Impact of a multifunctional image-guided therapy suite on emergency multiple trauma care.

BACKGROUND: The multifunctional image-guided therapy suite (MIGTS), a combined diagnostic and operating theatre, is currently the subject of considerable interest. This study investigated the effect of instituting a MIGTS on the emergency treatment of multiply injured patients. METHODS: This prospective controlled intervention study (MIGTS versus conventional treatment) included consecutive multiply injured trauma patients (Injury Severity Score of 16 or more) admitted between February 2003 and April 2005 to a university hospital. Main outcome measures were time to computed tomography (CT) and number of in-hospital transfers. RESULTS: A total of 168 patients were enrolled, 87 in the MIGTS and 81 in the control group. On average, CT was started at least 13 min sooner in the MIGTS group (P < 0.001), and these patients underwent fewer within-hospital transfers before arrival in the intensive care unit (median 2 versus 4 for controls; odds ratio -2.92, P < 0.001). Team members indicated increased satisfaction with the quality of the MIGTS procedure over the course of the study (P = 0.009). Thirty-day mortality rate (17 per cent for MIGTS versus 22 per cent for controls; P = 0.420) and long-term outcome did not differ between the two groups. CONCLUSION: Implementation of a MIGTS in the emergency treatment of multiple trauma significantly accelerated the procedure and reduced the number of in-hospital transports. REGISTRATION NUMBER: NCT0072213 (http://www.clinicaltrials.gov).

Cytotoxicity of Au-based dental solders alone and on a substrate alloy.

Gold-based dental solders are commonly combined with a substrate alloy in dental prostheses and are in long-term intimate contact with oral tissues, yet the biological properties of dental solders are almost unknown. Previous studies have shown that combinations of dissimilar alloys may increase the risk of elemental release and adverse biological effects. The purpose of the current study was to measure the cytotoxicity of dental solders alone and in combination with a substrate metal. Based on previous reports, which measured the cytotoxicity of combinations of dissimilar alloys, we hypothesized that the cytotoxicity of solder-substrate combinations cannot be predicted based on the cytotoxicity of the solders alone. Specimens of 13 high-noble (Au >/= 40 wt%; Au+Pt+Pd >/= 60%) and 6 noble (Au+Pt+Pd >/= 25 wt%) solders were made either in bulk or in combination with a compatible Au-Pd substrate alloy. The results showed that, most often, solder-substrate combinations were less toxic than the solders alone, but three high-noble solders were more cytotoxic in combination. We concluded that, when screening new Au-based dental solders for cytotoxicity, the solder should be assessed in combination with a clinically relevant substrate alloy.

Sebaceous carcinoma of the eyelid: a clinicopathological study.

BACKGROUND: Sebaceous carcinoma of the eyelid is rare. The diagnosis might be difficult because of its ability to masquerade as other periocular lesions. Prognosis is still regarded as being poor compared with most other malignant eyelid tumours with a mortality second only to malignant melanoma. The present study retrospectively analyses clinical and histopathological findings and outcome in a series of patients with sebaceous carcinoma of the eyelid in Britain. METHODS: 43 patients with histologically confirmed sebaceous carcinoma treated at Moorfields Eye Hospital between 1976 and 1992 were subjected to retrospective analysis. Clinical data of all patients were reviewed from the charts; all surviving patients except four cases lost for follow up were re-examined. Histological specimens were reviewed in 41 cases. RESULTS: 23 females and 20 males, mean age 63 years (range 37-79), were treated. Primary therapy was surgery in 37 and radiotherapy in six cases. After a median follow up of 40 months (range 1-148) 30 patients were alive without recurrences, four patients had died from the tumour, and one was alive with local recurrence and distant metastases. Four patients had died of non-tumour related causes. Histologically, unfavourable outcome was correlated with poor tumour differentiation and extensive invasion. CONCLUSION: Early diagnosis and consequent surgical therapy of sebaceous carcinoma of the eyelid leads to a better outcome and higher survival rates than generally assumed. Even local recurrences can be treated successfully. However, sebaceous carcinoma remains a threatening disease, which leads to death in 9% and to mutilating exenteration in 23% of our patients.

[Tumor embolism with fatal cerebral infarct in pneumonectomy. Case report and review of the literature]. / Tumorembolie mit letalem Hirninfarkt unter Pneumektomie. Fallbericht und Literaturübersicht.

Carcinomas of the bronchi often infiltrate veins, particularly in advanced stages. Tumor propagation in pulmonary veins with intra-atrial extension has been reported. Systemic arterial tumor embolism is a potentially fatal hazard that is caused by surgery or it can be the initial manifestation of a bronchogenic carcinoma. The importance of early pulmonary venous ligation in lung cancer surgery, first stressed by Aylwin in 1951, is evident, particularly when intravenous tumor progression has been diagnosed preoperatively by echocardiography or CT scan. We report a case of lethal hemispheric brain infarction following tumor embolism during lobectomy for bronchus carcinoma. A review of the literature on this subject is presented; there were 38 cases of arterial tumor embolism because of primary lung neoplasms.

Mersilene mesh brow suspension: efficiency and complications.

The use of the Mersilene mesh sling brow suspension procedure for the correction of severe blepharoptosis in 76 lids of 54 patients is presented. After a median follow up of 20 months functional and cosmetic results and complications were evaluated. The method is considered to be an alternative for those cases not primarily suitable for autogenous fascia lata brow suspension.

[Blepharophimosis syndrome. Clinical aspects and therapy]. / Das Blepharophimose-Syndrom. Klinik und Therapie.

Symptoms, genetics and differential diagnosis of this rare, congenital deformity of the lids are described. Strategies for the conservative and surgical therapy on the basis of own experiences and an extensive review of the literature are presented.

[The Excimer laser. I. The Lucerne evaluation procedure for Excimer therapy]. / Excimer Laser. I. Das Luzerner Evaluationsverfahren zur Excimertherapie.

The Excimer laser has been available for clinical applications in the Lucerne Eye Hospital since September 1990. Excimer laser keratectomy as a refractive therapy option is meeting with widespread interest among patients. As this is an invasive method whose complications cannot be neglected and for which long-term experience is so far lacking, this interest has to be balanced by extremely strict and responsible diagnosis by those offering the therapy. The authors present their evaluation concept here. The figures below document the reticence exercised in diagnosis: 1100 information leaflets dispatched are contrasted in the final analysis with only 34 laser treatments in a period of 10 months. 50 of the 200 patients admitted (referred by specialists) for preliminary examinations were definitively excluded from treatment in Lucerne as early as the administrative stage, and 61 during the clinical evaluation proper.

[The Excimer laser. II. Initial experiences with the Excimer laser in Lucerne]. / Excimer Laser. II. Erste Erfahrungen mit dem Excimer Laser in Luzern.

In the period between September 1990 and July 1991, 35 patients (46 eyes) were treated with the Excimer Laser. In 25 patients (34 eyes), a Myopia-Laser-Shaping was performed, one patient was treated for both myopia and astigmatism. In eight patients (10 eyes) correction of astigmatism was carried out. Two patients with recurrent erosions and one patient with superficial scarring of the cornea were treated. The authors review their initial experience with the Excimer Laser. The decision to initiate treatment must not be undertaken lightly, because the possibility of serious complications may not be neglected. This method shows promise in selected patients with light to medium degrees of myopia. In cases of severe myopia, our experience is encouraging. Subjectively, the patients are satisfied with the results, which do not fall short of their expectations. Further research and clinical experience in this area is urgently required.

[Spot-like to reticular pigment displacement in a patient with pseudoxanthoma elasticum (Grönblad-Strandberg syndrome)]. / Punktförmige bis retikuläre Pigmentverschiebungen bei einem Patienten mit Pseudoxanthoma elasticum (Grönblad-Strandberg-Syndrom).

The authors report a rare observation of leopard spot-like and reticular pigmentary patterns in a patient with pseudoxanthoma elasticum (PXE). Characteristic fundus changes associated with PXE have been described as angioid streaks, subretinal neovascularization membranes, peau d'orange, focal retinal pigment epithelium atrophy (salmon spots), drusen, and optic nerve head drusen. The new manifestation of PXE in the fundus of the patient described here is a random scattering of small, dark brown pigment dots throughout the macula and around the disk. These clumps may flow into one another or join together like a string of pearls. These changes are rare and should be distinguished from the others mentioned above. To the authors' knowledge no more than ten cases have been reported in the literature so far.

[Quality of life following heart valve prosthesis]. / Lebensqualität nach Herzklappenersatz.

The subjective and objective health status of 69 patients with a mean age of 58 +/- 9 years was evaluated 2-4 years after replacement of the aortic or mitral valve. All findings were compared to the preoperative status. Subjectively, 80% of all patients felt a considerable improvement following surgery and the mean NYHA functional class dropped postoperatively from 2.68 +/- 0.63 to 1.32 +/- 0.53 (p less than 0.001). 66% of all patients felt better mentally as well. However, 64% of all patients indicated that their intellectual capacity had decreased postoperatively. Objectively the signs of congestive heart failure had decreased significantly (edema -50%, rales -83%, neck vein distention -87%). Cardiomegaly and redistribution had improved in 77% and 80% of all patients, and left ventricular hypertrophy on ECG had disappeared in 46% of all cases. Despite this important subjective and objective improvement, there was little change in the degree of postoperative employment. Thus, valve surgery leads to a dramatic subjective and objective improvement of cardiac performance and quality of life. However, the improvement has little influence on postoperative resumption of work. Results of this study also suggest that cardiac surgery has a negative effect on intellectual capacity.