Closed suctioning system reduces cross-contamination between bronchial system and gastric juices

In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (TrachCare) influences crossover contamination between bronchial system and gastric juices when compared with an open suctioning system (OS). The secondary aims were an analysis of the frequency of ventilator-associated pneumonia (VAP) and an analysis of alteration in gas exchange. Antibiograms were performed from tracheal secretions and gastric juice aspirates on Days 1 and 3 of intubation in 24 patients in a medical intensive care unit. Five cross-contaminations were observed in the OS group on Day 3 versus Day 1; the 5 strains shared common genotypes as determined by random amplification of polymorphic DNA. No cross-contaminations were seen in the CS group (P = 0.037). VAP occurred in 5 patients of the OS group but in none of the CS group patients (P = 0.037). Spao(2) decreased significantly in the OS group compared with presuctioning values--the opposite of the CS group. Whereas presuctioning values were comparable between groups, postsuctioning Spao(2) was significantly higher in the CS group. CS significantly reduced cross-contamination between bronchial system and gastric juices and reduced the incidence of VAP when compared with OS. Hypoxic phases can be reduced by the help of CS.     

The effect of different stages of neuromuscular block on the bispectral index and the bispectral index-XP under remifentanil/propofol anesthesia

Facial electromyographic activity and neuromuscular block could influence bispectral index (BIS) depth of anesthesia monitoring. In this study we examined, in 30 patients undergoing general surgical procedures, the effect of different stages of neuromuscular block on BIS monitoring and compared the conventional A-2000 BIS trade mark (BIS(3.4)) with the new BIS-XP trade mark (BIS(XP)). At deep surgical anesthesia BIS(3.4) of approximately 40, under a propofol 3.61 microg/mL target-controlled infusion and a 0.15-0.3 microg. kg(-1). min(-1) remifentanil infusion, mivacurium 0.15 mg/kg was administered. The onset of neuromuscular block triggered a brief transient odd divergence in response that manifested as a BIS(3.4) increase from 43 +/- 4 to 49 +/- 7 (P = 0.007) and a BIS(XP) decline from 41 +/- 3 to 35 +/- 3 (P = 0.003) at 1 +/- 0.2 min. Then, 2.5 +/- 1 min after mivacurium administration, both monitors returned to baseline values of 43 +/- 5 and 40 +/- 4, respectively. After that, BIS(3.4) and BIS(XP) did not significantly change during complete neuromuscular block or during various levels of neuromuscular recovery. At all phases, BIS(XP) was significantly lower than BIS(3.4). Our study indicated that the BIS(3.4)/BIS(XP) bias and the wide limits of agreement do not allow values given by the two monitors to be used interchangeably.     

Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results

OBJECTIVE: We sought to evaluate the early angiographic and clinical outcomes of the first session of endovascular coil occlusion of a large number of patients with intracranial aneurysms treated by five neurointerventionalists during a decade at a single center. METHODS: We performed retrospective analyses of pre- and postprocedural angiographic studies and early clinical outcomes. Enrolled patients underwent endovascular treatment of intracranial aneurysms with detachable coils. RESULTS: A total of 1811 aneurysms in 1579 patients were treated with coil occlusion. Of these, 90 to 100% occlusion of 86.5% of the aneurysms was achieved. In 82.3% of the procedures, no complications occurred. The clinical outcome profile at primary discharge according to the Glasgow Outcome Scale was as follows: Grade V, 74.6%; Grade IV, 6.7%; Grade III, 11.1%; Grade II, 3.1%; and Grade I, 4.5%. In patients with large aneurysms with wide necks, a lower occlusion rate and an increased complication rate were encountered. The use of three-dimensional and fibered coils resulted in higher occlusion rates. Balloon remodeling and stent deployment increased the complication rate. Previous aneurysm rupture, procedural complications, and vasospasm correlated with poor outcome. Of the patients in poor grade after aneurysm rupture, 42% recovered to Glasgow Outcome Scale Grade IV or V, as opposed to 90% of patients who were treated for unruptured aneurysms. The ischemic complication rate was 9%, and the hemorrhagic complication rate was 3%. The early procedural morbidity rate was 5.3%, and the procedural mortality rate was 1.5%. The management mortality rate was 4.4%. CONCLUSION: These data confirm the safety and efficacy of endovascular coil occlusion for patients with intracranial aneurysms.     

Effects of an Er:YAG laser on mitochondrial activity of human osteosarcoma–derived osteoblasts in vitro

The aim of the present study was to investigate the collateral damage of an Er:YAG laser on bone cells in vitro using a special application tip designed for treatment of periimplantitis. Before laser irradiation, SaOs-2 osteoblasts (2×10⁴ cells) were inoculated into 96-well tissue culture plates and incubated for 48 h under standardised conditions. A total of 120 cell cultures were irradiated with an Er:YAG laser using a cone-shaped quartz glass fibre tip at energy settings of 40, 60, 80 and 100 mJ at 10 Hz (energy densities of 5.08, 7.62, 10.16 and 12.7 J cm^–2) for 10 s. Each energy setting was used at a distance of 1, 2 and 3 mm between the application tip and the bottom of the culture plate. Following irradiation, mitochondrial activity of the cells was measured using a luminescent cell viability assay. After laser irradiation, mitochondrial activity of SaOs-2 osteoblasts was significantly reduced when compared with nonirradiated cells (P<0.001), dependent on the energy setting used and the distance between the application tip and the bottom of the culture plate. Mitochondrial activity increased significantly with decreasing energy settings and increasing distances (P<0.001). Within the limits of the present study, it was concluded that an Er:YAG laser, used with a cone-shaped glass fibre tip designed for treatment of periimplantitis, has detrimental effects on mitochondrial activity of SaOs-2 osteoblasts in vitro at energy settings of 40, 60, 80 and 100 mJ (10 Hz).     

Prognosis of stage pT0 after prolonged neoadjuvant endocrine therapy of prostate cancer: a matched-pair analysis

OBJECTIVES: Stage pT0 following prolonged neoadjuvant endocrine therapy (PPNET) of prostate cancer is of great clinical interest, because this finding suggests maximum tumor damage. Therefore pT0 patients are expected to have an extremely favorable PSA progression rate. The purpose of this study was to assess whether the PSA progression rate of pT0 patients after PPNET is lower than that of non-pT0 patients after PPNET. METHODS: 174 patients with previously untreated, clinical stage cT1-3 carcinomas were submitted to PSA monitored complete androgen deprivation therapy followed by radical prostatectomy (RP). In 138 patients the RP specimens showed residual cancer, in 36 patients no residual cancer was found. Biochemical progression was defined as PSA >/=0.2ng/ml. To control for confounding prognostic factors (Gleason score, cT-stage) between both groups a matched-pair analysis for the cumulative risk of biochemical failure was performed, resulting in 30 matched pairs. RESULTS: With a median follow-up of 37.9 and 46.0 months in the matched non-pT0 and pT0 cohort respectively, matched-pair analysis failed to demonstrate significant differences in crude PSA relapse-free survival between both groups (p=0.7758). CONCLUSION: The results suggest that patients converted into pT0 after PPNET do not represent a subgroup with an extremely favorable prognosis. However our results have to be confirmed by the assessment of larger cohorts of pT0 patients with a longer follow-up. The presented data do not allow drawing any conclusions on the prognostic impact of PPNET in general.     

Internal fixation of complex fractures of the proximal humerus

We treated 34 consecutive articular fractures of the proximal humerus in 33 patients with good bone quality by open reduction and internal fixation. Anatomical or nearly anatomical reduction was achieved in 30, at a mean follow-up of 63 months (25 to 131), complete or partial avascular necrosis had occurred in 12 cases (35%). Two patients subsequently underwent arthroplasty and six further patients required additional surgery. The 32 patients who did not require arthroplasty obtained a mean Constant score of 78 points or 89% of an age- and gender-matched normal score (66 points or 76% in the presence and 83 points or 96% in the absence of avascular necrosis (p < 0.0005)); 22 were painfree, and seven had mild pain and three moderate pain. The mean active anterior elevation was 156 degrees. Internal fixation of complex fractures of the proximal humerus restored good shoulder function if avascular necrosis did not develop.     

Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal massive bleeding

We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved.     

Are unnecessary follow-up procedures induced by computer-aided diagnosis (CAD) in mammography? Comparison of mammographic diagnosis with and without use of CAD

OBJECTIVE: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. MATERIALS AND METHODS: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers = group 1; 49 histologically proven benign lesions = group 2 and 100 screening cases (4 years-follow up = group 3). Mammograms were evaluated by a CAD system (Second Look, CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). RESULTS: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. CONCLUSION: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid.     

Multiplanar functional imaging of the larynx and hypopharynx with multislice spiral CT

The purpose of this study is to evaluate multislice spiral CT (MSCT) in multiplanar functional imaging of the larynx and hypopharynx and to define the optimal image planes for the delineation of the tumor and specific anatomical structures. Forty patients with suspected tumors of the larynx or hypopharynx were examined with MSCT during quiet breathing (QB), E-phonation (EP) and modified Valsalva maneuver (VM). Images were read in the axial, coronal and sagittal planes. Overall image quality, delineation of the tumor and anatomic structures for different conditions and orientations were graded using a three-point scale; the conditional permutation test was applied to detect quality differences. Differences between image types were statistically significant. The axial plane was superior in overall image quality and the delineation of the tumor, pyriform sinus, vocal cords and fat within the parapharyngeal/visceral space. The coronal plane was best for delineating the ventricle and the paraglottic space, the sagittal plane for the retropharyngeal and the preepiglottic space. For tumor detection, sensitivity, specificity and accuracy were 0.92, 1.0 and 0.93 for QB.ax, 0.94, 0.8 and 0.92 for EP.ax and 0.85, 1.0 and 0.87 for VM.ax, respectively. Examination during QB should be the standard procedure; additional scanning with EP improved tumor assessment.