[Perioperative evaluation and treatment of cardiovascular risk patients for noncardiac surgery : Guidelines of the European Society of Cardiology/European Society of Anaesthesiology 2014]. / Perioperative Beurteilung und Behandlung kardiovaskulärer Risikopatienten für nichtherzchirurgische Eingriffe : Leitlinien 2014 der European Society of Cardiology/European Society of Anaesthesiology.

In late summer 2014, the joint working group of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) presented new guidelines for the evaluation and treatment of cardiovascular risk patients undergoing noncardiac surgery. In addition to the preoperative collation of patient and intervention-specific risks, the guidelines deal with anaesthesiological and cardiological aspects of the perioperative management of patients with diseases of the heart and common comorbidities. This article summarizes the essential aspects of the guidelines in a clearly arranged form.

Thromboelastometric detection of clotting Factor XIII deficiency in cardiac surgery patients.

AIM(S): In this article, we aimed to investigate plasma Factor XIII levels after extracorporeal circulation in cardiac surgery by thromboelastometric detection, as extracorporeal circulation causes various coagulation disorders due to the exposure of blood to artificial surfaces, inflammatory induction and mechanical destruction of platelets and coagulation factors, which may particularly affect factors with long half-lives, such as Factor XIII. BACKGROUND: Since transfusion algorithms are often empirical and laboratory analysis of Factor XIII plasma levels may not be available 24 h a day, bed-side testing using rotational thromboelastometry (ROTEM) could offer a splendid option to define the cause of excessive peri-operative bleeding disorders in general and Factor XIII levels in particular in a timely manner and thus facilitating exact substitution therapy. METHODS: In this trial, we investigated 25 cardiac surgery patients with extracorporeal bypass times over 100 min. Standard laboratory and ROTEM analyses were performed post-operatively at the time of intensive care unit admission and 6 h later. We implemented EXTEM with additional Factor XIII (teenTEM) as additional test by adding 0·625 IU Factor XIII to standard EXTEM reagents. RESULTS: In this observational study, we could not demonstrate a correlation between Factor XIII and MCFEXTEM , CFTEXTEM or MLEXTEM . Neither Factor XIII plasma levels nor MCFEXTEM could predict blood loss. In accordance with previous findings, we were able to demonstrate increased maximum clot firmness (MCF), decreased clot formation time and decreased maximum lysis by adding Factor XIII in vitro (teenTEM vs EXTEM) indicating an improvement in the coagulation process. As shown before, we also found a strong correlation between MCF and platelet and fibrinogen plasma levels. CONCLUSION: In summary, 'teenTEM' test does not seem to detect Factor XIII deficient patients in cardiac surgery. Furthermore, post-operative blood loss could not be predicted neither by ROTEM nor by laboratory analysis of Factor XIII. In vitro administration of Factor XIII appears to improve laboratory measures of haemostasis.

Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an important tool in the management of patients with peritoneal malignancies. It is a complex surgical procedure with significant fluid loss during debulking leading to relevant pathophysiological alterations and therefore a challenge for anesthesiologists and critical care physicians. This review summarizes perioperative changes in hemodynamics, oxygen supply, coagulation, hematopoetic parameters and fluid status during cytoreductive surgery and HIPEC and how to deal with these pathophysiological alterations.

[Case report: Libyostrongylus douglassii-associated proventriculitis in ostriches in Germany]. / Libyostrongylus douglassii-assoziierte Magenentzündungen bei Straussen (Struthio camelus) in Deutschland.

Cases of Libyostrongylus douglassii-associated proventriculitis in an adult female ostrich and two ostrich chicks occurring on two farms in different federal states of Germany are described. The adult bird was recently bought and kept under quarantaine conditions without contact to other animals of the herd. Without developing clinical signs of illness, the animal died. At necropsy, typical lesions of wireworm infection were found. The lining of the stomach had a moth-eaten appearance. Massive amounts of adult stages of trichostrongyloid nematodes were diagnosed in histological specimens of the proventricular mucosa and under the koilin layer of the ventriculus. The worms were isolated from the proventriculus and identified as L. douglassii. The feces of the bird contained high amounts of typical eggs of the worms with a medium size of approximately 70 x 40 microm. A polyphasic degeneration of heart and skeletal muscle was diagnosed in addition to the wireworm infection and interpreted to be a result of a malnutrition (Vit. E-/selenium deficiency). The ostrich chicks were reared on another farm and submitted for necropsy because of high mortality (8 out of 12 chicks died). A massive invasion of the proventricular mucosa with L. douglassi was macroscopically and histologically detected at necropsy of the anemic birds.

Correlation of gender and age with magnetic resonance imaging findings in patients with arthrogenic temporomandibular disorders: a cross-sectional study.

The objective of this study was to analyse the correlation between the gender and age of individuals with arthrogenic temporomandibular disorders (TMDs) and magnetic resonance imaging (MRI) findings. A total of 199 patients were included in the study and were divided into four age groups: group A, ≤30 years; group B, 31-44 years; group C, 45-55 years; group D, ≥56 years. MRI scans were analysed for the presence or absence of the following conditions: morphological changes in the mandibular condyle and/or articular tubercle, disc displacement with (DDWR) and without reduction (DDWoR), bone oedema, effusion, and avascular necrosis. Statistical analyses were conducted using logistic regression models (P<0.05). The mean patient age was 44.47±16.39 years; 158 (79.4%) were female and 41 (20.6%) were male. Only DDWoR was more significantly found in females than in males (P<0.05). Group D showed an odds ratio three times higher for the presence of morphological changes than group A (odds ratio 3.042, 95% confidence interval 1.421-6.512; P=0.0042). No differences were found among groups for the other findings. Based on the results of the present study it may be concluded that MRI findings tend to differ according to age and gender.

Clostridium difficile toxins influence hepatocyte protein synthesis through the interleukin 1 receptor.

HYPOTHESIS: Clostridium difficile toxins require interleukin 1 (IL-1) production or a functioning IL-1 receptor to elicit acute-phase protein production by murine hepatocytes. DESIGN: Experimental study. SETTING: Research laboratory at the DVA Medical Center, St Louis, Mo. CELLS STUDIED: Hepatocytes prepared from normal mice, from knockout mice deficient in IL-1 production due to loss of IL-1 converting enzyme, or from knockout mice deficient in the IL-1 p80 receptor. INTERVENTIONS: Cells were treated with lipopolysaccharide, a crude C difficile toxin extract, or purified C difficile toxins A or B for 24 hours in vitro, then radiolabeled with (35)S methionine. Newly synthesized acute-phase proteins were identified by electrophoresis and autoradiography. MAIN OUTCOME MEASURES: Synthesis of a 23-kd acute-phase protein in response to the various stimuli. RESULTS: Lipopolysaccharide, C difficile culture extract, and purified toxins A and B stimulated the synthesis of the 23-kd acute-phase protein by hepatocytes from normal mice and by hepatocytes from knockout mice deficient in the IL-1 converting enzyme. However, hepatocytes from knockout mice deficient in the IL-1 p80 receptor failed to produce this acute-phase protein when treated with the C difficile toxins, although they responded fully to lipopolysaccharide. CONCLUSIONS: Stimulation of acute-phase protein synthesis by C difficile toxins does not require IL-1 production, but does require a functioning IL-1 p80 receptor. This suggests that some of the actions of these toxins are mediated by this receptor.

Role of cytosolic phospholipase A2 in cytokine-stimulated prostaglandin release by human gallbladder cells.

Eicosanoids are involved in gallbladder inflammation, epithelial water transport, and mucous secretion. Phospholipase Asubscript2 enzymes liberate arachidonic acid from membrane phospholipids for the synthesis of eicosanoids. The purpose of this study was to determine the effect of selective cytoplasmic and secretory phospholipase A2 inhibitors on basal and stimulated arachidonic acid and prostaglandin E2 release in gallbladder cells. Western immunoblotting was employed to evaluate both cytosolic and secretory phospholipase A2 enzymes in human gallbladder cells. Cells were incubated for 22 hours with (3)H-labeled arachidonic acid. Arachidonic acid and prostaglandin E2 release was then measured in the supernate after 2 hours of exposure to human interleukin-1beta, alone or after pretreatment for 1 hour with the inhibitors. Unstimulated gallbladder cells express both 85 kDa cytosolic and 14 kDa secretory phospholipase A2++. The 85 kDa phospholipase A2 was induced by interleukin-1beta, whereas there was no apparent change in secretory phospholipase A2 enzyme concentrations. Both the secretory phospholipase A2 inhibitor p-bromophenylacyl bromide and the cytosolic phospholipase A2 inhibitor arachidonyl trifluoromethyl ketone decreased basal and interleukin-1beta-stimulated arachidonic acid release. In contrast, only inhibition of cytosolic phospholipase A2 led to a decrease in interleukin-1beta-stimulated prostaglandin E2 release. Basal and interleukin-1beta-stimulated arachidonic acid release appears to be the result of the activity of both cytosolic and secretory phospholipase A2. Interleukin-1beta-stimulated prostaglandin E2 release appears to be dependent on the activity of cytosolic phospholipase A2.

Genetic characterization of a Chlamydophila pneumoniae isolate from an African frog and comparison to currently accepted biovars.

The amphibian isolate DE177 identified as Chlamydophila (C.) pneumoniae was sequenced in five genomic regions: 16S ribosomal RNA gene, 16-23S intergenic spacer, ompA, ompB, and groESL genes. Comparison with corresponding sequences of the currently accepted equine, human and koala biovars of C. pneumoniae revealed that koala strains represented the most closely related taxon, although sequence dissimilarities in the ompA (VD4) and ompB gene regions were noted. In this respect, the present isolate is distinct from a previously described frog isolate (Berger et al., 1999) whose sequence analysis yielded identity to the koala biovar. As three of the nucleotide substitutions in ompA (VD4) of DE177 will be translated into two altered amino acids the possible existence of another biovar is discussed.

Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus.

We reviewed 24 displaced fractures through the physis of the medial epicondyle of the distal humerus. One was a Salter-Harris type-II fracture-separation of the whole distal humeral epiphysis; the others involved only the medial epicondylar centre of ossification. Two cases had presented as pseudarthroses. One fracture had been treated closed in a plaster slab and 21 had had open reduction and internal fixation with sutures, Kirschner wires or Palmer nails. At 2 to 13 years later we found five types of deformity of the epicondyle: pseudarthrosis, an ulnar sulcus, a double-contoured epicondyle, hypoplasia or hyperplasia. Pseudarthrosis had developed after either no treatment, closed reduction and plaster, or open reduction and suturing. Hypoplasia followed nailing, as did a trend to varus tilting of the joint surface. One very young patient, with fracture-separation of the whole distal epiphysis treated by nailing, developed marked cubitus varus.

New compounds with cytotoxic and antitumor effects. Part 6: Monomeric indole alkaloids of vinca minor L. and their effect on P388 cells.

Vincaminorine and vincaminoreine, the monomeric indole alkaloids, belonging to the respective quebrachamine skeletal types, and vincadifformine of the aspidospermine group were those of 15 bases examined found to exhibit a considerable inhibition effect on the P388 cells. The above-mentioned secondary metabolites inhibited the synthesis of nucleic acids and proteins. Vincadifformine, which was found to inhibit most significantly the biochemical functions of P388 cells of all monomers under study, stopped the proliferation of cells in vitro in a 50 micrograms X ml-1 concentration even after 12 h of action. The effect of vincadifformine was greater than that of vinblastine, which was evaluated under the same conditions on the P388 cells in vitro.

Eagle's syndrome: a case report.

The authors analyzed, through a review of the literature, Eagle's Syndrome which is a complex entity which presents common symptoms varying from an aching sensation in the throat to dysphagia and pain when rotating the head. Diagnosis and treatment are the main topics discussed relative to this abnormality which involves the styloid/stylohyoid complex. A case report is presented of a woman, aged 52, who submitted to surgical treatment using an extraoral approach for removal of the elongated styloid process to illustrate and facilitate the explanation of Eagle's Syndrome, including its manifestations and proper treatment.

[Candidiasis of the stomach as a complication of hiatal hernia surgery]. / Candidiasis i ventriklen som komplikation til hiatushernieoperation.

Candidiasis in the stomach after hiatus hernia sac operation has not previously been reported in the literature. We present a case in which a 46 year old woman developed candidiasis of the stomach, two months after hiatus hernia sac operation. The disease was primarily diagnosed radiologically and was later confirmed by gastroscopy and culture of gastric fluid. The pentagastrin test was performed six months after the operation and showed significantly reduced acid production. The most probable explanation for the condition is peroperative accidental lesion of branches of the vagus nerve resulting in reduced acid production thus facilitating growth of gastric candidiasis.

[Emergency ultrasonic examinations]. / Akutte ultralydundersøgelser.

The employment and yields of emergency examinations carried out outside normal working hours in Bispebjerg Hospital, Copenhagen, in 1987 are illustrated. This facility is employed particularly by surgical departments for examination of patients with acute abdominal and retroperitoneal conditions and it is frequently supplemented by immediate ultrasonically guided drainage. The possibility of emergency examinations contributed to rapid, certain and gentle diagnosis in the treatment of patients.

[Post-traumatic pseudoaneurysm of the posterior tibial artery]. / Posttraumatisk pseudoaneurisme på arteria tibialis posterior.

A case of post-traumatic pseudoaneurysm of the posterior tibial artery is presented. The diagnosis was made by ultrasound one week after the trauma, and a vascular reconstruction was performed. The purpose of this case report is to bring attention to this complication to vascular trauma, which may cause delayed symptoms long time after the injury. We suggest that these patients should be treated with vascular reconstruction rather than ligation, thereby preserving the function of this artery.

[Radiological findings in patients with a J-shaped ileal reservoir]. / Billeddiagnostiske fund hos patienter med J-formet ileumreservoir.

This study comprised 116 patients with either ulcerative colitis or familial adenomatous polyposis, who were treated from 1983 to 1990. The patients were subjected to total colectomy followed by formation of an ileoanal reservoir (J-pouch). In a retrospective study the radiological findings of the J-pouch and the reservoir related complications are presented and a description of the applied technique for pouchography is given. A total of 513 radiological investigations were performed--median two per patient (range: 1-44). All 116 patients were subjected to pouchography while 59 patients additionally underwent conventional X-ray investigations, 42 patients were referred to ultrasound and ten patients to CT. Fourty-five percent of the patients presented no radiological complications at all. Patients with a normal primary pouchogram showed a significantly lower risk of long term complications related to the pouch. Pouchography was a useful method for excluding pouch pathology before restoring intestinal continuity as well as showing fistulas or cavities. In cases of leakage and especially stenosis and pouchitis pouchography was, however, less reliable. Ultrasound examination combined with CT-scan was beneficial in diagnosing abscesses.

[Chlamydial diseases of domestic animals--zoonotic potential of the agents and diagnostic issues]. / Chlamydienerkrankungen der Nutz- und Haustiere--Zoonotisches Potential der Erreger und diagnostische Fragen.

The role of chlamydiae as agents of a number of important animal and human diseases is still the subject of intensive research. Recently, a proposal for taxonomic reclassification of this group of obligate intracellular bacteria was published, which was based on a large amount of new data on genetic relatedness. According to this proposal, the family Chlamydiaceae now comprises two genera (Chlamydia and Chlamydophila) with 9 largely host-related species. The previously accepted classification scheme had distinguished 4 species within the genus Chlamydia. The most important animal chlamydiosis with zoonotic character is psittacosis, a systemic disease in psittacine birds of acute, protracted, chronic or subclinical manifestation. The analogous infection in domestic and wild fowl is known as ornithosis. Avian strains of C. psittaci (new classification: Chlamydophila psittaci) can also infect humans, the symptoms being mainly unspecific and influenza-like, but severe pneumonia, endocarditis and encephalitis are also known. The main group of persons facing an elevated risk of infection includes those having frequent contact with domestic and companion birds at work or in their spare time. In Germany, the annual average of notified cases is approximately 100. Cases of transmission to humans were repeatedly reported in connection with enzootic abortion in sheep (causative agent: C. psittaci or Chlamydophila abortus, respectively). Various chlamydial species occur as pathogens and commensals as well in cattle, pigs, horses, and cats. The assessment of the actual epidemiological importance is, however, often difficult because of their almost ubiquitous spread. Likewise, those strains of C. pneumoniae (new classification: Chlamydophila pneumoniae) found in several animal species can not yet be assessed for pathogenic properties. The possibilities for diagnostic detection of chlamydiae have considerably improved following the introduction of molecular methods, particularly the polymerase chain reaction (PCR), which permits direct identification from clinical specimens and differentiation of species.

Use of osseointegrated implants in the intermaxillary suture: a new possibility for the prosthetic rehabilitation of atrophic maxillae.

Patients with atrophy of the maxillae, generally the elderly, are usually difficult to handle clinically, mainly due to the lack of retention, stability, and masticatory effectiveness of the total removable prosthesis. A new technique involving osseointegrated implants that are parallel to each other and arranged in the intermaxillary suture seems to provide great advantages over the current options for oral rehabilitation. This technique is quick and effective, being performed with local anesthesia and without a bone graft, and still presents low morbidity and cost.