Growth Performance of Crossbred Steers on Unfertilised Mountain Pastures at Low Stocking Rates

As a consequence of increasing economic pressure on Swiss agriculture, marginal areas are threatened by abandonment, especially in the mountainous regions. Using these areas for extensive beef production might preserve an open landscape and favour biodiversity. A grazing experiment was conducted with steers on an unfertilised mountain pasture to study the effects of a reduction of stocking rate on the growth of the animals and on changes in the vegetation

Protective subpleural blanketing of intrathoracic esogastric anastomosis after esophagectomy

Esophagectomy followed by intrathoracic anastomosis is threatened by leakage which may prove all the more serious that mediastinal contamination is extensive. In the technique presented, the esogastric anastomosis is slipped under the upper mediastinal pleura which is kept intact, after the azygos vein has been ligated and divided. This pleural ‘blanket' may act as an efficient barrier against potential digestive spillage into the mediastinu

Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction

Recent clinical data show that the risk of coronary thrombosis after antiplatelet drugs withdrawal is much higher than that of surgical bleeding if they are continued. In secondary prevention, aspirin is a lifelong therapy and should never be stopped. Clopidogrel is regarded as mandatory until the coronary stents are fully endothelialized, which takes 3 months for bare metal stents, but up to 1 yr for drug-eluting stents. Therefore, interruption of antiplatelet therapy 10 days before surgery should be revised. After reviewing the data on the use of antiplatelet drugs in cardiology and in surgery, we propose an algorithm for the management of patients, based on the risk of myocardial ischaemia and death compared with that of bleeding, for different types of surgery. Even if large prospective studies with a high degree of evidence are still lacking on different antiplatelet regimens during non-cardiac surgery, we propose that, apart from low coronary risk situations, patients on antiplatelet drugs should continue their treatment throughout surgery, except when bleeding might occur in a closed space. A therapeutic bridge with shorter-acting antiplatelet drugs may be considere

Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non‐cardiac surgery

The increasing number of patients with coronary artery disease undergoing major non‐cardiac surgery justifies guidelines concerning preoperative evaluation, stress testing, coronary angiography, and revascularization. A review of the recent literature shows that stress testing should be limited to patients with suspicion of a myocardium at risk of ischaemia, and coronary angiography to situations where revascularization can improve long‐term survival. Recent data have shown that any event in the coronary circulation, be it new ischaemia, infarction, or revascularization, induces a high‐risk period of 6 weeks, and an intermediate‐risk period of 3 months. A 3‐month minimum delay is therefore indicated before performing non‐cardiac surgery after myocardial infarction or revascularization. However, this delay may be too long if an urgent surgical procedure is requested, as for instance with rapidly spreading tumours, impending aneurysm rupture, infections requiring drainage, or bone fractures. It is then appropriate to use perioperative beta‐block, which reduces the cardiac complication rate in patients with, or at risk of, coronary artery disease. The objective of this review is to offer a comprehensive algorithm to help clinicians in the preoperative assessment of patients undergoing non‐cardiac surgery. Br J Anaesth 2002; 89: 747-5

Persistent Correlation of Ghrelin Plasma Levels with Body Mass Index Both in Stable Weight Conditions and during Gastric-bypass-induced Weight Loss

Background: Studies done on serial changes in plasma ghrelin levels after gastric bypass (GBP) have yielded contrasting results since decreased, unchanged, or increased levels have been reported in the literature. This study investigates whether or not GBP has an inhibitory effect on fasting ghrelin levels independently of weight loss. Methods: Fasting ghrelin levels were measured in 115 stable body weight females, classified as normal body weight (NW; body mass index (BMI) 50kg/m2). Results: Each obese subgroup showed significantly lower ghrelin levels as compared to both NW (p < 0.0001) and OW subjects (p < 0.05 or 0.005); however, no significant differences were observed within the three obese subgroups. Forty-nine obese patients underwent a GBP. Plasma ghrelin, measured at 3, 6, and 12months after GBP, significantly increased from the sixth month on (p < 0.0001). When patients were classified, at each postoperative time point, according to their actual BMI, ghrelin was significantly (p = 0.0002) related to postoperative BMI and not significantly different from ghrelin measured in stable body weight conditions. Conclusions: Fasting ghrelin displays an inversely significant correlation with BMI in both stable body weight conditions and after GBP. No evidence was found that GBP had an effect on fasting ghrelin levels, independent of weight los

NETQOS policy management architecture for flexible QOS provisioning in Future Internet

This paper is focussed on the NETQOS architecture for automated QoS policy provisioning, which can be used in Future Internet scenarios by the different actors (i.e. network operators, service providers, and users) for flexible QoS configuration over combinations of mobile, fixed, sensor and broadcast networks. The NETQOS policy management architecture opens the possibility to specify QoS policies on a "business" level using ontology descriptions and policy management interfaces, which are specific to the actors. The business level policy specifications are translated by the NETQOS system into intermediate and operational QoS policies for automated QoS configuration at the managed heterogeneous network and transport entities. NETQOS allows QoS policy specification and dependency analysis considering Service Level Agreements (SLAs) between the actors, as well as automated policy provisioning and adaptation. The interaction of the NETQOS components is based on a common po licy repository. The particular focus of the paper is aimed to discuss ontology and actor oriented QoS policy specification and configuration for heterogeneous networks, as well as NETQOS QoS policy management interfaces at business level and automated translation of business QoS policies to intermediate and operational policy level

Fatal myocardial infarction after lung resection in a patient with prophylactic preoperative coronary stenting†

In this report we present the case of a 77-yr-old man who underwent resection of the upper lobe of the left lung for a carcinoma, six weeks after percutaneous transluminal coronary angioplasty (PTCA) with stenting of the left anterior descending (LAD) and circumflex coronary arteries. Antiplatelet therapy with clopidogrel was interrupted two weeks before surgery to allow for epidural catheter placement and to minimize haemorrhage. The surgical procedure was uneventful. In the immediate postoperative period, however, the patient suffered severe myocardial ischaemia. Emergency coronary angiography showed complete thrombotic occlusion of the LAD stent. In spite of successful recanalization, reinfarction occurred and the patient died in cardiogenic shock. Prophylactic preoperative coronary stenting may put the patient at risk of stent thrombosis if surgery cannot be postponed for three months. In such cases, other strategies such as perioperative β-blockade for preoperative cardiac management should be considered. Br J Anaesth 2004; 92: 743-

Intensivmedizinische Behandlung von Erwachsenen mit angeborenen Herzfehlern

Zusammenfassung: Dank Verbesserungen in der Herzchirurgie und der perioperativen Betreuung steigt die Anzahl der Erwachsenen mit einem angeborenen Herzfehler stetig. Die perioperative und intensivmedizinische Betreuung dieser Patienten stellt aufgrund der vielen verschiedenen Pathologien und chirurgischen Möglichkeiten sowie der komplexen Pathophysiologie eine Herausforderung dar. Viele Patienten entwickeln mit der Zeit Organdysfunktionen und viele von ihnen benötigen Folgeoperationen am Herzen sowie nichtkardiale Eingriffe im Erwachsenalter. Aufgrund der Komplexität sind diese Patienten in spezialisierten tertiären Krankenhäusern zu behandeln, die über ein disziplinenübergreifendes Fachwissen verfügen. Da dies in Notfällen nicht immer möglich sein wird, sind grundlegende Kenntnisse dieser Patientengruppe für in der Akutversorgung Tätige wichtig. In dieser Übersicht werden allgemeine Aspekte, wie pulmonale Hypertonie, Eisenmenger-Syndrom, Zyanose, Schwangerschaft und perioperative Betreuung, behandelt. Ein besonderes Augenmerk gilt dabei der intensivmedizinischen Versorgung von kritisch kranken Patienten mit angeborenen Herzfehler