Cardiovascular dynamics during peroral endoscopic myotomy for esophageal achalasia: a prospective observational study using non-invasive finger cuff-derived pulse wave analysis

Peroral endoscopic myotomy (POEM) is natural orifice transluminal endoscopic surgery to treat esophageal achalasia. During POEM, cardiovascular dynamics can be impaired by capnoperitoneum, capnomediastinum, and systemic carbon dioxide accumulation. We systematically investigated changes in cardiovascular dynamics during POEM. We included 31 patients having POEM in this single-center prospective observational study. Before and every 5 min during POEM we measured mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) using non-invasive finger cuff-derived pulse wave analysis. During POEM, the median MAP was higher than the median baseline MAP of 77 (67;86) mmHg. HR (median at baseline: 67 (60;72) bpm), CI (2.8 (2.5;3.2) L/min/m²), SVI (42 (34;51) mL/m²), and SVRI (1994 (1652; 2559) dyn × s × cm^?5 × m^?2) remained stable during POEM. Mixed model-derived 95% confidence limits of hemodynamic variables during POEM were 72 to 106 mmHg for MAP, 65 to 79 bpm for HR, 2.7 to 3.3 L/min/m² for CI, 37 and 46 mL/m² for SVI, and 1856 and 2954 dyn × s × cm^?5 × m^?2 for SVRI. POEM is a safe procedure with regard to cardiovascular dynamics as it does not markedly impair MAP, HR, CI, SVI, or SVRI.

     

Evaluation of non-radioactive in situ hybridisation method to detect Chlamydia trachomatis in cell culture.

A DNA probe combined with a non-radioactive stain was used to detect inclusions of Chlamydia trachomatis in cell culture. Of 39 positive cultures detected by monoclonal antibodies in combination with direct immunofluorescence, 35 were positive by the DNA hybridisation method, the sensitivity being 89.7%. Staining with iodine showed a sensitivity of 87.2%, corresponding to 34 positive cultures. The specificity of DNA hybridisation method was 100%, as all 162 cultures that were negative by the immunofluorescence method were also negative when assessed by the DNA hybridisation method.     

The spermatozoal volume as indicative of the plasma membrane integrity (modification of the hypoosmotic swelling test). II. Diagnostic approach

Summary. If using a method of statistical sifting based on the Kolmogoroff-Smirnov test for differentiation of volume distribution curves of a modified HOS-test, different curve types are obtained under isotonic as well as under hypotonic conditions. Arrangement of spermatological parameters of the relevant ejaculates according to the individual curve types reveals significant differences for motility. No correlation can be seen with the results of the microscopic HOS-test. Consequences for the use of the modified HOS-test in medical practice are discussed.     

Tumoral calcinosis

Tumoral calcinosis is a distinct entity, which is rarely seen in Europe and North America but much more common in black Africans. Typical symptoms are calcified nodules, which grow while remaining asymptomatic and are found in the tissues adjacent to the large joints of the body. Histologically there is collagen necrobiosis initially, which results in aggregates of densely calcified material. The aetiology is unknown, but the condition is probably a form of dystrophic calcification caused by mechanical injury. A patient with tumoral calcinosis is presented, and the clinical and histological findings are described.     

Quantitative Venous Severity Scoring Using the Venous Arterial Flow Index by Duplex Sonography

BACKGROUND: Volume flow, as the product of the mean blood flow velocity by the cross sectional area, means an interesting hemodynamic pattern that can be calculated by duplex. OBJECTIVE: To quantify the severity of venous insufficiency using the correlation between the volume flow in the common femoral vein (VFV) and artery (VFA), called the venous arterial flow index (VAFI). METHODS: A total of 163 consecutive patients were included: 46 patients with postthrombotic syndrome (PTS, group 1), 38 patients with complete varicosity of the greater saphenous vein (group 2), 40 patients with only segmental or truncal varicosity (group 3), and 39 patients with competent veins (group 4). Under standardized conditions, duplex sonography was performed to calculate volume flow in the common femoral vein and artery as a product of mean blood flow velocity (vm) and precise diameter (d = 2pir) of the vessel due to the formula VF = vmxpir2 (L/min). Division of the venous and arterial volume flow data calculated the VAFI. RESULTS: Significant differentiation of VFV (P <.001) and VAFI (P <.0001) between varicose veins and healthy limbs were found. In PTS the mean VFV was 0.50 L/min and the mean VAFI was 1.465. In the complete varicosity group, mean VFV was 0.46 L/min and mean VAFI was 1.48. In group 3, the mean VFV was 0.41 L/min and the mean VAFI was 1.31. In healthy persons, mean VFV was 0.36 L/min and mean VAFI was 0.87. CONCLUSION: The VAFI can be used to quantify the hemodynamic severity in venous insufficiency.     

Manual lymph drainage]

The manual lymphdrainage is a special method of massage which is often used for cosmetical purposes. Methodology, mode of action and indications are presented and the results of treatment are reviewed.     

Effects of plastic-foil-occlusion on psoriatic lesions

Summary In 24 patients with psoriasis vulgaris two individual lesions were excized. One lesion had been occluded with plastic-foil for up to 16 days, while one lesion remained untreated. By comparison of the occluded with the non-occluded one the following clinical, histological and histochemical results were obtained:After occlusion there was a slight clinical reduction of lesions consisting in flattening, fading of erythema and diminution of scales.Histologically a decrease in acanthosis with persisting dermal inflammatory infiltrates was seen.Histochemically there was a reduction in activities of enzymes of the energy-producing metabolism. Qualitative and topical enzyme distribution patterns, typical for psoriasis, remained practically the same although there was an overall decrease of enzyme activities. The reconstruction of the Intermediärzone remained incomplete.The dermal inflammatory infiltrate persisted.

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Zusammenfassung Bei 24 Patienten mit Psoriasis vulgaris wurden jeweils 2 Psoriasisherde excidiert. Der eine Herd was bis zu 16 Tagen mit Plastikfolie occludiert worden, während der andere unbehandelt blieb. Beim Vergleich der occludierten Herde mit den nicht-occludierten konnten folgende klinische, histologische und histochemische Befunde erhoben werden:Unter der Occlusion kam es zu einer gewissen Rückbildung der Herde mit Abflachung und Verminderung von Erythem und Schuppung. Histologisch fand sich eine Rückbildung der Acanthose bei persistierendem entzündlichen Infiltrat.Histochemisch kam es zur Verminderung der Aktivitäten von Enzymen des energieliefernden Stoffwechsels. Trotz dieser generellen Verminderung blieb das für Psoriasis typische qualitative und topische Enzymverteilungsmuster praktisch unverändert. Das entzündliche Infiltrat im Corium persistierte.