Neonatal hemoperitoneum caused by a congenital liver angioma

Severe intraabdominal bleeding in neonates within 24 hours after birth are an extremely seldom event. In our neonate, the intraabdominal bleeding was diagnosed by the clinical picture and by abdominal ultrasound examination. The etiology for this bleeding was primarily a blunt abdominal trauma as described in most cases of the liver; however, histology showed a congenital cavernous angioma of the liver resulting in a different tensile strength of this part of the liver in comparison with the rest of the liver tissue. Therefore, a relatively blunt abdominal trauma caused a rupture of the liver in a histologically altered part, which histologically was found to be a relatively soft and fragile tumor of the liver.     

Complications in high tibial (medial opening wedge) osteotomy

Introduction The high tibial (medial opening wedge) osteotomy (HTO) is a standard procedure in the treatment of varus gonarthrosis. This is potentially associated with various complications. The aim of this study was an analysis of complications and potential technical mistakes.Materials and methods A total of 85 patients (49 male and 36 female) suffering from varus gonarthrosis underwent a medial opening wedge HTO. The osteotomy was fixed in 55 patients by a spacer plate (Puddu plate; group A). In group B (n=30), the osteotomies were fixed by C-plate.Results The rate of complications was 43.6% in group A and 16.7% in group B (p<0.05). Infraction of the lateral tibial head is a possible intraoperative complication. This was seen in 11.7%. An additional osteosynthesis was required in group A. In contrast, the C-plate can solve this problem without additional measures. General complications of the HTO were seen: infection (4.7%), hematoma (4.7%), and thrombosis (2.3%). In every case of a severe deep infection, the osteotomy space was filled with synthetic bone graft. These grafts were used only in group A. Failure of the implants is a potential cause of loss of correction. This complication was seen nine times in group A but never in group B.Conclusion A diligent surgical technique and a convenient implant are obligatory in (medial opening wedge) HTO.     

Laryngeal mask airway versus endotracheal tube for outpatient surgery: analysis of anesthesia-controlled time

STUDY OBJECTIVE: To show that efficiency of operating room times can be improved significantly using rapid changes between operative procedures. DESIGN: Randomized, prospective clinical study. SETTING: Tertiary care university hospital, elective peripheral trauma-related orthopedic surgery. PATIENTS: 72 adult, ASA physical status I, II, and III patients scheduled for elective peripheral trauma-related orthopedic surgery requiring general anesthesia. INTERVENTIONS: Patient airways were managed using either a Laryngeal Mask Airway (LMA) or an endotracheal tube (ETT) in the hands of anesthesiologists experienced in both. They were not informed as to the primary intention of the study. All perioperative data, including the preoperative and postoperative outpatient stay at the outpatient surgical ward, were recorded with an anesthesia information management system. MEASUREMENTS: The primary outcome measures were: time needed for anesthesia induction and emergence from anesthesia. All manual recording into the anesthesia information management system during anesthesia was accomplished by nurses who were uninformed as to the aim of the study. MAIN RESULTS: Anesthesia induction was significantly (p < 0.01) shorter using LMAs (means +/- SD, medians, [interquartile ranges]) (LMA: 5.8 +/- 1.5, 5, [5;7] vs. ETT: 7.4 +/- 1.8, 7, [7;8] min), whereas emergence from anesthesia was not different (LMA: 11.8 +/- 3.3, 11, [9;14] vs. ETT: 13.2 +/- 4.8; 12, [10;16] min). CONCLUSION: The clinical relevance of reduced anesthesia induction time using LMA is questionable. The lack of difference in emergence time could be a result of the use of total intravenous anesthesia.     

Stimulatory effect of antidepressants on the production of IL-6

A body of evidence indicates that the therapeutic activity of antidepressants is connected with their modulatory effect on the inflammatory response system and cell-mediated immunity. The present study was carried out to examine the effects of antidepressant agents, such as imipramne, venlafaxine, l-5-hydroxytryptophan, fluoxetine and a combination of l-5-hydroxytryptophan and fluoxetine, on the production of the pleotrophic cytokines TNF-alpha and IL-6. Diluted whole blood from fluoxetine-treated patients with treatment-resistant depression (TRD) (mean age: 50.6+/-3.9 years), age-matched healthy controls (mean age: 51.6+/-1.7 years) and younger healthy volunteers (mean age: 35.4+/-1.7 years) was stimulated with phytohemagglutinin (PHA) and lipopolysaccharide (LPS) for 48 h with or without incubation with the antidepressants at 10(-6) and 10(-5) M. The major findings of this study are: (1). imipramine and venlafaxine (at the higher concentration), 5-HTP (at lower and higher concentrations) and a combination of 5-HTP and fluoxetine (both at the lower concentration) increased the production of IL-6; (2). all drugs used did not affect TNF-alpha production. IL-6 production was significantly higher in depressed patients than in age-matched volunteers, whereas TNF-alpha production was significantly higher in older volunteers than in younger ones. We speculate that the therapeutic activity of these antidepressants is at least partly connected with their effect on the cytokine network and IL-6 production.     

Morphosyntax, prosody, and linking elements: the auditory processing of German nominal compounds

The morphosyntactic decomposition of German compound words and a proposed function of linking elements were examined during auditory processing using event-related brain potentials. In Experiment 1, the syntactic gender agreement was manipulated between a determiner and the initial compound constituent (the 'nonhead' constituent), and between a determiner and the last constituent ('head'). Although only the head is (morpho)syntactically relevant in German, both constituents elicited a left-anterior negativity if its gender was incongruent. This strongly suggests that compounds are morphosyntactically decomposed. Experiment 2 tested the function of those linking elements which are homophonous to plural morphemes. It has been previously suggested that these indicate the number of nonhead constituents. The number agreement was manipulated for both constituents analogous to Experiment 1. Number-incongruent heads, but not nonhead constituents, elicited an N400 and a subsequent broad negativity, suggesting that linking elements are not processed as plural morphemes. Experiment 3 showed that prosodic cues (duration and fundamental frequency) are employed to differentiate between compounds and single nouns and, thereby, between linking elements and plural morphemes. Number-incongruent words elicited a broad negativity if they were produced with a single noun prosody; the same words elicited no event-related potential effect if produced with a compound prosody. A dual-route model can account for the influence of prosody on morphosyntactic processing.     

ERPs reflect lexical identification in word fragment priming

Behavioral evidence suggests that spoken word recognition involves the temporary activation of multiple entries in a listener's mental lexicon. This phenomenon can be demonstrated in cross-modal word fragment priming (CMWP). In CMWP, an auditory word fragment (prime) is immediately followed by a visual word or pseudoword (target). Experiment 1 investigated ERPs for targets presented in this paradigm. Half of the targets were congruent with the prime (e.g., in the prime-target pair: AM-AMBOSS [anvil]), half were not (e.g., AM-PENSUM [pensum]). Lexical entries of the congruent targets should receive activation from the prime. Thus, lexical identification of these targets should be facilitated. An ERP effect named P350, two frontal negative ERP deflections, and the N400 were sensitive to prime-target congruency. In Experiment 2, the relation of the formerly observed ERP effects to processes in a modality-independent mental lexicon was investigated by presenting primes visually. Only the P350 effect could be replicated across different fragment lengths. Therefore, the P350 is discussed as a correlate of lexical identification in a modality-independent mental lexicon.