„Feel confident and know what to do?“ Wissensstand und Handlungssicherheit von Rettungsdienstfachpersonal zur präklinischen Erwachsenenreanimation

Notfall + Rettungsmedizin - Deutsches Rettungsdienstfachpersonal jeder Qualifikation erlernt die Erwachsenenreanimation im Rahmen der Ausbildung bzw. der Lehrgänge. Es soll ermittelt werden,...     

Re-dosing of del Nido cardioplegia in adult cardiac surgery requiring prolonged aortic cross-clamp

Open in a separate window OBJECTIVESFew data exist on the use of del Nido cardioplegia in adults, specifically during operations requiring prolonged aortic cross-clamp. In this pilot study, we evaluate outcomes of patients undergoing surgery with cross-clamp time >3 h based on re-dosing strategy, using either full dose (FD; 1:4 blood to crystalloid ratio) or dilute (4:1 blood to crystalloid ratio) solution.METHODSConsecutive adult patients (>18 years) undergoing cardiac surgery from 2012 to 2018 with cross-clamp time >3 h were reviewed. Patients were excluded if del Nido cardioplegia was not used. Patients were categorized into FD or dilute groups based on re-dosing solution. Propensity score matching was used to control for baseline differences between groups. The primary endpoint was in-hospital mortality. Other outcomes examined included: postoperative mechanical support, arrhythmia, stroke, dialysis and cardiac function.RESULTSIncluded for analysis were 173 patients (115 male) with median age of 63.8 (interquartile range 53.9–73.1). Major comorbidities included diabetes (45), cerebrovascular disease (34), hypertension (131), atrial fibrillation (52) and previous cardiac surgery (83). There were 108 patients (62%) who received FD re-dosing, while 65 (38%) received dilute. A greater proportion of patients in the dilute group received retrograde delivery, for both induction (32/108 vs 39/65, P < 0.001) and re-dose (50/108 vs 53/65, P < 0.001). After propensity score matching, in-hospital mortality was not different between groups (6/48 vs 1/48, P = 0.131). There were no differences in rates of postoperative mechanical circulatory support, stroke, left ventricular ejection fraction or right ventricle dysfunction.CONCLUSIONSDel Nido cardioplegia has been used in complex cardiac surgery requiring prolonged cross-clamp. Re-dosing can be performed with either FD or dilute del Nido solution with no statistical difference in outcomes.     

Neuroimaging of emotional brain circuitry in bipolar disorder

Abnormalities in the regulation of emotion and motivational behavior are core features of bipolar disorder (BD) implicating the brain structures that subserve these functions. Converging neuroimaging evidence supports the involvement in BD of a neural system comprised of ventral prefrontal cortex, amygdala, and ventral striatum. Neuroimaging studies demonstrate abnormalities in both the structure and function of these brain regions. Findings in amygdala and ventral striatum in adolescents with BD suggest a neurodevelopmental trajectory for the appearance of regional abnormalities in this neural system. Preliminary studies suggest that mood-stabilizing medications may provide beneficial effects for the structure and functioning of this circuitry. New research directions, including those that integrate genetic studies with neuroimaging research, may provide important insights into the pathophysiologic mechanisms contributing to BD, and point to new strategies for its detection and treatment.     

Differentiation of obsessive-compulsive-, panic-, obsessive-compulsive personality-, and non-disordered individuals by variation in the promoter region of the serotonin transporter gene

Past research investigating the role of the serotonin transporter gene in OCD has produced mixed findings. One possible reason for the mixed findings is comorbidity. In this study, non-comorbid OCD individuals were compared to non-disordered controls. A sample of panic disordered individuals was also compared to a non-disordered group. Finally, as an exploratory analysis, individuals were assessed for OCPD and their allelic frequencies were also compared to non-disordered individuals. Analyses revealed that there were higher frequencies of the s/s genotype among the OCD group when compared to non-disordered controls. There were no differences in allelic frequencies on the serotonin transporter gene between the panic disordered group, the OCPD group, and the non-disordered control group. This study found that non-comorbid OCD individuals tended to have a higher percentage of the homozygous short genotype than non-disordered individuals. The s/s genotype might serve as a contributory risk factor for OCD.     

Do synaesthetic colours act as unique features in visual search?

For individuals with grapheme-colour synaesthesia, letters, numbers and words elicit vivid and highly consistent colour experiences. A critical question in determining the mechanisms underlying the phenomenon is whether synaesthetic colours arise early in visual processing, prior to the allocation of focused attention, or at some later stage following explicit recognition of the inducing form. If the synaesthetic colour elicited by an achromatic target emerges early in visual processing, then the target should be relatively easy to find in an array of achromatic distractor items, provided the target and distractors elicit different synaesthetic colours. Here we present data from 14 grapheme-colour synaesthetes and 14 matched non-synaesthetic controls, each of whom performed a visual search task in which a target digit was distinguished from surrounding distractors either by its unique synaesthetic colour or by its unique display colour. Participants searched displays of 8, 16 or 24 items for a specific target. In the chromatic condition, target and distractor digits were presented in different colours (e.g., a yellow '2' amongst blue '5's). In the achromatic condition, all digits in the display were black, but targets elicited a different synaesthetic colour from that induced by the distractors. Both synaesthetes and controls showed the expected efficient (pop-out) search slopes when the target was defined by a unique display colour. In contrast, search slopes for both groups were equally inefficient when the target and distractors were achromatic, despite eliciting distinct colours for the synaesthetes under normal viewing conditions. These results indicate that, at least for the majority of individuals, synaesthetic colours do not arise early enough in visual processing to guide or attract focal attention. Our findings are consistent with the hypothesis that graphemic inducers must be selectively attended to elicit their synaesthetic colours.     

Localized Bullous Pemphigoid Following Orthopedic Surgery

Bullous pemphigoid is an autoimmune condition whereby the immune system forms antibodies that target the skin, resulting in the formation of blisters in a generalized and symmetric pattern. Localized bullous pemphigoid can occur in special circumstances. Here, we describe two patients that developed localized bullous pemphigoid in one lower extremity following orthopedic surgery. We propose that underlying edema following orthopedic surgery is a potential trigger for localized bullous pemphigoid.     

Arthroscopic revision Bankart repair: a preliminary evaluation

Arthroscopic stabilization of primary, recurrent anterior shoulder instability has become the procedure of choice with infrequent exceptions. Failures of stabilization can and do occur. This is a Level IV retrospective analysis of arthroscopic revision Bankart surgery performed on 15 non-consecutive patients over a 4-year period with an average 22-month follow-up. The average patient age was 27.5 with 12 men and 3 women. Four of the 15 failures were from the senior author's (R.K.N.R.) practice with the remaining 11 referred for treatment. Four of the 15 failures resulted from open surgery while the remaining 11 failed an arthroscopic stabilization procedure. Four contact/collision athletes were included, and significant bone loss was recorded in 5 patients. Operative findings included 10 recurrent Bankart lesions while 9 patients were felt to demonstrate capsular attenuation. Fourteen of the 15 had a Hill-Sachs lesion while chondromalacic change involving the anterior glenoid was noted in 13 of the 15 patients. A suture anchor technique was used with an average of 2.5 double-loaded suture anchors. In this series, 4 failures occurred after revision arthroscopic stabilization (27%) with an average SANE score of 86 (range, 65-100). One of the 5 patients with significant bone loss sustained a recurrence while 1 of 4 contact athletes failed the revision arthroscopic stabilization. Two of the 4 failures in this study subsequently underwent an open bone block procedure. Arthroscopic revision Bankart repair can be an effective alternative, but should only be considered in the properly selected patient.     

Average 7-Year Survivorship and Clinical Results of a Newer Primary Posterior Stabilized Total Knee Arthroplasty

We evaluated the average 7-year survivorship and clinical results of a newer primary posterior stabilized total knee arthroplasty (TKA). The modifications in this design included a deeper patellar sulcus aimed at reducing contact stresses, improving patellar tracking, and achieving greater maximum flexion. A consecutive group of 137 patients (171 knees) who underwent TKAs using the Optetrak PS knee prosthesis between October 1997 and March 2004 were followed for an average of 6.8?years (range 4.0-11.5?years). Preoperative range of motion (ROM) and Knee Society scores were obtained and compared to that of the patients' most recent follow-up. Manipulation under anesthesia (MUA) and revision of the implant for any reason were considered endpoints for Kaplan-Meier survival analysis of all knees. Twenty-one knees (12.3%) underwent MUA. Three knees (1.8%) underwent revision, resulting in a 97.2% survival at a mean 10?years follow-up. Pain scores and ROM significantly improved after surgery (from preoperative average of 5.3 and 105° respectively to 44.6 and 120° postoperatively). These findings suggest that this posterior stabilized knee design is both a safe and effective option for patients undergoing primary TKA.     

Traumatic Complex Hawkins Type IV Talar Fracture: A Case Report

Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.