Subarachnoid-Pleural Fistula: Applied Anatomy of the Thoracic Spinal Nerve Root

Subarachnoid-pleural fistula (SPF) is a rare complication of chest or spine operations for neoplastic disease. Concomitant dural and parietal pleural defects permit flow of cerebrospinal fluid into the pleural cavity or intrapleural air into the subarachnoid space. Dural injury recognized intraoperatively permits immediate repair, but unnoticed damage may cause postoperative pleural effusion, intracranial hypotension, meningitis, or pneumocephalus. We review two cases of SPF following surgical intervention for chest wall metastatic disease to motivate a detailed review of the anatomy of neural, osseous, and ligamentous structures at the intervertebral foramen. We further provide recommendations for avoidance and detection of such complication

Effect of development of antibodies to hla and cytomegalovirus mismatch on lung transplantation survival and development of bronchiolitis obliterans syndrome

AbstractObjective: A retrospective analysis was performed to examine the role of HLA antibodies and cytomegalovirus mismatch on the development of bronchiolitis obliterans syndrome and survival after lung transplantation. Methods: Of 339 consecutive lung transplantations performed over a 102-month interval, 301 patients survived at least 3 months. There was a minimum follow-up period of 13 months. Bronchiolitis obliterans syndrome was defined as a decline in forced expiratory volume in 1 second less than 80% of posttransplantation baseline and/or histologic presence of obliterative bronchiolitis and was defined as occurring “early” if documented within 3 years of transplantation. Variables analyzed included preoperative donor and recipient cytomegalovirus status and the development of antibodies to human leukocyte antigens after transplantation. Microcytotoxicity was used to determine the presence of antibodies to human leukocyte antigens. Variables were subjected to Kaplan-Meier analysis to determine their impact on freedom from bronchiolitis obliterans syndrome and survival. Results: The development of antibodies to human leukocyte antigens after transplantation correlated significantly with bronchiolitis obliterans syndrome (P = .02). The development of antibodies to human leukocyte antigens did not affect survival (P = .33) unless they were detected within 2 years of transplantation (P = .04). There was greater frequency of early bronchiolitis obliterans syndrome in cytomegalovirus seronegative patients who received allografts from seropositive donors compared with all other combinations (P = .02). There was also a trend toward worse survival of cytomegalovirus seronegative patients who received allografts from seropositive donors (P = .13). Conclusion: These data suggest that bronchiolitis obliterans syndrome is the result of an immune-mediated process in which HLA antibodies and cytomegalovirus may play a significant role. (J Thorac Cardiovasc Surg 1998;116:812-20

Pediatric And Adult Lung Transplantation For Cystic Fibrosis

AbstractObjective: This paper was undertaken to review the experience at our institution with bilateral sequential lung transplantation for cystic fibrosis.Methods: Since 1989, 103 bilateral sequential lung transplants for cystic fibrosis have been performed (46 pediatric, 48 adult, 9 redo); the mean age was 21 ± 10 years. Cardiopulmonary bypass was used in all but one pediatric (age <18) transplant, and in 15% of adults.Results: Hospital mortality was 4.9%, with 80% of early deaths related to infection. Bronchial anastomotic complications occurred with equal frequency in the pediatric and the adult populations (7.3%). One- and 3-year actuarial survival are 84% and 61%, respectively (no significant difference between pediatric and adult age groups; average follow-up 2.1 ± 1.6 years). Mean forced expiratory volume in 1 second increased from 25% ± 9% before transplantation to 79% ± 35% 1 year after transplantation. Acute rejection occurred 1.7 times per patient-year, with most episodes taking place within the first 6 months after transplantation. The need for treatment of lower respiratory tract infections occurred 1.2 times per patient in the first year after transplantation. Actuarial freedom from bronchiolitis obliterans was 63% at 2 years and 43% at 3 years. Redo transplantation was performed only in the pediatric population and was associated with an early mortality of 33%. Eight living donor transplants (four primary transplants, four redo transplants) were performed with an early survival of 87.5%.Conclusion: Patients with end-stage cystic fibrosis can undergo bilateral lung transplantation with morbidity and mortality comparable to that seen in pulmonary transplantation for other disease entities. (J Thorac Cardiovasc Surg 1998;115:404-14

Continuous Multi-Parameter Heart Rate Variability Analysis Heralds Onset of Sepsis in Adults

BACKGROUND: Early diagnosis of sepsis enables timely resuscitation and antibiotics and prevents subsequent morbidity and mortality. Clinical approaches relying on point-in-time analysis of vital signs or lab values are often insensitive, non-specific and late diagnostic markers of sepsis. Exploring otherwise hidden information within intervals-in-time, heart rate variability (HRV) has been documented to be both altered in the presence of sepsis, and correlated with its severity. We hypothesized that by continuously tracking individual patient HRV over time in patients as they develop sepsis, we would demonstrate reduced HRV in association with the onset of sepsis. METHODOLOGY/PRINCIPAL FINDINGS: We monitored heart rate continuously in adult bone marrow transplant (BMT) patients (n = 21) beginning a day before their BMT and continuing until recovery or withdrawal (12+/-4 days). We characterized HRV continuously over time with a panel of time, frequency, complexity, and scale-invariant domain techniques. We defined baseline HRV as mean variability for the first 24 h of monitoring and studied individual and population average percentage change (from baseline) over time in diverse HRV metrics, in comparison with the time of clinical diagnosis and treatment of sepsis (defined as systemic inflammatory response syndrome along with clinically suspected infection requiring treatment). Of the 21 patients enrolled, 4 patients withdrew, leaving 17 patients who completed the study. Fourteen patients developed sepsis requiring antibiotic therapy, whereas 3 did not. On average, for 12 out of 14 infected patients, a significant (25%) reduction prior to the clinical diagnosis and treatment of sepsis was observed in standard deviation, root mean square successive difference, sample and multiscale entropy, fast Fourier transform, detrended fluctuation analysis, and wavelet variability metrics. For infected patients (n = 14), wavelet HRV demonstrated a 25% drop from baseline 35 h prior to sepsis on average. For 3 out of 3 non-infected patients, all measures, except root mean square successive difference and entropy, showed no significant reduction. Significant correlation was present amongst these HRV metrics for the entire population. CONCLUSIONS/SIGNIFICANCE: Continuous HRV monitoring is feasible in ambulatory patients, demonstrates significant HRV alteration in individual patients in association with, and prior to clinical diagnosis and treatment of sepsis, and merits further investigation as a means of providing early warning of sepsis

The protection of National Minorities in policing by the Council of Europe with case studies of Hungary and Slovakia

Diese Diplomarbeit beschäftigt sich mit dem Thema ?Der Schutz nationaler Minderheiten in Bezug auf Polizeiarbeit durch den Europarat?. Hauptaugenmerk wird dabei auf die Überwachungsmechanismen gelegt, welche durch den Europarat geschaffen wurden. Diese Überwachungsmechanismen sind erstens der Beratende Ausschuss für das Rahmenübereinkommen zum Schutz nationaler Minderheiten, zweitens die Europäische Kommission gegen Rassismus und Intoleranz, und drittens das Europäische Komitee zur Verhütung von Folter und unmenschlicher oder erniedrigender Behandlung oder Strafe. Ein besonderes Augenmerk muss auf nationale Minderheiten gelegt werden, da Zugehörige nationaler Minderheiten in den verschiedensten Bereichen besonders anfällig für ungerechte Behandlung sind. Besonders besorgniserregend ist Diskriminierung durch die Polizei. Der Hauptteil dieser Diplomarbeit umfasst zwei Fallstudien. Die erste Fallstudie befasst sich mit der Situation in Ungarn, und die zweite mit der Lage in der Slowakei. Diese Länder wurden ausgesucht, da nationale Minderheiten einen signifikanten Anteil der Bevölkerung ausmachen. Sowohl Medienberichterstattung, als auch die politische Entwicklung über die letzten Jahre zeigen einen besorgniserregenden Anstieg von Rassismus und Fremdenfeindlichkeit in verschiedenen osteuropäischen Staaten. Diese Fallstudien erfolgen durch eine Bewertung des Dialogs zwischen den Expertenkomitees und den Staaten. Die Forschungsfragen dieser Diplomarbeit zeigen auf, welche die unterschiedlichen Zugänge und Methoden der Expertenkomitees sind. In weiterer Folge wird die Frage beleuchtet, in wie weit eine Zusammenarbeit zwischen den Komitees erfolgt. Außerdem stellt sich die Frage, ob die Komitees Standards entwickeln, und wie diese zu einander stehen. Die Schlussbeurteilung klärt, in wie weit dieser Schutzmechanismus Einfluss auf die überwachten Staaten hat, gefolgt von der Frage in wie weit Verbesserungen notwendig wären, um die Effektivität dieses Systems zu erhöhen.This Diploma Thesis deals with the protection of national minorities in policing by the council of Europe. The focus of this thesis is on the monitoring mechanisms installed by the Council of Europe which contribute to the protection of national minorities in policing. These monitoring bodies are firstly the Advisory Committee on the Protection of National Minorities (ACFC) established under the Framework Convention for the Protection of National Minorities (FCNM), secondly the European Commission against Racism and Intolerance (ECRI), and finally the Committee for the Prevention of Torture and Inhumane or Degrading Treatment or Punishment (CPT). A special focus must be laid on national minorities, as they tend to be extremely vulnerable to discrimination in various fields. Policing is an area in which discrimination can be especially alarming. The main part of this Thesis is two case studies. The first case study is on Hungary, followed by a case study on Slovakia. These countries were chosen as they have a significant percentage of national minorities. Media coverage and political developments over the past years have shown that racism and xenophobia in general are on a rise in many eastern European countries. The assessment will mainly take place through the dialogue between the expert bodies and the states. The questions that were raised are firstly what the different approaches and working methods of the expert bodies are. Secondly, to which extent the expert bodies cooperate. Another question that is raised is whether the expert bodies develop standards, followed by a comparison of these standards. The final assessment is on the impact of this protection mechanism, and raises the question whether improvements would be necessary to increase its effectiveness.eingereicht von Sudhir Samuel SundaresanAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersZsfassung in dt. SpracheGraz, Univ., Dipl.-Arb., 2010(VLID)21157