Single-incision laparoscopic surgery for cholecystectomy: an evolving technique

Background  

Laparoscopic techniques have allowed surgeons to perform complicated intraabdominal surgery with minimal trauma. Recent innovators have pioneered the use of single-incision laparoscopic surgery (SILS), which has the potential of further reducing the trauma of surgical access. This may lead to reduced postoperative pain and improved patient cosmesis.     

Über diep H-Messung in strömenden Flüssigkeiten

Zusammenfassung Die vonUhl undKestranek angegebene Antimonelektrode eignet sich zwar zup _H-Messungen, besonders zu elektrometrischen Titrationen sehr gut, dagegen nicht zup _H-Messungen in strömenden Flüssigkeiten, da an ihrer Oberfläche Strömungspotentiale entstehen und bei Änderung der Strömungsgeschwindigkeit Galvanometerausschläge beobachtet werden, auch wenn dasp _H der durchströmenden Flüssigkeit nicht verändert wird. Bei der Einbindung einer besonders konstruierten Elektrode in die Carotis bei der Vergleichs- und Ableitungselektrode in direkter Verbindung mit der strömenden Flüssigkeit stehen, traten synchron mit der Herzaktion Ströme auf, die durch die pulsatorische Beschleunigung des Blutstromes erzeugt wurden.Bei Verwendung der Manganelektrode (Tower, Smith, Gesell) konnten nach unseren bisherigen Versuchen in strömenden Flüssigkeiten ebenfalls, wenn auch nicht regelmäßig, Strömungspotentiale nachgewiesen werden. Die Manganelektrode eignet sich aus diesem Grunde unserer Meinung nach zu Messungen an strömenden Flüssigkeiten nicht viel besser als die Antimonelektrode. Sie hat außerdem den Nachteil, daß sie aufp _H-Veränderungen weniger gut anspricht wie die Antimonelektrode und die Potentiale sehr viel schlechter reproduzierbar sind und es häufig sogar schwer ist, überhaupt konstante Potentiale zu erhalten.     

One for all,all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV

Background

With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time-consuming and logistically demanding. We developed a neuro-HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach.

Methods

People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt-out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced.

Results

Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV-associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non-HIV-associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV-1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV-RNA was detectable in 18.4% out of 185 participants.

Conclusions

Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non-HIV causes of NCI. A 1-day evaluation system is beneficial for both participants and referring physicians.