Pseudoaneurysm--a rare complication of internal jugular vein cannulation: two case reports in liver transplant patients

Internal jugular vein catheterization is nowadays a routine procedure in clinical practice. Arterial puncture is the most common complication of internal jugular vein catheterization. Two cases of pseudoaneurysm formation as a complication of accidental arterial puncture in liver transplant patients with coagulopathy are presented. Punctures of the common carotid artery, thyrocervical trunk, respectively were the source for these lesions. Coagulopathy is seen as an essential factor in the formation of pseudoaneurysm. Especially in patients with coagulopathy the threshold for ultrasound guidance should be low. Under these circumstances using the external jugular vein seems to be more prudent as it eliminates the risk for arterial punctures. We illuminate the genesis, signs and symptoms, diagnosis, and therapy of pseudoaneurysm. Recommendations for risk reduction are given.     

ARX-derived auditory evoked potential index and bispectral index during the induction of anesthesia with propofol and remifentanil

A new commercial auditory evoked potential (AEP) monitor (A-line AEP monitor) was developed to calculate an index (ARX AEP index; AAI) by automatically using the amplitudes and latencies of the AEP. We investigated 30 patients before spine surgery. AAI; bispectral index (BIS); relative (%) delta, theta, alpha, and beta; spectral edge frequency; median frequency; mean arterial blood pressure; heart rate; and oxygen saturation were obtained simultaneously during stepwise (1.0 micro g/mL) induction of target-controlled propofol concentration until 5.0 micro g/mL, followed by an infusion of 0.3 micro g. kg(-1). min(-1) of remifentanil. Every minute, the patients were asked to squeeze the observer's hand. Prediction probability (Pk), receiver operating characteristic, and logistic regression were used to calculate the probability to predict the conditions AWAKE, UNCONSCIOUSNESS (first loss of hand squeeze), and steady-state ANESTHESIA (5.0 micro g/mL of propofol and 0.3 micro g. kg(-1). min(-1) of remifentanil). Although a statistically significant difference among the conditions was observed for AAI, BIS, mean arterial blood pressure, median frequency, and %alpha, only AAI and BIS were able to distinguish UNCONSCIOUSNESS versus AWAKE and ANESTHESIA versus AWAKE with better than Pk = 0.90. The modern electroencephalographic variables AAI and BIS were superior to the classic electroencephalographic and hemodynamic variables to distinguish the observed anesthetic conditions. IMPLICATIONS: The modern electroencephalographic ARX-derived auditory evoked potential index and the bispectral index were superior to the classic electroencephalographic and hemodynamic variables for predicting anesthetic conditions. Variables derived from the auditory evoked potential did not provide an advantage over variables derived from spontaneous electroencephalogram.     

Evaluation of the first cytostatically active 1-aza-9-oxafluorenes as novel selective CDK1 inhibitors with P-glycoprotein modulating properties

The first series of synthetic 1-aza-9-oxafluorenes with cytostatic activities in the micromolar range was evaluated as cyclin-dependent kinase (CDK1) inhibitors. Activity was found to be selective in comparison to the inhibition of other kinases within the CDK family. Compounds were shown to inhibit the membrane-efflux pump P-glycoprotein responsible for multidrug resistance in cancer cells. First structure-activity relationships are discussed.     

Welche Vorteile bietet die volare Plattenosteosynthese gegenüber der Kirschner-Drahtstabilisierung bei distalen Radiusextensionsfrakturen des alten Menschen?

Purpose

The purpose of this retrospective study was to compare the outcome of open reduction and internal fixation (ORIF) followed immediately by physiotherapy and of percutaneous K-wire-fixation and casting for unstable distal radius fractures in elderly patients, considering the results both in general, for all such fractures, and selectively for A3 and C2fractures.

Methods

Follow-up examinations were performed 26 (18–48) months after surgery in 43 patients (median age 67 (60–83) years) treated with K-wire fixation and 9 (5–17) months after surgery in 46 patients (median age 76 (60–90) years) treated with ORIF, and the outcome of each was recorded as Disabilities of the Arm, Shoulder and Hand (DASH), Gartland-Werley and Castaing scores; the radiological loss of correction was also assessed. Statistical analysis was performed first without reference to the specific type of fracture for the K-wire- and the total ORIF –groups, and then selectively for A3 and C2 –fractures only; in the second analysis the patients were divided into three groups: KD, ORIF with and ORIF without angular stability.

Results

The Garland-Werley and Castaing scores do not indicate any significant difference between the procedures specified. According to the Garland-Werley score 37 patients (86%) treated by K-wire fixation and 39 (85%) treated by ORIF achieved “excellent” and “good” results; according to the Castaing score there were 33 (77%) “good” results after K-wire fixation and 34 (74%) good results after ORIF. The radiological loss of correction (K-wire fixation/ORIF) as measured by the radial inclination (median 2/2.5°), the palmar tilt (median 3/5°) and the radial shortening (median 1/1°mm) do not differ significantly. Suboptimal radiological results do not always correlate with results that are only “fair” or “poor”. The non-fracture-specific DASH score suggests a higher degree of patient satisfaction after K-wire fixation (7 [0–87] points) than after ORIF (17 [0–82] points), which is not confirmed by fracture-specific evaluation. There is a significantly earlier return to the “activities of daily living” (4 as against 8 weeks) after ORIF.

Conclusion

All the treatments compared are suitable for the treatment of A3 and C2 fractures. The important advantages of ORIF are the early functional physiotherapy without casting and without obligatory second surgery and the earlier return to “activities of daily living”, which are all of decisive importance for older patients, who are the ones most frequently affected.     

Die Candida-albicans-induzierte Spondylodiszitis der Halswirbelsäule bei einem polytraumatisierten Patienten

With the increasing occurrence of predisposing factors, invasive candidiasis is being diagnosed more frequently. Based on a review of only a few previous reported cases, we describe and discuss the unusual case of candidal cervical spondylodiscitis in a 36 year old man who had sustained a polytrauma, complicated through a Candida albicans pneumonia. The main symptom was disabling neck pain. Clinical, laboratory and radiological findings were unspecific. The definitive diagnosis was determined by MRI imaging and biopsy. The early diagnosis and surgical treatment with a sufficient debridement and stabilisation of the affected segment combined with a prolonged antifungal therapy lead to good results.     

Breast Shaping by an Isolated Tissue Flap

Breast reshaping surgery for tuberous breast, breast reduction, and mastopexy procedures aim to keep the gained shape for a long time. In breast reduction, the surgeon must avoid loss of fullness in the upper pole, descent of the breast mass known as secondary dropout, and relapsed shape of the repaired tuberous breasts. As described in their clinical report, the authors use a caudally based thoracic wall flap to avoid these problems. The blood supply to the breast comes from two main sources: the mammary internal and lateral arteries. Because of vessels constantly perforating the pectoralis major muscle, it is possible to isolate a caudally based thoracic wall flap. These vessels originate from intercostal arteries as anteromedial intercostal perforators, and from the thoracoacromial artery as in the skin paddle of the pectoralis major muscle flap. This flap is long enough to reach every part of the breast where it is needed. Between January 2002 and June 2005, 64 patients underwent procedures in which the caudally based thoracic wall flap was used.     

Rhizotoxicity of cadmium and copper in soil extracts

Dissolved organic matter (DOM) influences metal speciation in soil solutions and, hence, metal toxicity. Root-elongation experiments were conducted to examine the effect of soil solution components, such as Ca, H, and DOM, on metal rhizotoxicity. A biotic ligand model (BLM) was tested for its ability to predict the rhizotoxicity of Cd and Cu in soil extracts. It was hypothesized that the concentration of Cd and Cu bound to functional groups at the root surface estimated using a BLM would be a better predictor of rhizotoxicity than the free-metal ion activity in solution. Both metals became less toxic at higher DOM, Ca, and H concentrations. Solution speciation and the effect on root growth explained most of the variability observed in the DOM experiments, but not in the cation experiments. It was concluded that Ca and H inhibited the rhizotoxicity of both metals tested. Rhizotoxicity data correlated better with estimates of metal-root complexes that have been estimated with a BLM than with free-metal ion activity or with total metal concentrations. The BLM seems to be a promising approach for predicting metal availability in soils and for assessing the associated risk.     

Nuclei of stroma: Site of highest estrogen concentration in human benign prostatic hyperplasia

In an earlier publication we found significantly more estrogen receptor-positive cases in the stroma if compared with the epithelium of human benign prostatic hyperplasia (BPH). We were therefore interested to find out whether this preferential assay of estrogen receptor in stroma is reflected by a higher estrogen content in this tissue fraction. Estradiol (E₂) and estrone (E₁) were measured by RIA in whole BPH tissue, stroma, and epithelium as well as in the nuclear fraction of stroma and epithelium. For comparison, E₂ and E₁ were measured in blood also. The main results are as follows: 1) In all BPH samples the E₂ (26.0 ± 3.5(SEM) pg/g (n = 20)) and E₂ (53.5 ± 7.4 (14)) content was significantly higher than in the corresponding plasma (E₂: 17.5 ± 2.3 pg/ml (11); E₁: 26.5 ± 4.4 (7)), the mean ratio of E₂/E₁, was 0.52 and 0.69 for BPH and plasma, respectively; 2) in stroma significantly more E₂ (53.6 ± 7.8 fmol/mg DNA (18)) and E₁, (55.9 ± 8.4 (12)) were measured than in epithelium (E₂: 15.7 ± 1.9(16); ₁: 20.7 ± 3.2(13)); 3) in nuclei of stroma significantly higher E₂ (38.0 ± 5.3 fmol/mg DNA (20)) and E₁ (19.2 ± 4.8 (14)) concentrations were present than in epithelium (E₂: 6.8 ± 3.1 (19); E₁: 2.5 ± 0.5 (13)), the mean ratio of E₂/ E₁ for thenuclear fractions of stroma (2.3) and epithelium (2.7) increased dramatically if compared with the respective ratio in whole BPH tissue. In conclusion, there is a distinct accumulation of estrogens in the nuclei of stroma, E₂ concentration being significantly higher than E₁. These data support the hypothesis that E₂ could play a preferential role in stimulating the growth of the BPH stroma.