Erstes kontinuierliches Nerven-Monitoring in der Schilddrüsenchirurgie

Zusammenfassung. Ein neuartiges „all in one“ Monitoringsystem für den N. laryngeus recurrens (NLR) erlaubt sowohl eine kontinuierliche, atraumatische überwachung des NLR als auch eine in situ Detektion des Nerven. Patienten und Methode: Das System basiert auf einem Doppelballontubus mit integrierten Oberfl?chenelektroden zur transtrachealen Stimulation und Ableitung des Erfolgsorgans. Fakultativ kann über eine elektrische Stimulationsnadel der NLR im OP-Feld identifiziert werden. Die Signalverarbeitungs-Software stellt eine Neuentwicklung unserer Arbeitsgruppe dar und führt eine Echtzeit-Signalanalyse mit akustischer Rückkoppelung durch. 55 Patienten wurden in die klinische Zulassungsstudie eingebracht, 35 Prim?reingriffe, 20 Sekund?reingriffe, davon 10 Halsausr?umungen. Ergebnisse: Die Plazierung des EMG-Tubus ist mit der Routineintubation abgeschlossen und erfordert keinen zus?tzlichen Zeitbedarf. Das System ist au?erhalb des OP Feldes lokalisiert und beeintr?chtigt daher nicht den OP Ablauf. Die akustische Rückkoppelung wurde von allen 8 Operateuren als hilfreich und nicht st?rend beurteilt. Die phoniatrische und HNO-?rztliche Analyse erbrachte keine permanenten Beeintr?chtigungen. Schlu?folgerung: Das neue kontinuierliche Monitoringsystem erm?glicht erstmals eine atraumatische nebenwirkungsfreie Dauerüberwachung des NLR. Es ist einfach anzuwenden, arbeitet au?erhalb des OP-Gebiets und ist so sensitiv, da? auch reversible Irritationen erkannt werden k?nnen.      

Contrôle de l’équilibre et port unilatéral d’une orthèse rigide de cheville. Partie II : effets sur des sujets sains évalués debout en bipédie

In order to compare the effects induced by the unilateral wearing of a rigid orthosis (Thuasne, Ligacast Immo^®) in comparison to a reference model consisting of an elastic stocking, balance control strategies of 14 healthy subjects have been evaluated in two-legged standing. To this aim, 10 trials lasting 32 s have been recorded through a device made of two separate force platform allowing the separate measurement of the reaction forces intervening under each foot. Balance strategies have been assessed from the centre of pressure trajectories issued from the left (CP_G) and right feet (CP_D) and, through a calculation, from the resultant CP (CP_Res). These various trajectories, projected along mediolateral (ML) and anteroposterior (AP) axes, have been then analysed in the frequency domain. If no difference has been observed for the CP_Res trajectories, the separate analysis of each support has furnished statistically significant results for the CP trajectories measured under the foot wearing the orthosis since the amplitudes decrease along both ML and AP axes. Contrary to what was observed in the previous study conducted in one-legged standing, with effects occurring only along the AP axis, these results appear thus in better accordance with the objectives of an orthosis since diminishing the involvement of the lateral ligaments. This kind of protocol appears thus more relevant for characterising in situ the effects of an orthosis made of two rigid shells.     

甲苯达唑、阿苯达唑和吡喹酮对小鼠细粒棘球蚴囊壁延胡索酸酶、磷酸烯醇丙酮酸羧激酶和丙酮酸激酶的影响(英文)

细粒棘球蚴囊壁的延胡索酸酶(FH)活力为911—14333,磷酸烯醇式丙酮酸羧激酶(PEPCK)与丙酮酸激酶(PK)的活力之比为2.2—2.7,表明囊壁的糖代谢以酵解途径为主,感染小鼠用甲苯达唑、阿苯达唑或吡喹酮ig治疗,剂量各为25—50,300和500mg·kg~(-1)·d~(-1),连给7—14d,未见对FH有明显的影响,而PK和PEPCK则可明显被前二种药物所抑制。     

Therapie der Glomerulonephritis

Zusammenfassung Die Therapie der Glomerulonephritis ist kompliziert, weil das klinische Bild sehr unterschiedlich sein kann. Eine akute Nephritis, ein nephrotisches Syndrom oder lediglich eine geringe Proteinurie oder Hämaturie können Ausdruck einer Glomerulonephritis sein. Die Indikation zu einer symptomatischen Therapie kann vom klinischen Bild abgeleitet werden, eine immunsuppressive Therapie setzt eine histologische Diagnose voraus, um die mögliche Differenzialtherapie abzudecken.Die sofortige Therapie einer rapid-progressiven Glomerulonephritis kann den Patienten vor der Dialyse bewahren. Ein nephrotisches Syndrom wird entsprechend dem klinischen Verlauf zuerst symptomatisch; bei histologischen oder klinischen Anzeichen für eine Progression in die Niereninsuffizienz ist meist eine definierte Immunsuppression zusätzlich indiziert. Die durch Studien untersuchten Therapieschemata werden detailliert vorgestellt.

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Use of random versus apheresis platelet concentrates

The respective use of random (RPC) and apheresis (APC) platelet concentrates is highly heterogeneous among countries, ranging from 10 to 98% RPC in countries supposed to provide a similar transfusion service to patients. Moreover, when considering each country in the past 10 years, one can observe that some have changed their policy, switching from a majority of APC to RPC or vice versa. This presentation intends to analyse which factors may impact such decisions. For many years, the only available platelet component was a RPC obtained from whole blood donation by a two centrifugation steps process, the "platelet rich plasma" or PRP method. Since the beginning of the 1970s, APCs became available, with in fact many different techniques leading to many APCs that may not be equivalent. Since the end of the 1980s, a new method of RPC preparation was developed, using the buffy-coat (BC-PC), providing a blood component with highly preserved platelet functions as compared to RPCs prepared by the PRP technique. Finally, the use of each of these components either native, or leuco-reduced, or suspended in a storage solution, or processed with a pathogen inactivation technique adds new layers of complexity to compare them. Innumerable references can be found in the literature describing in vitro functional parameters of platelet concentrates. Although it is clear that BC-RPC retain much more their in vitro functions than PRP-RPC, indicating that no one should use the latter any more, it is much more difficult to distinguish differences between other PCs. Conversely, only a very few studies have been published related to a comparison of clinical efficacy of RPC versus APC, the endpoints being mainly CCI. Similarly to the in vitro studies, although RPC prepared with the PRP method show the lowest CCIs, no clear difference exists between "modern" RPC and APC. Another factor that may impact policy decision is the occurrence of adverse reactions in recipients. When considering only comparable data, for example leuco-reduced RPC versus leuco-reduced APC, there is now evidence that the latter is more associated with adverse reactions in recipients: data from hemovigilance in France show that, although no difference is noted for febrile non haemolytic transfusion reactions, nor for bacteria contamination, the incidence of allergic adverse reactions is about four times higher with APC as compared with RPC. Other aspects may impact the decision: the fact that using APC in place of RPC reduces the total donor exposure of patients was considered critical in some countries to reduce the risk of transmission of blood transmissible disease. Finally, the cost of the components, much higher for APC may be considered.     

Pathophysiological mechanisms of Flavivirus infection of the central nervous system

Flaviviruses are important human pathogens. Transmitted by the bite of infected mosquitoes, Flaviviruses such as West Nile and Japanese encephalitis may reach the central nervous system where they can elicit severe diseases. Their ability to cross the blood-brain-barrier is still poorly understood. The newly emerging Zika Flavivirus on the other hand very rarely reaches the brain of adults, but can infect neural progenitors in the developing central nervous system of fetuses, eliciting devastating congenital malformations including microcephaly. This short review focuses on selected aspects of West Nile, Japanese encephalitis and Zika virus pathophysiological features such as neuroinvasion and neurovirulence, and highlights what we know about some possible mechanisms involved in Flaviviral neuropathogenesis.     

First human transcatheter implantation of an aortic valve prosthesis in a case of severe calcific aortic stenosis

A percutaneous implantable prosthetic heart valve was developed, and after animal studies, the first human case was performed in a 57-year-old man with calcific aortic stenosis with cardiogenic shock. The implantation was performed with the use of an antegrade trans-septal approach after aortic valvuloplasty, and over a follow-up period of 4 months, the valvular function remained satisfactory. However, severe noncardiac complications occurred leading to death 17 weeks after implantation.     

Embolie gazeuse cérébrale compliquant une pleurodèse au talc : à propos d’un cas

Cerebral air embolism is a severe complication which can occur during many invasive medical procedures. Its prognosis depends on early diagnosis and hyperbaric oxygen therapy. We report a case of cerebral air embolism which occurred during a talc pleurodesis within a chest tube, in chest postoperative period. After early and appropriate treatment, we observed a significant functional recovery.