Repeated successful surgical rescues of early and delayed multiple ruptures of ventricular septum, right ventricle and aneurysmal left ventricle following massive biventricular infarction

A 58 year old man underwent 6 surgical interventions for various complications of massive biventricular myocardial infarction over a period of 2 years following acute occlusion of a possibly "hyperdominant" left anterior descending coronary artery. These included concomitant repair of apicoanterior post-infarction VSD and right ventricular free wall rupture, repeat repair of recurrent VSD following inferoposterior extension of VSD in the infarcted septum 5 weeks later, repair of delayed right ventricular free wall rupture 4 weeks subsequently, repair of a bleeding left ventricular aneurysm eroding through left chest wall 16 months thereafter, repair of right upper lobe lung tear causing massive anterior mediastinal haemorrhage, mimicking yet another cardiac rupture, 2 months later, followed, at the same admission, 2 weeks later, by sternal reconstruction for dehisced and infected sternum using pedicled myocutaneous latissimus dorsi flap. 5 years after the latissimus myoplasty, the patient remains in NYHA class 1 and is leading a normal life

Overactive bladder – 18 years – part I

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder

Advances in Software Engineering and Aeronautics

Avionics, like any other safety-critical real-time systems, pose unique challenges on system design, development, and testing. Specifically, the rigorous certification process mandated for avionics software calls for additional attention. The DO-178C Software Considerations in Airborne Systems and Equipment Certification provides detailed guidelines to ensure safety measures. This chapter gives a different angle to avionics development and certification, highlighting model-based approaches for advancing the design, development, testing, and maintenance of airborne software systems. Modern software engineering processes such as agile and scrum are discussed as the new techniques in speeding up the certification hurdle, while achieving higher return on investment

Verhaltens- und emotionale Störungen mit Beginn in der Kindheit und Jugend

Die Verhaltens- und emotionalen Störungen mit Beginn in der Kindheit und Jugend umfassen ein weites Spektrum verschiedener Störungen: Störungen der motorischen Aktivität und Aufmerksamkeit, Störungen des Sozialverhaltens, emotionale Störungen, Störungen sozialer Funktionen, Ticstörungen sowie Verhaltens- und emotionale Störungen mit Beginn in der Kindheit und Jugend. Einige der Störungen beschränken sich auf Kindheit und Jugend, andere können bis ins Erwachsenenalter hinein persistieren. Die Klassifikation der ICD-10, besonders bei den emotionalen Störungen, ist in einzelnen Punkten inkonsequent oder unlogisch. So kommen z. B. depressive Entwicklungen und Angststörungen auch schon im Kindes- und Jugendalter vor, werden aber andernorts klassifiziert. Ebenso werden potenzielle komorbide Störungen als Ausschlussgrund definiert, z. B. bei Autismus und ADHS, so dass die klinische Praxis häufig vom ICD-10 abweicht. Die Krankheitsursachen sind häufig multikausal. Demzufolge kann die Therapie u. U. auch multimodal von der Beratung der Eltern über Psycho- und Familientherapie bis hin zur Pharmakotherapie reichen. Manchmal ist auch die Beratung weiterer Bezugspersonen, z. B. der Lehrer, nötig