[Removal of an epidural catheter under ongoing antithrombotic therapy]. / Entfernung eines Epiduralkatheters unter antithrombotischer Therapie.

A rare though extremely harmful complication in neuraxial anaesthesia is an epidural hematoma which can be associated with deleterious consequences for the patient, e. g. persistent paraplegia. The risk of epidural haematomas after neuraxial blockade is dependent on abnormal anatomy of the spine, difficult and multiple punctures and coagulation disorders. Especially when patients undergo therapy with anticoagulants like low molecular heparin or platelet inhibitors (tyclopidine) or a combination of them, the indication for neuraxial blockade must strictly outweigh risk of spinal bleeding. In this context, the precautions and contraindications are the same for spinal puncture and catheter insertion as for catheter removal. We describe the case of a patient who underwent emergency coronary angioplasty in combination with coronary stent implantation due to acute postoperative myocardial infarction following knee replacement in continuous epidural anaesthesia. Under the symptoms of a beginning local infection at the puncture site the epidural catheter had to be removed in spite of ongoing antithrombotic therapy. A possible management of such cases is discussed with regard to risk minimization.

Effects of isovolaemic haemodilution on oxygenation of liver and skeletal muscle.

BACKGROUND AND OBJECTIVE: Hydroxyethyl starch is frequently used for volume substitution during surgical procedures and for isovolaemic haemodilution. Haemodilution has also been shown to improve tissue oxygen tension in skeletal muscle: However, effects of this volume substitute on tissue oxygen tension of the liver during haemodilution remains unknown. METHODS: Fourteen foxhounds were anaesthetized with fentanyl/midazolam and mechanically ventilated with 30% oxygen. Following splenectomy animals were randomly assigned to a control group without haemodilution but fluid substitution with Ringer's lactate (Group C) or underwent isovolaemic haemodilution to a haematocrit of 25% with hydroxyethyl starch 70/0.5 (Group H). Haemodynamic parameters and oxygen transport during 100 min following isovolaemic haemodilution were measured. Liver oxygen tension was recorded using a flexible polarographic electrode tonometer, whereas in the muscle a polarographic needle probe was used. RESULTS: Animal characteristics and baseline haematocrit were similar in both groups. At baseline the tissue oxygen tension of liver and skeletal muscle were not different between groups. Haemodilution with hydroxyethyl starch 70/0.5 provided augmentation of mean liver tissue oxygen tension (baseline: 46 +/- 13 mmHg; 20 min: 60.3 +/- 12 mmHg; 60 min: 60 +/- 16 mmHg; 100 min: 63 +/- 16 mmHg; P < 0.05 vs. baseline), while oxygen tensions in Group C remained unchanged (baseline: 48 +/- 16 mmHg; 20 min: 52 +/- 19 mmHg; 60 min: 49 +/- 12 mmHg; 100 min: 52 +/- 16 mmHg) and no differences could be detected between groups. Oxygen tension in skeletal muscle changed as follows: Group H - baseline: 24 +/- 32 mmHg; 20 min: 32 +/- 3 mmHg; 60 min: 33 +/- 7 mmHg; 100 min: 33 +/- 11 mmHg. Group C - baseline: 22 +/- 6 mmHg; 20 min: 21 +/- 3 mmHg; 60 min: 24 +/- 4 mmHg; 100 min: 18 +/- 4 mmHg (P < 0.05 vs. baseline, p < 0.05 vs. Group C). CONCLUSION: In this animal model, isovolaemic haemodilution with hydroxyethyl starch 70/0.5 increased tissue oxygen tension in liver and skeletal muscle in comparison with baseline values. However, when compared between groups haemodilution only resulted in an increase of tissue oxygen tension in the muscle but not in the liver.

Estimates of the distributions of forest ecosystem model inputs for deciduous forests of eastern North America.

Techniques for evaluating uncertainties in process-based, computer simulation models are evolving in response to the proliferation of such models and the demand for their use in the management of forest ecosystems. Many evaluation techniques require precise statements of the uncertainties associated with each model input. Statements of uncertainty are typically formulated as probability density functions (pdfs). Here, pdfs are developed for 29 inputs of the process-based, forest ecosystem, computer simulation model PnET-II, many of which are inputs to other well-known forest ecosystem models. The inputs considered describe vegetation characteristics of forests typical of the Eastern Deciduous Forest biome of North America. Data were compiled largely from published literature to estimate pdfs. The compiled distributions can be used to conduct various model evaluations including uncertainty assessment, calibration, and sensitivity analysis.

Postreplantation management of avulsed teeth: an endodontic literature review.

Today's dental treatment goals are directed at reducing the incidence of root resorption resulting from periodontal ligament devitalization or pulp necrosis. Although the American Association of Endodontists recommends the use of long-term therapy, short-term therapy may be utilized with confidence in well-defined clinical applications. Early final obturation with gutta-percha will increase the long-term prognosis in those cases where patient motivation is questionable or long-term follow-up prior to obturation is not possible. However, where inflammatory resorption is already present, long-term calcium hydroxide therapy is indicated. Long-term post treatment follow-up is imperative in both calcium hydroxide therapies.

A review of endodontic medicaments.

Endodontic intracanal medicaments are often used when root canal therapy cannot be completed in a single visit. Properties of the more commonly used medicaments are outlined, their effectiveness is examined, and recommendations for use are made, based on evidence in the literature reviewed here.

[Art and rehabilitation]. / Kunst und Rehabilitation.

The therapeutic benefit of art therapy in rehabilitation differs from that of art in general in that the creative activity is viewed as a vehicle of remediation in the one case while, in the other, art is an end in itself. In the arts, being disabled may be brought to bear as a quality of the creative processes involved. In no other field have integration and equality of disabled people been realized more fully than in the artistic-cultural domain, while artistic achievements of disabled people, in turn, hold the potential for lasting impact on public awareness generally. Creation of a centre to provide professional training opportunities for persons with disabilities in the performing arts would be desirable. A national umbrella organization of groups and individuals active in the field of creativity, EUCREA-Deutschland is planning to step up its efforts in drawing attention to the importance of arts and culture for disabled people.