[Troubleshooting with difficult replacement of voice prostheses and a novel retrograde procedure]. / Tipps und Tricks beim erschwerten Stimmprothesenwechsel und ein neues retrogrades Wechselverfahren.

The implantation of a voice prosthesis has become a standard procedure during a laryngectomy. A voice prostheses enables patients to develop speech shortly after surgery, which strongly improves rehabilitation and quality of life.The lifetime of a voice prosthesis is limited and highly variable due to different causes. A replacement is usually necessary several times a year and can easily been done in an outpatient setting with surface anesthesia. In some cases, replacing the prosthesis becomes difficult. This article will take a closer look at different reasons that can lead to difficulties in prostheses replacement and discuss possible solutions, thereby focusing especially on a retrograde technique. The aim of this article is to help colleagues that already have experience with voice prostheses and want to expand their therapeutic armamentarium.

Survival after repair of pararenal and paravisceral abdominal aortic aneurysms.

OBJECTIVE: The objective of this study was to review our 27-year clinical experience with open proximal abdominal aortic aneurysm repairs, with a focus on long-term survival. METHODS: A retrospective cohort study was undertaken of all patients who underwent proximal abdominal aortic aneurysm repair between 1986 and 2013 at a tertiary care referral center. Demographics, operative variables, complications, and 30-day mortality were analyzed. Postoperative acute kidney injury was analyzed by the RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease)/Acute Kidney Injury Network criteria. Long-term survival was assessed through review of electronic medical records and the Social Security Death Index. Associations between demographics and complications were investigated to determine predictors of long-term survival. RESULTS: The study identified 245 patients. Mean age was 71 years (range, 38-92 years); 69% were men, and 88% were white. Aneurysm type was juxtarenal in 127 patients (52%), suprarenal in 68 patients (28%), and type IV thoracoabdominal in 50 patients (20%). In-hospital mortality was 3.3% (eight patients), and 30-day mortality was 2.9% (seven patients). At least one major complication occurred in 64% of the patients, which included the following: acute kidney injury, 60% (persistent acute kidney injury at discharge, however, was 28%, and hemodialysis at discharge was 1.6%); major pulmonary complications, 22%; myocardial infarction, 4%; visceral ischemia, 2%; and paraplegia, 0.5%. Median follow-up was 54 months. Kaplan-Meier survival estimates were 70% at 5 years and 43% at 10 years. Variables associated with poorer survival included congestive heart failure (hazard ratio [HR], 3.5; P < .001), chronic obstructive pulmonary disease (HR, 1.8; P < .002), and increased aneurysm size at presentation (HR, 1.1; P < .013). Persistent stage 3 acute kidney injury was associated with poor long-term survival. CONCLUSIONS: Open surgical repair of proximal abdominal aortic aneurysms can be performed with low mortality. Acute kidney injury is the most frequent complication, but the need for hemodialysis at discharge is low. Long-term survival is favorable. These data should assist in establishing benchmarks for endovascular repair of complex proximal abdominal aortic aneurysms.

Comparison of different diagnostic assays for the detection of Borrelia burgdorferi-specific antibodies in dogs.

BACKGROUND: Antibody tests are frequently used in the diagnosis of canine Lyme borreliosis, including immunofluorescence assay (IFA) for immunoglobulin G (IgG) and M (IgM) antibodies, kinetic enzyme-linked immunosorbent assay (KELA), and Western blotting (WB). Recently, the SNAP4Dx, an in-house test using C6 technology has become available. OBJECTIVES: The aim of this study was to compare IFA, KELA, and SNAP4Dx assay results, and to determine their sensitivity and specificity when compared with the WB, used as gold standard in this study. METHODS: Two hundred canine sera were tested for the presence of specific antibodies against Borrelia spp. using the above-mentioned tests. RESULTS: The sensitivity and specificity of IFA-IgG was 76.6% (95% confidence interval [CI] 46.87-86.72) and 87.1% (95% CI 80.06-91.90), and 26.3% (95% CI 11.81-48.79) and 81.0% (95% CI 73.64-86.71) for IFA-IgM, respectively. KELA was 100% (95% CI 83.18-100) sensitive and 75.4% (95% CI 67.02-82.09) specific, and the SNAP4Dx was 84.2% (95% CI 62.43-94.48) sensitive and 98.5% (95% CI 94.83-99.60) specific. CONCLUSIONS: Both IFAs had very low sensitivity and specificity and cannot be recommended for screening purposes. In contrast, KELA showed excellent sensitivity, but positive results always need to be confirmed by WB to differentiate the source of antibody formation. The SNAP4Dx had a high sensitivity and specificity, and thus can potentially replace the more labor-intensive WB, at least in untreated dogs.

Comparison of different diagnostic tools for the detection of Anaplasma phagocytophilum in dogs.

BACKGROUND: Anaplasma phagocytophilum is common in dogs, but the best way to diagnose an infection is still not determined. Antibody detection assays are frequently used in veterinary practice. Additionally, polymerase chain reaction (PCR) is available for detection of A phagocytophilum DNA. It is still unknown, how well different diagnostic methods correlate. OBJECTIVES: The aim of the study was to compare 2 antibody detection assays, an immunofluorescence assay (IFA) and the ELISA SNAP4Dx, and to determine the correlation of these assays by evaluating the sensitivity and specificity compared with PCR as a direct detection method of the organism. METHODS: Sera of 200 prospectively included dogs were tested for antibodies to A phagocytophilum using IFA and SNAP4Dx. DNA of the organism was detected by PCR on whole blood. Sensitivity, specificity, and predictive values, including their 95% confidence intervals, were calculated for IFA and SNAP4Dx in relation to PCR. RESULTS: Four of 200 animals were PCR-positive. Sensitivity of IFA and SNAP4Dx was 100% (95% CI 51.01-100). Specificity of IFA was 52.9% (95% CI 50.42-64.17) and that of SNAP4Dx, 57.4% (95% CI 45.83-59.70). Agreement of the 2 antibody tests was fair (κ 0.334). CONCLUSIONS: Immunofluorescence assay and SNAP4Dx were very sensitive and therefore can be useful as screening tests for A phagocytophilum infection. However, the specificity was low, and agreement between both antibody tests was insufficient. This could be due to either false-positive antibody test results, or false-negative PCR results in dogs that were actually infected.

Prevalence of antibodies against Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum and their clinical relevance in dogs in Munich, Germany.

Although prevalences of antibodies against Borrelia (B.) burgdorferi sensu lato (sl) and Anaplasma (A.) phagocytophilum have been reported to be high in the German dog population, the importance of the diseases caused by both agents is still not well characterized in a field situation.The aim of this study was (1) to determine the prevalence of antibodies to B. burgdorferi sl and A. phagocytophilum in dogs in Munich, Germany, and (2) to assess the clinical presentation and laboratory values of antibody-positive dogs and compare them to a negative control group. In total, 448 randomly selected dogs were screened for antibodies to B. burgdorferi sl and A. phagocytophilum with the SNAP 4Dx assay (IDEXX, Laboratories, Inc., USA). Dogs carrying antibodies against B. burgdorferi sl and/or A. phagocytophilum were classified as "positive"(n=100), the following 100 negative dogs served as control group. In both groups, physical examination and laboratory parameters were compared. 22 (4.9%) dogs had antibodies to B. burgdorferi sl, 78 (19.4%) to A. phagocytophilum, nine (2.0%) to both agents. Bernese Mountain Dogs had significantly more often antibodies against B. burgdorferi sl. Negative dogs were more often diagnosed as "healthy" compared to A. phagocytophilum antibody-positives that showed more often elevated body temperature and poor general condition; beyond that, there were no differences in clinical and laboratory abnormalities between both groups. Although dogs tested negative were more often considered healthy, there were no differences in parameters considered "specific" for both infections between dogs with and without antibodies. Hence, tests detecting antibodies against both agents are not able to detect animals with the clinical disease.