD measurement of the femoral neck, spine, whole hand, metacarpophalangeal (MCP) joints II-V, personal identity profile (PIP) joints II-V, and wrist using dual-energy X-ray absorptiometry (DXA). Synovitis of the hand was examined by ultrasonography and magnetic resonance imaging (MRI). Three subgroups were further analyzed: early RA, established RA with moderate and with high disease activity. Early RA and established RA patients with high disease activity were Followed up after 12 months. RESULTS: We found (1) best precision of BMD measurement for the wrist, (2) BMD in RA significantly reduced if compared to normal controls, (3) a highly significant positive correlation between hand and spine/femur BMD and the power of correlation to depend on disease activity and disease duration (high correlation in RA with moderate disease activity and early RA, very high correlation in RA with high disease activity), (4) a negative correlation between hand BMD and hand synovitis in RA with high disease activity, and (5) a significant reduction of synovitis but no change in hand BMD after 12 months, respectively. CONCLUSIONS: This study shows a highly significant correlation between hand BMD and spine/femur BMD in RA patients depending on disease activity and disease duration. We conclude to measure BMD at different sites including hands in order to quantify bone loss in RA patients most properly.

Nanocap arrays of granular CoCrPt:SiO2 films on silica particles: tailoring of the magnetic properties by Co+ irradiation.

An approach for tailoring the magnetic properties by ion irradiation of granular perpendicular CoCrPt:SiO(2) films grown on silica particles with sizes down to 10 nm was investigated. The as-prepared samples reveal an intriguing scaling dependence of the coercive field and remnant magnetization: both parameters are found to decrease with decreasing particle size. However, Co(+) irradiation at a low fluence of 0.5 x 10(14) cm(-2) already results in an opposite scaling behavior. It is assumed that this modification is due to the enhancement of the intergranular magnetic exchange coupling of the granular CoCrPt:SiO(2) film initiated by Co(+) irradiation resulting in a modified reversal behavior. Further increase of the irradiation fluence beyond 1.6 x 10(14) ions cm(-2) leads to a degradation of the magnetic layer properties, lowering the remnant magnetization and the coercive field in the easy-axis direction. Moreover, the local magnetic properties of the samples were analyzed by magnetic force microscopy revealing magnetic multi-domain cap structures.

[Medical ethics : The pioneering role of critical care medicine]. / Angewandte klinische Ethik : Die Vorreiterrolle der Intensivmedizin.

The development of intensive care medicine started over more than 50 years. Effective organ system support for ventilation initially and subsequently for circulation, nutrition and renal function resulted in improved outcomes in patients with a variety of severe medical conditions. One of the unfortunate consequences of this development was that it did not allow dying or prolonged the dying process and without the possibility of recovery to a quality of life acceptable to the patients. The early realization of this dilemma ultimately led to broad ethical discussions concerning withholding and withdrawal of curative therapies in intensive care units, and introducing palliative care.

[The first case of anisakiasis acquired in Austria]. / Anisakiasis - der erste in Osterreich akquirierte Fall einer seltenen Helminthozoonose.

Anisakiasis is caused by a fish parasite of the Nematode family. This kind of rare helminthozoonosis can mainly be found in countries where consumption of raw fish is traditionally high like Japan, the Netherlands, Pacific Islands, South Europe, Scandinavia, USA, and Canada. Man is the wrong hoste. Clinical manifestation depends on the localisation of penetration in the GI tract. In Japan, predominantly the stomach is affected in 97 % of cases, probably due to hypo- and achlorhydria; whereas mainly intestinal anisakiasis occurs in Europa. We report on a 67-year-old male patient with a gastric infestation of anisakiasis. The patient was on proton pump inhibitor which migh have caused the localisation of the infestation. The anisakis was an accidental endoscopic finding in a patient for control of an H. p.-positive gastric ulcer. Otherwise the patient was free of pain. The helminth (larva III) was endoscopically extracted. Thereafter, the patient remained in good health. Anisakis serology as well as repeated differential blood counts were without finding. The uneventful medical history and the normal blood findings indicate that our patient had a very early stage of infestation of anisakiasis. The patient reported no stay outside of Austria within the last years. However, he consumed on a regular basis "rolled pickled herring" produced by a well-known Viennese company for canned fish. This is the first documented case of this rare helminthozoonosis acquired in Austria.

Prospective evaluation of comorbidity and psychosocial need in children and adolescents with anorectal malformations. Part 2: evaluation of psychosocial need.

PURPOSE: Only a few patients with anorectal malformations (ARM) have satisfactory bowel functions. Studies of ARM have reported psychosocial problems in up to 73% of patients. The aim of the current study was to document the psychosocial needs of patients with ARM. METHODS: Between June 2004 and September 2005, 44 patients with ARM were treated; the sample included 30 patients (23 males and 7 females) aged 4-17. To focus on potential psychosocial strain, a comprehensive grading system with a sophisticated perspective of continence, associated malformations, number of surgical interventions and postoperative complications was introduced. For psychosocial screening, the following instruments were used: German "Basis-Dokumentation" (BADO), Impact on Family Scale (IFS), the Strengths and Difficulties Questionnaire (SDQ). All families assessed their own psychosocial needs. An extensive psychosocial programme was provided. RESULTS: Twenty-three patients were suffering severe burden according to the comprehensive grading system. Nearly half of the families reported increased financial stress, and one-third reported emotional or hyperactivity problems of the child. More than 70% confirmed psychosocial need. CONCLUSIONS: Paediatric surgeons should promote psychosocial support for all patients who suffer severe forms of ARM or its numerous associated malformations as well as for patients undergoing numerous surgical interventions or having many postoperative complications.

[Diagnostic of personality disorders in adolescence according to SCID-II]. / Diagnostik von Persönlichkeitsstörungen im Jugendalter nach SKID-II.

OBJECTIVES: The aim of the present study was to ascertain whether the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) is applicable for use with adolescents. Furthermore, the diagnostic concordance between SCID-II and the clinicians' estimations of personality disorders (PD) is assessed. In addition, we identified predicting factors for personality disorders in adolescent psychiatric inpatients. METHODS: 110 adolescent psychiatric inpatients aged 14-18 years were assessed by means of SCID-II and a personality and disorder inventory (PSSI). RESULTS: 32.7% of the inpatients met the criteria for PD according to SCID-II. While agreement between the presence of any PD based on SCID-II and that found according to clinicians' estimations was low, moderate and very good agreement between SCID-II and clinicians' estimations was found with regard to borderline PD and histrionic PD. Logistic regression analyses identified "anorexia nervosa (binge-purging)", "attention-deficit/hyperactivity disorder/conduct disorder (ADHD/CD)" and "socioeconomic status" as good predictors for PD. CONCLUSIONS: The SCID-II - which was primarily developed for use with adults - is suitable for use among adolescents. Anorexia nervosa (binge-purging type) and ADHD/CD are closely associated with the development of PD in adolescents.

Fate of 5-fluorouracil, doxorubicin, epirubicin, and daunorubicin in hospital wastewater and their elimination by activated sludge and treatment in a membrane-bio-reactor system.

Antineoplastic agents are applied in cancer therapy and end up in hospital wastewater by human excretions. In this study, the raw wastewater of the sewer of the oncologic in-patient treatment ward of the Vienna University Hospital was monitored for 98 d over 2 years for the cytostatics 5-fluorouracil (5-FU), doxorubicin (DOX), epirubicin, and daunorubicin. In a next step, the elimination of the drugs by a membrane-bio-reactor system was investigated. In addition, their fate in wastewater and elimination by activated sludge was investigated with radio-labelled substances. During the monitoring periods, concentration levels ranging from <8.6 to 124 microgl(-1) for 5-FU and from <0.26 to 1.35 microgl(-1) for DOX were determined. The concentrations analysed fitted the lower ranges calculated by an input-output model. Treatment of oncologic wastewater in the membrane bio-reactor as well as the analysis of the effluents of the Vienna University Hospital resulted in concentrations below the limit of detection. Investigations with radio-labelled compounds showed that 5-FU is eliminated from the liquid phase below the limit of detection. But, up to 25% of radio-labelled equivalents of the drug's amount were found in the gaseous phase and only a marginal part in the solid phase, this indicates that at least one part of the drug is biodegraded. For the anthracyclines more than 90% was eliminated from the liquid phase. In this case, adsorption to suspended solids seems to be the major elimination pathway, as up to 30% of the radio-labelled equivalents of the drug's amount was detected in the solid phase. Our results indicate that the investigated anticancer drugs are eliminated by sewage treatment plants, either by biodegradation or adsorption.

Monitoring, removal and risk assessment of cytostatic drugs in hospital wastewater.

Cytostatic agents are applied in cancer therapy and subsequently excreted into hospital wastewater. As these substances are known to be carcinogenic, mutagenic and toxic for reproduction, they should be removed from wastewater at their source of origin. In this study the fate and effects of the cancerostatic platinum compounds (CPC) cisplatin, carboplatin, oxaliplatin, 5-fluorouracil (5-FU) and the anthracyclines doxorubicin, daunorubicin and epirubicin were investigated in hospital wastewater. Wastewater from the in-patient treatment ward of a hospital in Vienna was collected and monitored for the occurrence of the selected drugs. A calculation model was established to spot the correlation between administered dosage and measured concentrations. To investigate the fate of the selected substances during wastewater treatment, the oncologic wastewater was treated in a pilot membrane bioreactor system (MBR) and in downstream advanced wastewater treatment processes (adsorption to activated carbon and UV-treatment). Genotoxic effects of the oncologic wastewater were assessed before and after wastewater treatment followed by a risk assessment. Monitoring concentrations of the selected cytostatics in the oncologic wastewater were in line with calculated concentrations. Due to different mechanisms (adsorption, biodegradation) in the MBR-system 5 - FU and the anthracyclines were removed < LOD, whereas CPC were removed by 60%. In parallel, genotoxic effects could be reduced significantly by the MBR-system. The risk for humans, the aquatic and terrestrial environment by hospital wastewater containing cytostatic drugs was classified as small in a preliminary risk assessment.

[Palliative care consultation in the ICU : Descriptive analysis of internal medicine intensive care using a mixed model over 12 months]. / Palliative Care auf der Intensivstation : Deskriptive Analyse der Ergebnisse eines Mischmodells an einer internistischen Intensivstation über einen Zeitraum von 12 Monaten.

We retrospectively analyzed the data of 56 of 669 critically ill patients admitted to an internal medicine intensive care unit (ICU) with palliative care provided by a palliative care team over the period of 12 months. For delivering palliative care, we used a mixed model-consisting of both integrative and consultative elements. SAPS III severity score in patients with palliative care was 63 ± 15 compared to 50 ± 15 in all critically ill patients. Hospital mortality was 62.5 vs. 16%. After 3 months, 19.6% of patients with palliative care provided by the palliative care team were still alive. In 15 patients curative therapies were discontinued, while there was no further escalation of the therapy in 30 patients. In 47 patients, special help to the relatives was offered. In 13 cases, there was a disagreement between relatives and the ICU team; in 5 cases a family conference was implemented. Two patients wanted extensive intensive care therapy, despite unfavorable prognosis; one patient wished to die. One patient had an advanced directive.

Spin caloritronic nano-oscillator.

Energy loss due to ohmic heating is a major bottleneck limiting down-scaling and speed of nano-electronic devices, and harvesting ohmic heat for signal processing is a major challenge in modern electronics. Here, we demonstrate that thermal gradients arising from ohmic heating can be utilized for excitation of coherent auto-oscillations of magnetization and for generation of tunable microwave signals. The heat-driven dynamics is observed in Y3Fe5O12/Pt bilayer nanowires where ohmic heating of the Pt layer results in injection of pure spin current into the Y3Fe5O12 layer. This leads to excitation of auto-oscillations of the Y3Fe5O12 magnetization and generation of coherent microwave radiation. Our work paves the way towards spin caloritronic devices for microwave and magnonic applications.Harvesting ohmic heat for signal processing is one of major challenges in modern electronics and spin caloritronics, but not yet well accomplished. Here the authors demonstrate a spin torque oscillator device driven by pure spin current arising from thermal gradient across an Y3Fe5O12/Pt interface.

[Hepatorenal syndrome in decompensated cirrhosis : A special form of acute renal failure]. / Hepatorenales Syndrom bei dekompensierter Leberzirrhose : Eine besondere Form der akuten Niereninsuffizienz.

Renal failure is a serious complication in patients with advanced cirrhosis. It occurs in about 20 % of patients hospitalized with cirrhosis. In about 70 % it is caused by prerenal failure, and in 30 % it is due to intrarenal causes. In about 70 % of patients with rperenal failure, renal function can be restored with fluid replacement, but the remaining 30 % are unresponsive to volume expansion. Minor increase in serum creatinine have been shown to be clinically relevant and can adversely affect survival. Therefore early efforts should be made to avoid precipitation of renal failure.Hepatorenal syndrome (HRS) is a  fully reversible impairment of renal function in patients with cirrhosis unresponsive to volume expansion characterized by an acute progressive decrease in kidney function (serumcreatinin > 1,5 mg/dl) - type 1 HRS, whereas type 2 HRS features a decrease in kidney function over a long time, mostly in patients with refractory ascites. Therapy with vasoconstrictors like terlipressin to reverse splanchnic vasodilation, together with albumin is effective in 30-50 % of patients with HRS 1 and improves survival. The only effective longterm therapy is livertransplantation. An improvement of kidney fuction before transplantation is associated with a better outcome and posttransplant kidney function.