Tracheotomy-endoscop for dilatational percutaneous tracheotomy (TED)

While surgical tracheotomies are currently performed using state-of-the-art operative techniques, percutaneous dilatational tracheostomy (PDT) is in a rapidly evolving state with regard to its technology and the number of techniques available. This has resulted in a range of new complications that are difficult to quantify on a scientific basis, given the fact that more than half of the patients who are tracheotomized in intensive care units die from their underlying disease. The new Tracheotomy Endoscope (TED) is designed to help prevent serious complications in dilatational tracheotomies and facilitate their management. The endoscope has been specifically adapted to meet the require-ments of percutaneous dilatational tracheotomies. It is fully compatible with all current techniques of PDT. The method is easy to learn. The percutaneous dilatational tracheotomy with the Tracheotomy Endoscope is a seven-step procedure: Advantages of the Tracheotomy Endoscope: Injuries to the posterior tracheal wall ar impossible (tracheoesophageal fistulas, pneumothorax). Minor bleeding sites on the tracheal mucosa can be controlled with a specially curved suction-coagulation tube introudeced through the Tracheotomy Endoscope. In cases with heavy bleeding and a risk of aspiration, the rigid indwelling Tracheotomy Endoscope provides a secure route for reintubating the patient with a cuffed endotracheal tube. It also allows for rapid conversion to an open surgical procedure if necessary. All the parts are easy to clean and are autoclavable. This type of endoscopically guided PDT creates an optimal link between the specialties of intensive care medicine and otorhinolaryngology. The Tracheotomy Endoscope (TED) increases the standard of safety in PDT.     

Motor signals in visual localization

We demonstrate a strong sensory-motor coupling in visual localization in which experimental modification of the control of saccadic eye movements leads to an associated change in the perceived location of objects. Amplitudes of saccades to peripheral targets were altered by saccadic adaptation, induced by an artificial step of the saccade target during the eye movement, which leads the oculomotor system to recalibrate saccade parameters. Increasing saccade amplitudes induced concurrent shifts in perceived location of visual objects. The magnitude of perceptual shift depended on the size and persistence of errors between intended and actual saccade amplitudes. This tight agreement between the change of eye movement control and the change of localization shows that perceptual space is shaped by motor knowledge rather than simply constructed from visual input.     

The quantification inventory for somatoform syndromes (QUISS): a novel instrument for the assessment of severity

Background To date, specific scales for the assessment of severity of somatoform disorders are still rare. Characteristic cognitive and behavioural domains, representing severity are not incorporated in the existing scales. Results with the novel quantification inventory for somatoform syndromes (QUISS) are presented in this paper. Methods The QUISS has been developed as a qualified severity scale for patients fulfilling diagnostic criteria according to DSM-IV or/and ICD-10. It was designed to be particularly suitable for application in clinical trials and for monitoring the efficacy of psychotherapy and pharmacotherapy. Not only number, severity and frequency of somatoform symptoms, but also common cognitive and behavioural domains of somatoform disorders have been included into this instrument. Both an 18-item patient- and observer-rated version are available taking about 20 min to complete. The questionnaire was applied to patients with somatoform disorder (N = 96), major depression (N = 24), and panic disorder (N = 16). Results The psychometric properties of the scale are satisfactory. The QUISS showed high objectivity (Cronbach’s α = 0.90 for both versions; inter-scale correlations r = 0.64–0.88; p < 0.05), good test-retest- (r = 0.87; p < 0.05) and inter-rater-reliability (r = 0.89; p < 0.05). External validity (moderately high correlations of QUISS-T to SOMS 7T (r = 0.54), significant discrimination to major depression p < 0.05) was satisfactory. Factor structure revealed five relevant factors. Conclusions The QUISS could be a useful instrument in somatoform disorders for the assessment of syndrome severity and treatment outcome in scientific and clinical settings.     

Four-dimensional single breathhold magnetic resonance imaging using kt-BLAST enables reliable assessment of left- and right-ventricular volumes and mass

PURPOSE: To prospectively determine the accuracy of four-dimensional (4D) kt-broad-use linear acquisition speed-up technique (BLAST) accelerated MRI (kt-BLAST) for the assessment of left-ventricular (LV) volumes and mass as well as right-ventricular (RV) volumes in comparison to standard multiple breathhold cine imaging. MATERIALS AND METHODS: A total of 40 patients with suspected or known coronary artery disease (CAD) underwent cardiac MRI. In each patient a standard multislice cine steady-state free precession (SSFP) sequence was performed with complete ventricular coverage during multiple breathholds. Additionally, a kt-BLAST-accelerated 4D sequence with complete ventricular coverage was acquired during one single breathhold. For comparison of SSFP and kt-BLAST, the following LV parameters were determined: end-diastolic and end-systolic volumes, ejection fraction, end-diastolic diameter and mass. For comparison of RV dimensions, end-diastolic and end-systolic volumes and ejection fraction were assessed. RESULTS: LV volumes, ejection fraction, diameter, and mass showed a strong correlation between SSFP and kt-BLAST (r=0.98-0.99; P<0.01). In addition, RV parameters demonstrated a high correlation (r=0.97-0.98; P<0.01). For all parameters, the calculated bias between both methods was found to be minimal (0.4-4%). CONCLUSION: 4D kt-BLAST-accelerated MRI enabled the accurate assessment of LV and RV quantitative parameters during one single breathhold when compared to standard multislice, multiple breathhold SSFP imaging.     

Myopotentials leading to ventricular fibrillation detection after advisory defibrillator generator replacement

We present an unusual source of oversensing following an internal cardioverter‐defibrillator generator change. The early appearance of reproducible myopotentials in the defibrillator sensing channel is usually due to a technical complication at the time of device implantation. Clues such as abrupt impedance change or reproduction with mechanical stimulation can help to localize a problem. Frequently the complication requires reoperation to examine the system. What do you do when everything seems to be working fine?     

Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome

OBJECTIVE: (1) To perform a 9-year study of abstinence, lapse, and relapse in 180 chronic alcoholic patients, participants of the Outpatient Longterm Intensive Therapy for Alcoholics (OLITA); (2) To investigate the role of supervised alcohol deterrents (AD) in relapse prevention and as an adjunct for maintenance of long-term abstinence. METHOD: This prospective open treatment study evaluates the long-term course of drinking outcomes and AD use of 180 chronic alcoholics consecutively admitted from 1993 to 2002. Subsamples are compared for (1) sham-AD versus verum-AD (disulfiram/calcium carbimide), (2) coped lapses versus finally detrimental lapses versus malignant relapses, and (3) AD use for 13 to 20 versus >20 months. RESULTS: In this 9-year study, the cumulative probability of not having relapsed was 0.52, and that of not having consumed any alcohol was 0.26. Despite long-term use, disulfiram/calcium carbimide was well tolerated. Patients on sham-AD (due to contraindications to verum-AD) showed higher cumulative abstinence probability than patients on verum (S = 0.86 vs. S = 0.49, p = 0.03). Detrimental lapses and malignant relapses occurred earlier than successfully coped lapses (p < 0.001); patients with detrimental lapse and with malignant relapse had fewer days of AD intake and less subsequent days without AD than patients with coped lapse (p < 0.001). The cumulative abstinence probability was S = 0.75 for patients with long-term intake compared with S = 0.50 for patients who stopped AD between months 13 and 20 (p < 0.001). CONCLUSIONS: An abstinence rate of >50% in this 9-year study strongly supports the concept of comprehensive, long-term outpatient treatment of alcoholics. Supervised, guided intake of AD, also over extended periods, can be used as a predominantly psychologically acting ingredient of successful alcoholism therapy.     

Shared networks for auditory and motor processing in professional pianists: evidence from fMRI conjunction

To investigate cortical auditory and motor coupling in professional musicians, we compared the functional magnetic resonance imaging (fMRI) activity of seven pianists to seven non-musicians utilizing a passive task paradigm established in a previous learning study. The tasks involved either passively listening to short piano melodies or pressing keys on a mute MRI-compliant piano keyboard. Both groups were matched with respect to age and gender, and did not exhibit any overt performance differences in the keypressing task. The professional pianists showed increased activity compared to the non-musicians in a distributed cortical network during both the acoustic and the mute motion-related task. A conjunction analysis revealed a distinct musicianship-specific network being co-activated during either task type, indicating areas involved in auditory-sensorimotor integration. This network is comprised of dorsolateral and inferior frontal cortex (including Broca's area), the superior temporal gyrus (Wernicke's area), the supramarginal gyrus, and supplementary motor and premotor areas.     

Anatomical and functional evaluation of myocardial bridging on the left anterior descending artery by cardiovascular magnetic resonance imaging.

A myocardial muscle bridge spans a segment of a major epicardial coronary artery that is located in the myocardium. This anatomic configuration can be responsible for angina pectoris, arrhythmias or even death. The current reference standard for diagnosis is conventional x-ray coronary angiography showing systolic compression of an epicardial vessel and the typical angiographic "milking effect." We report the case of a patient with myocardial bridging on the left anterior descending artery, in whom a combination of noninvasive high resolution display of the coronary artery lumen, visualization of the myocardium and functional assessment of blood flow during dobutamine stimulation by cardiovascular magnetic resonance imaging was performed.