[Traumatic abruption of the placenta with disseminated intravascular coagulation]. / Traumatische plazentalösung mit disseminierter intravasaler gerinnung.

Trauma in pregnancy is infrequent and a systematic primary strategy constitutes a real challenge for the interdisciplinary team. With a high fetal mortality rate and a substantial maternal mortality rate traumatic placental abruption is a severe emergency which every anesthetist should be aware of. After hemodynamic stabilization of the mother and control of the viability of the fetus the therapy of traumatic placental abruption consists mostly of an immediate caesarean section. Coagulopathy by depletion of coagulation factors as well as disseminated intravascular coagulation (DIC) have to be expected and consequently a massive blood loss must be anticipated. Thrombelastography provides assistance for fast differential diagnosis and goal-directed treatment of the disturbed sections of the coagulation cascade.

T2 and DWI in pilocytic and pilomyxoid astrocytoma with pathologic correlation.

OBJECTIVE: To quantify and compare T2 signal and apparent diffusion coefficient (ADC) in pilocytic and pilomyxoid astrocytoma (PA and PMA) and correlate results with myxoid content. METHODS: Echo-planar diffusion weighted images (DWI) and standard magnetic resonance imaging (MRI) findings were reviewed retrospectively in patients with PA (n=34) and PMA (n=8). Regions of interest (ROIs) were drawn on ADC maps within tumor parts with lowest ADC values. Apparent diffusion coefficient values in tumor were normalized to those in cerebrospinal fluid (ADC/CSF). The ratio of T2 signal intensity in solid tumor parts to CSF (T2/CSF) was registered. Myxoid matrix was histologically quantified retrospectively in 8 PMAs and 17 PAs and correlated with imaging findings. RESULTS: Mean ADC/CSF for PA and PMA was 0.53±0.10 and 0.69±0.10 (p<0.01). Mean T2/CSF for PA and PMA was 0.78±0.19 and 0.93±0.09 (p<0.01). Mean proportion of myxoid tumor matrix in PA was 50% (range, 10-100%) and 93% (range, 90-100%) in PMA (p=0.004). Eight patients (32%; all PA) had less than 50% myxoid content and 17 (68%; 8 PA; 9 PMA) had more. There was positive correlation of ADC/CSF, T2/CSF and ADC (r2=0.61, 0.65 and 0.60 respectively) and significant difference between the groups with more and less than 50% myxoid content (p=0.01 for ADC/CSF and T2/CSF and p=0.02 for ADC). CONCLUSIONS: General imaging features of PA and PMA are non-specific, ADC values and T2 signal intensity are generally higher in the latter, reflecting the proportion of myxoid matrix in these tumors.

[Infections with respiratory syncytial virus. Underestimated risk during anaesthesia in infants]. / Infektionen mit dem "respiratory syncytial virus". Unterschätzte Gefahr bei Säuglingsnarkosen.

Infections with respiratory syncytial virus (RSV) are responsible for a large proportion of seasonal winter airway diseases. After an infection with RSV no persistent immunity remains. Adults show no or only a few symptoms similar to the common cold. However, in preterm and newborn children RSV infections lead to severe and even life-threatening bronchiolitis. These children require supplementary oxygen and often need respiratory support. The infection with RSV considerably enhances the risk of anaesthesia-related complications in infants. So far this problem has rarely been mentioned in the literature. We report on an infant with a RSV infection who was ventilation-dependent for 9 days after anaesthesia for a minor intervention.