Near fatal posterior reversible encephalopathy syndrome complicating chronic liver failure and treated by induced hypothermia and dialysis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Posterior reversible encephalopathy syndrome is a clinico-neuroradiological entity characterized by headache, vomiting, altered mental status, blurred vision and seizures with neuroimaging studies demonstrating white-gray matter edema involving predominantly the posterior region of the brain.</p> <p>Case presentation</p> <p>We report a 47-year-old Caucasian man with liver cirrhosis who developed posterior reversible encephalopathy syndrome following an upper gastrointestinal hemorrhage and who was managed with induced hypothermia for control of intracranial hypertension and continuous veno-venous hemodiafiltration for severe hyperammonemia.</p> <p>Conclusion</p> <p>We believe this is the first documented case report of posterior reversible encephalopathy syndrome associated with cirrhosis as well as the first report of the use of induced hypothermia and continuous veno-venous hemodiafiltration in this setting.</p

Sclerostin: Current Knowledge and Future Perspectives

In recent years study of rare human bone disorders has led to the identification of important signaling pathways that regulate bone formation. Such diseases include the bone sclerosing dysplasias sclerosteosis and van Buchem disease, which are due to deficiency of sclerostin, a protein secreted by osteocytes that inhibits bone formation by osteoblasts. The restricted expression pattern of sclerostin in the skeleton and the exclusive bone phenotype of good quality of patients with sclerosteosis and van Buchem disease provide the basis for the design of therapeutics that stimulate bone formation. We review here current knowledge of the regulation of the expression and formation of sclerostin, its mechanism of action, and its potential as a bone-building treatment for patients with osteoporosis

A case report of delayed cortical infarction adjacent to sulcal clots after traumatic subarachnoid hemorrhage in the absence of proximal vasospasm

Background Cortical ischemic lesions represent the predominant pathomorphological pattern of focal lesions after aneurysmal subarachnoid hemorrhage (aSAH). Autopsy studies suggest that they occur adjacent to subarachnoid blood and are related to spasm of small cortical rather than proximal arteries. Recent clinical monitoring studies showed that cortical spreading depolarizations, which induce cortical arterial spasms, are involved in lesion development. If subarachnoid blood induces adjacent cortical lesions, it would be expected that (i) they also develop after traumatic subarachnoid hemorrhage (tSAH), and (ii) lesions after tSAH can occur in absence of angiographic vasospasm, as was found for aSAH. Case presentation An 86-year-old woman was admitted to our hospital with fluctuating consciousness after hitting her head during a fall. The initial computed tomography (CT) was significant for tSAH in cortical sulci. On day 8, the patient experienced a secondary neurological deterioration with reduced consciousness and global aphasia. Whereas the CT scan on day 9 was still unremarkable, magnetic resonance imaging (MRI) on day 10 revealed new cortical laminar infarcts adjacent to sulcal blood clots. Proximal vasospasm was ruled out using MR and CT angiography and Doppler sonography. CT on day 14 confirmed the delayed infarcts. Conclusions We describe a case of delayed cortical infarcts around sulcal blood clots after tSAH in the absence of proximal vasospasm, similar to results found previously for aSAH. As for aSAH, this case suggests that assessment of angiographic vasospasm is not sufficient to screen for risk of delayed infarcts after tSAH. Electrocorticography is suggested as a complementary method to monitor the hypothesized mechanism of spreading depolarizations

MONITORING SEABIRDS AND MARINE MAMMALS BY GEOREFERENCED AERIAL PHOTOGRAPHY

The assessment of anthropogenic impacts on the marine environment is challenged by the accessibility, accuracy and validity of biogeographical information. Offshore wind farm projects require large-scale ecological surveys before, during and after construction, in order to assess potential effects on the distribution and abundance of protected species. The robustness of site-specific population estimates depends largely on the extent and design of spatial coverage and the accuracy of the applied census technique. Standard environmental assessment studies in Germany have so far included aerial visual surveys to evaluate potential impacts of offshore wind farms on seabirds and marine mammals. However, low flight altitudes, necessary for the visual classification of species, disturb sensitive bird species and also hold significant safety risks for the observers. Thus, aerial surveys based on high-resolution digital imagery, which can be carried out at higher (safer) flight altitudes (beyond the rotor-swept zone of the wind turbines) have become a mandatory requirement, technically solving the problem of distant-related observation bias. A purpose-assembled imagery system including medium-format cameras in conjunction with a dedicated geo-positioning platform delivers series of orthogonal digital images that meet the current technical requirements of authorities for surveying marine wildlife at a comparatively low cost. At a flight altitude of 425&thinsp;m, a focal length of 110&thinsp;mm, implemented forward motion compensation (FMC) and exposure times ranging between 1/1600 and 1/1000&thinsp;s, the twin-camera system generates high quality 16 bit RGB images with a ground sampling distance (GSD) of 2&thinsp;cm and an image footprint of 155 x 410&thinsp;m. The image files are readily transferrable to a GIS environment for further editing, taking overlapping image areas and areas affected by glare into account. The imagery can be routinely screened by the human eye guided by purpose-programmed software to distinguish biological from non-biological signals. Each detected seabird or marine mammal signal is identified to species level or assigned to a species group and automatically saved into a geo-database for subsequent quality assurance, geo-statistical analyses and data export to third-party users. The relative size of a detected object can be accurately measured which provides key information for species-identification. During the development and testing of this system until 2015, more than 40 surveys have produced around 500.000 digital aerial images, of which some were taken in specially protected areas (SPA) of the Baltic Sea and thus include a wide range of relevant species. Here, we present the technical principles of this comparatively new survey approach and discuss the key methodological challenges related to optimizing survey design and workflow in view of the pending regulatory requirements for effective environmental impact assessments