Intensive care delirium monitoring and standardised treatment: A complete survey of Dutch Intensive Care Units

OBJECTIVE: Delirium is a frequent and serious problem in the Intensive Care Unit (ICU). Several international guidelines recommend daily monitoring for ICU-delirium. The purpose of this article is to give an up-to-date overview of the current status of monitoring and treatment of ICU-delirium in the Netherlands. DESIGN: Nation-wide, telephone-based questionnaire survey. PARTICIPANTS: Head nurse of all ICUs and a random sample of intensivists. RESULTS: Only 14% (n=14) of all Dutch ICUs (n=103) monitored for ICU-delirium. Of these, only half (7%) used a tool that is validated in ICU patients. In 31% of Dutch ICUs, a protocol was used to treat ICU-delirium. Responses were obtained from 100% of ICUs. CONCLUSION: Despite an international guideline, not more than 7% of ICUs in our study routinely evaluated the presence of delirium with a validated instrument. Fewer than one-third of Dutch ICUs use a protocol to treat ICU-delirium.     

Activation of Coagulation Factor V by a Platelet Protease

Factor V must be converted to Factor V_a in order to bind to a high affinity platelet surface site and participate in prothrombin activation. Osterud et al. (10) presented data that suggested that human platelets contain an activated form of Factor V and a Factor V activator. We find that the Factor V released when platelets are disrupted by freezing and thawing or sonication is activated 3- to 10-fold by thrombin as determined by coagulation assay and is therefore stored as the relatively inactive procofactor rather than in the active form Factor V_a.     

Left atrial volume determination by echocardiography

To validate echocardiographic left atrial volume measurements, 25 patients with mitral stenosis were studied before and after mitral balloon valvuloplasty. Seven normals served as controls. The modified Simpson's rule was used for echocardiographic and angiographic left atrial volume determination from two orthogonal planes. Left atrial antero-posterior diameter was measured from parasternal long axis view and supero-inferior and medio-lateral diameters from apical four-chamber view. Transthoracic echocardiographic left atrial volume correlated well, but systematically underestimated angiographic left atrial volume (y=0.4x+27, r=0.92). Monoplane transesophageal echocardiography did not improve correlation, nor the underestimation. Out of the several left atrial diameters, antero-posterior dimension showed the closest correlation with angiographic volume (r=0.91), which persisted after exclusion of patients with atria >400 ml (r=0.84). Futhermore, relative changes of antero-posterior diameter after mitral valvuloplasty were closely related to the relative changes observed in left atrial volume (r=0.82). Our results suggest that, in spite of a consistent underestimation, bidimensional, transthoracic echocardiographic and angiographic left atrial assessment correlate closely. Moreover, it is suggested that the mere antero-posterior diameter from transthoracic two-dimensional image is sufficient in clinical practice for routine follow-op of left atrial volume.     

实验性短期电刺激引起的机体紊乱

SourcepapersdealingwiththeuseofLateralElectricSurfaceStimulation（LESS）totreatidiopathicscoliosis（IS）inchildrenandadolescentshavesofarpresentedcontroversialopinions犤５，６，８，１０，１２，１６，１７犦．Authorsrecommendingthistreatmentusuallyapplyitfor９hoursatnight．Theymention，however，thatthetherapywhichmaylastuntilthebonesarefullydeveloped，oftenresultsinskincomplications，e．g．burns，emotionalandpsychicaldiscomfortofpatientsduringnoc－turnalrest，aswellasstressorevendisturbances…     

Calcifying epithelial odontogenic tumour of the maxilla: a case report with respect to immunohistochemical findings

Calcifying epithelial odontogenic tumour (Pindborg tumour) is a rare benign neoplasm with a poorly understood histogenesis. This report describes a single case of a maxillary calcifying epithelial odontogenic tumour including immunohistochemical analysis. The vast majority of tumour cells were positive for CK5/6 and p63. Furthermore, basal cells also displayed moderate reaction for vimentin and strong membranous positivity for podoplanin. Interestingly, the tumour invaded the dental pulp of the partially disintegrated tooth root. While the tumour showed focal connection with the superficial gingival epithelium and revealed intercellular bridges, the findings of this case study seem to support the suggestion of an epithelial origin of a calcifying epithelial odontogenic tumour derived from the dental lamina.     

Controlled release of chlorhexidine antiseptic from microporous amorphous silica applied in open porosity of an implant surface

Amorphous microporous silica (AMS) serving as a reservoir for controlled release of a bioactive agent was applied in the open porosity of a titanium coating on a Ti-6Al-4V metal substrate. The pores of the AMS emptied by calcination were loaded with chlorhexidine diacetate (CHX) via incipient wetness impregnation with CHX solution, followed by solvent evaporation. Using this CHX loaded AMS system on titanium substrate sustained release of CHX into physiological medium was obtained over a 10 day-period. CHX released from the AMS coating was demonstrated to be effective in killing planktonic cultures of the human pathogens Candida albicans and Staphylococcus epidermidis. This surface modification of titanium bodies with AMS controlled release functionality for a bioactive compound potentially can be applied on dental and orthopaedic implants to abate implant-associated microbial infection.