The Aegean in the Early 7th Millennium BC: Maritime Networks and Colonization.

The process of Near Eastern neolithization and its westward expansion from the core zone in the Levant and upper Mesopotamia has been broadly discussed in recent decades, and many models have been developed to describe the spread of early farming in terms of its timing, structure, geography and sociocultural impact. Until now, based on recent intensive investigations in northwestern and western Anatolia, the discussion has mainly centred on the importance of Anatolian inland routes for the westward spread of neolithization. This contribution focuses on the potential impact of east Mediterranean and Aegean maritime networks on the spread of the Neolithic lifestyle to the western edge of the Anatolian subcontinent in the earliest phases of sedentism. Employing the longue durée model and the concept of 'social memory', we will discuss the arrival of new groups via established maritime routes. The existence of maritime networks prior to the spread of farming is already indicated by the high mobility of Epipalaeolithic/Mesolithic groups exploring the Aegean and east Mediterranean seas, and reaching, for example, the Cyclades and Cyprus. Successful navigation by these early mobile groups across the open sea is attested by the distribution of Melian obsidian. The potential existence of an additional Pre-Pottery Neolithic (PPN) obsidian network that operated between Cappadocia/Cilicia and Cyprus further hints at the importance of maritime coastal trade. Since both the coastal and the high seas networks were apparently already well established in this early period, we may further assume appropriate knowledge of geographic routes, navigational technology and other aspects of successful seafaring. This Mesolithic/PPN maritime know-how package appears to have been used by later groups, in the early 7th millennium calBC, exploring the centre of the Anatolian Aegean coast, and in time establishing some of the first permanent settlements in that region. In the present paper, we link this background of newcomers to the western edge of Anatolia with new excavation results from Çukuriçi Höyük, which we have analysed in terms of subsistence strategies, materiality, technology and symbolism. Additionally, further detailed studies of nutrition and obsidian procurement shed light on the distinct maritime affinity of the early settlers in our case study, something that, in our view, can hardly be attributed to inland farming societies. We propose a maritime colonization in the 7th millennium via routes from the eastern Mediterranean to the eastern Aegean, based on previously developed sea networks. The pronounced maritime affinity of these farming and herding societies allows us to identify traces of earlier PPN concepts still embedded in the social-cultural memories of the newcomers and incorporated in a new local and regional Neolithic identity.

A supraomohyoidal plexus block designed to avoid complications.

Interscalene blocks of the brachial plexus are used for surgery of the shoulder and are frequently associated with complications such as temporary phrenic block, Horner syndrome or hematoma. To minimize the risk of these complications, we developed an approach that avoids medially directed needle advancement and favors spread to lateral regions only: the supraomohyoidal block. We tested this procedure in 11 cadavers fixed by Thiel's method. The insertion site is at the lateral margin of the sternocleidomastoid muscle at the level of the cricoid cartilage. The needle is inserted in the axis of the plexus with an angle of approximately 35 degrees to the skin, and advanced in lateral and caudal direction. Distribution of solution was determined in ten cadavers after bilateral injection of colored solution (20 and 30 ml) and followed by dissection. In an eleventh cadaver, computerized tomography and 3D reconstruction after radio contrast injection was performed. In additional five cadavers we performed Winnie's technique with bilateral injection (20 and 30 ml). Concerning the supraomohyoidal block the injection mass reached the infraclavicular region surrounded all trunks of the brachial plexus in the supraclavicular region and the suprascapular nerve in all cases. The solution did not spread medially beyond the lateral margin of the anterior scalene muscle into the scalenovertebral triangle. Therefore, phrenic nerve, stellate ganglion, laryngeal nerve nor the vertebral artery were exposed to the injected solution. Distribution was comparable with the use of 20 and 30 ml of solution. Injections on five cadavers performing the interscalene block of Winnie resulted in an extended spread medially to the anterior scalene muscle. We conclude that our method may be a preferred approach due to its safety, because no structures out of interest were reached. Solution of 20 ml is suggested to be enough for a successful block.

[Comparison between TCI-TIVA, manual TIVA and balanced anaesthesia for stereotactic biopsy of the brain]. / Vergleich zwischen TCI-TIVA, manueller TIVA und balanzierter Anästhesie während stereotaktischer Gewebsentnahme in der Neurochirurgie.

PURPOSE: Total intravenous anaesthesia (TIVA) is increasingly used in diagnostic surgery such as stereotactic biopsy of the brain. TIVA could lead to a faster recovery of cerebral function, which may lead to a better behavior and advantages in the postoperative management. The aim of this prospective, single-blind study was to compare the hemodynamics, the postoperative recovery period, the side-effects and the need for additional cardiovascular medication during and after the operation between the three study groups. PATIENTS AND METHODS: After giving informed consent and approval by the ethical committee of our hospital, 51 patients (ASA I and II) undergoing stereotactic biopsy of a brain tumor were randomized to receive either propofol via the TCI-system (group 1: TCI-TIVA), propofol by a manual technique (group 2: MAN-TIVA) or methohexitone-sevoflurane (group 3: BAL-SEVO). Remifentanil was used as the analgetic component in all groups. Systolic and diastolic blood pressure, heart rate und transcutaneous oxygen saturation were noted before and after induction and before and after the end of anaesthesia. The time until return of complete orientation relative to person, location and time were measured. The patients' ranking of their satisfaction with the anaesthesia was questioned 60 min and 24 hours after the end of the procedure (VAS). Undesirable side-effects (i. e. PONV, shivering, pain, dysphoria, tiredness) were noted, whenever they occurred. The number of hemodynamic interventions by the anaesthesiologist was counted, and the total doses of remifentanil and propofol were quoted. Depth of anaesthesia was monitored by using a BIS-system, a range between 40 and 50 was thought to be adequate. Besides this, the total doses of remifentanil, propofol and sevoflurane were ruled out and the costs of the three regimens were ranked. RESULTS: Heart rate dropped markedly in all groups with a maximum in the TIVA-collective. Systolic and diastolic pressure also fell in the groups. In the SEVO-group, the difference was statistically significant only at the end of anaesthesia. After extubation, the three groups reached their hemodynamic starting-point with a slight overshoot in the SEVO-group. The number of required hemodynamic interventions was two (TCI-TIVA) vs. 7 (MAN-TIVA) vs. 8 (BAL-SEVO) in each group, respectively. The difference scarcely failed to get significance. The remifentanil requirements were similar between the collectives, group 1 needed more propofol per time than group 2. The number of side-effects was very little after the different regimens. There were no differences with regard to the other measured parameters between the groups. The use of TCI-TIVA was more expensive than manual TIVA (18,85 euro vs. 12,50 euro). Surprisingly, balanced anaesthesia using Sevoflurane was the most expensive method during the first hour, mainly due to the use of methohexitone as the induction agent (23,90 euro). CONCLUSIONS: Each of the three techniques compared in our study is suitable for anaesthesia in diagnostic neurosurgery. Since fast recovery of vigilance is important to justify the neurological outcome, none of the methods seems to be superior to the others. The hemodynamics were largely stable with a strong trend towards minor necessity for hemodynamic intervention in the TCI-TIVA group. This is also the best method from the subjective point of view of the anaesthesiologist due to the easy handling and the low number of interventions. The use of newer TCI-systems (e. g. fm-controller, Braun, Melsungen) not operating with special application syringes will cheapen TCI-TIVA.