MANAGEMENT OF SEPTIC SHOCKAND HYPOXIA INDUCED CONJUGATED HYPERBILIRUBINAEMIA IN CASE OF MAJOR CHEST TRAUMA – CASE REPORT

This case report describes a 50-year-old male trauma patient with multiple crushed thoracic lesions: flail chest, bilateral hemopneumothorax, myocardial infarction and pulmonary contusion. In the ICU he developed ARDS and pulmonary infection which lead to septic shock. Hypoxia due to inadequate ventilation and reduced visceral perfusion due to shock induced elevated levels of conjugated bilirubin. Continuous veno-venous hemofiltration (CVVH) sessions in combination with CytoSorb® filters and MARS® were needed. After surgical fixation of the flail segment ventilatory parameters improved significantly

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efficiency of sample introduction into inductively coupled plasma by graphite furnace electrothermal vaporization

Conference: 3rd European Furnace Symposium on Atomic Spectroscopy Location: Prague, Czech Republic Date: JUN, 1998A laboratory constructed graphite furnace electrothermal vaporizer (GF-ETV) was used for studying transport efficiencies. This device enables collection of the vaporization products that exit the central sampling hole of the horizontal graphite tube. For determination of the transport efficiency between the GF-ETV and the ICP-torch three methods were tested: (1) deposition of the aerosol particles and the vapour of certain elements by mixing the vaporization product with supersaturated steam and subsequent condensation (direct method); (2) dissolution of the deposited sample fraction from the interface components (indirect method); and (3) calculation from line intensities when applying GF-ETV and pneumatic nebulization sample introduction methods using mercury as a reference element. The latter, 'mercury reference method' required 100% transport efficiency for mercury with the ETV, which could be approximated with the use of argon as carrier gas (without halocarbon addition). With a 200 cm(3)/min flow rate of internal argon in the graphite tube, the transport efficiency was between 67 and 76% for medium volatility elements (Cu, Mn and Mg) and between 32 and 38% for volatile elements (Cd and Zn). By adding carbon tetrachloride vapour to the internal argon flow, the transport efficiency increased to 67-73% for the five elements studied

White-matter microstructure and language lateralization in left-handers: a whole-brain MRI analysis.

Most people are left-hemisphere dominant for language. However the neuroanatomy of language lateralization is not fully understood. By combining functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we studied whether language lateralization is associated with cerebral white-matter (WM) microstructure. Sixteen healthy, left-handed women aged 20-25 were included in the study. Left-handers were targeted in order to increase the chances of involving subjects with atypical language lateralization. Language lateralization was determined by fMRI using a verbal fluency paradigm. Tract-based spatial statistics analysis of DTI data was applied to test for WM microstructural correlates of language lateralization across the whole brain. Fractional anisotropy and mean diffusivity were used as indicators of WM microstructural organization. Right-hemispheric language dominance was associated with reduced microstructural integrity of the left superior longitudinal fasciculus and left-sided parietal lobe WM. In left-handed women, reduced integrity of the left-sided language related tracts may be closely linked to the development of right hemispheric language dominance. Our results may offer new insights into language lateralization and structure-function relationships in human language system

The updated ESTRO core curricula 2011 for clinicians, medical physicists and RTTs in radiotherapy/radiation oncology.

Item does not contain fulltextINTRODUCTION: In 2007 ESTRO proposed a revision and harmonisation of the core curricula for radiation oncologists, medical physicists and RTTs to encourage harmonised education programmes for the professional disciplines, to facilitate mobility between EU member states, to reflect the rapid development of the professions and to secure the best evidence-based education across Europe. MATERIAL AND METHODS: Working parties for each core curriculum were established and included a broad representation with geographic spread and different experience with education from the ESTRO Educational Committee, local representatives appointed by the National Societies and support from ESTRO staff. RESULTS: The revised curricula have been presented for the ESTRO community and endorsement is ongoing. All three curricula have been changed to competency based education and training, teaching methodology and assessment and include the recent introduction of the new dose planning and delivery techniques and the integration of drugs and radiation. The curricula can be downloaded at http://www.estro-education.org/europeantraining/Pages/EuropeanCurricula.aspx. CONCLUSION: The main objective of the ESTRO core curricula is to update and harmonise training of the radiation oncologists, medical physicists and RTTs in Europe. It is recommended that the authorities in charge of the respective training programmes throughout Europe harmonise their own curricula according to the common framework.1 april 201