Kongenitale Nävi im Kindesalter

Zusammenfassung: Nävi stellen kongenitale hamartomatöse Fehlbildungen unterschiedlicher Bestandteile der Haut dar. Am häufigsten treten kongenitale melanozytäre Nävi (CMN) auf, gefolgt von Nävi epithelialen Ursprungs (epidermale und organoide Nävi). Insbesondere große CMN können zu schwerwiegenden Komplikationen führen, und das Management der Betroffenen stellt ab Geburt eine Herausforderung dar. Entgegen früheren Annahmen ist das Risiko einer malignen Entartung von CMN insgesamt als eher gering anzusehen, steigt jedoch in speziellen Situationen relevant an. Nicht zu vernachlässigen sind mögliche extrakutane Symptome im Falle einer ZNS-Beteiligung, und frühe bildgebende Untersuchungen gehören heute zur Routinediagnostik. Chirurgische Maßnahmen haben noch immer einen hohen Stellenwert in der Behandlung von CMN, die Indikation dazu ist jedoch von Fall zu Fall individuell abzuwägen. Nicht zuletzt leiden die Patienten häufig stark an der ästhetischen Beeinträchtigung durch ihr Muttermal, sodass in der Behandlung auch diesem Punkt Rechnung getragen werden muss. Der Naevus sebaceus ist der häufigste Vertreter der epithelialen Nävi. In 2-13% treten darin Zusatztumoren auf, und eine frühe chirurgische Exzision ist in den meisten Fällen nicht zuletzt auch aus ästhetischen Überlegungen sinnvoll. Epidermale Nävi erfordern bei generalisierter Ausdehnung Zusatzuntersuchungen zum Ausschluss von assoziierten ophthalmologischen, kardialen oder neurologischen Fehlbildunge

Detecting periodicity in experimental data using linear modeling techniques

Fourier spectral estimates and, to a lesser extent, the autocorrelation function are the primary tools to detect periodicities in experimental data in the physical and biological sciences. We propose a new method which is more reliable than traditional techniques, and is able to make clear identification of periodic behavior when traditional techniques do not. This technique is based on an information theoretic reduction of linear (autoregressive) models so that only the essential features of an autoregressive model are retained. These models we call reduced autoregressive models (RARM). The essential features of reduced autoregressive models include any periodicity present in the data. We provide theoretical and numerical evidence from both experimental and artificial data, to demonstrate that this technique will reliably detect periodicities if and only if they are present in the data. There are strong information theoretic arguments to support the statement that RARM detects periodicities if they are present. Surrogate data techniques are used to ensure the converse. Furthermore, our calculations demonstrate that RARM is more robust, more accurate, and more sensitive, than traditional spectral techniques.Comment: 10 pages (revtex) and 6 figures. To appear in Phys Rev E. Modified styl

Test your surrogate data before you test for nonlinearity

The schemes for the generation of surrogate data in order to test the null hypothesis of linear stochastic process undergoing nonlinear static transform are investigated as to their consistency in representing the null hypothesis. In particular, we pinpoint some important caveats of the prominent algorithm of amplitude adjusted Fourier transform surrogates (AAFT) and compare it to the iterated AAFT (IAAFT), which is more consistent in representing the null hypothesis. It turns out that in many applications with real data the inferences of nonlinearity after marginal rejection of the null hypothesis were premature and have to be re-investigated taken into account the inaccuracies in the AAFT algorithm, mainly concerning the mismatching of the linear correlations. In order to deal with such inaccuracies we propose the use of linear together with nonlinear polynomials as discriminating statistics. The application of this setup to some well-known real data sets cautions against the use of the AAFT algorithm.Comment: 14 pages, 15 figures, submitted to Physical Review

Randomized trial comparing the i-gel™ and Magill tracheal tube with the single-use ILMA™ and ILMA™ tracheal tube for fibreoptic-guided intubation in anaesthetized patients with a predicted difficult airway

Background The i-gel™ is a single-use supraglottic airway device (SAD) that allows fibreoptic-guided tracheal intubation through the device. Until now, no prospective data for this procedure are available. Therefore, in a prospective randomized controlled trial, we evaluated fibreoptic-guided tracheal intubation with a standard Rüsch™ PVC tracheal tube (TT) through the i-gel™ compared with the single-use ILMA™ (sILMA™) TT through the sILMA™ in patients with a predicted difficult airway. Methods With ethics committee approval and written informed consent, 160 patients were randomly assigned to either SAD. After placement of the SAD, a fibreoptic bronchoscope was introduced into the trachea as a railroad for the TT. Primary outcome variable was the first-attempt fibreoptic-guided intubation success rate. Secondary variables included time for insertion and intubation, airway leak pressures, fibreoptic view, and adverse events. Data are presented as mean (sd) or percentages. A P-value of <0.05 was considered statistically significant. Results Fibreoptic-guided intubation was successful at the first attempt in 76 patients (96%) using the i-gel™ and in 71 patients (90%) using the sILMA™ (P=0.21). Most of the failed intubations were rescued by conventional laryngoscopy. Airway leak pressure was higher for the sILMA™. There were no problems during removal of either type of SAD. Conclusions Fibreopic-guided tracheal intubation through the i-gel™ using a standard Rüsch™ Magill TT is successful and an alternative to the sILMA™ with the sILMA™ T

Time-energy correlations in solar flare occurrence

The existence of time-energy correlations in flare occurrence is still an open and much debated problem. This study addresses the question whether statistically significant correlations are present between energies of successive flares as well as energies and waiting times. We analyze the GOES catalog with a statistical approach based on the comparison of the real catalog with a reshuffled one where energies are decorrelated. This analysis reduces the effect of background activity and is able to reveal the role of obscuration. We show the existence of non-trivial correlations between waiting times and energies, as well as between energies of subsequent flares. More precisely, we find that flares close in time tend to have the second event with large energy. Moreover, after large flares the flaring rate significantly increases, together with the probability of other large flares. Results suggest that correlations between energies and waiting times are a physical property and not an effect of obscuration. These findings could give important information on the mechanisms for energy storage and release in the solar corona

i-gel™ supraglottic airway in clinical practice: a prospective observational multicentre study

Background The i-gel™ supraglottic airway device has been studied in randomized controlled studies, but it has not been evaluated in a large prospective patient cohort. Therefore, we performed this prospective multicentre observational study to evaluate success rates, airway leak pressure, risk factors for i-gel failure, and adverse events. Methods With Ethics Committee approval and waiver of patients' consent, data about anaesthesia providers, patient characteristics, and the performance of the i-gel were recorded in five independent hospitals in Switzerland over a period of 24 months. We analysed success rates, leak pressures, adverse events, and risk factors for failure. Results Data from 2049 i-gel uses were analysed. Patients' mean age was 47 (range 6-91) yr. The primary i-gel success rate without changing size was 93%; the overall success rate was 96%. Insertion was deemed very easy or easy in 92%. The mean airway leak pressure was 26 (8) cm H2O. The mean anaesthesia time was 67 (42) min. Risk factors associated with i-gel failure were males (P<0.001), impaired mandibular subluxation (P=0.01), poor dentition (P=0.02), and older age (P<0.01). Adverse events recorded were laryngeal spasms (n=25, 1.2%), blood stained airway devices (n=79, 3.9%), transient nerve damage (n=2, 0.1%), one case of transient vasovagal asystole, and one glottic haematoma. Conclusions The i-gel is a reliable supraglottic airway device failing in <5% and providing high airway leak pressures. Males, impaired mandibular subluxation, poor dentition, and older age are risk factors associated with primary device failure. Serious adverse events are rar

Extended Recurrence Plot Analysis and its Application to ERP Data

We present new measures of complexity and their application to event related potential data. The new measures base on structures of recurrence plots and makes the identification of chaos-chaos transitions possible. The application of these measures to data from single-trials of the Oddball experiment can identify laminar states therein. This offers a new way of analyzing event-related activity on a single-trial basis.Comment: 21 pages, 8 figures; article for the workshop ''Analyzing and Modelling Event-Related Brain Potentials: Cognitive and Neural Approaches`` at November 29 - December 01, 2001 in Potsdam, German

Randomized clinical trial of the i-gel™ and Magill tracheal tube or single-use ILMA™ and ILMA™ tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway

Background The single-use supraglottic airway device i-gel™ has been described in several case reports as a conduit for intubation, but no prospective data about success rates of blind intubation are available. Therefore, we performed this prospective randomized controlled trial to compare the success rate of blind tracheal intubation with a Magill PVC tube through the i-gel™ with intubation using an sILMA™ PVC tube through the single-use intubating laryngeal mask airway (sILMA™). Methods With ethics committee approval and written informed consent, 80 patients with predictors of a difficult airway were computer randomized to either supraglottic airway device (SAD). The corresponding tracheal tube (TT) was introduced through the SAD under fibreoptic visualization but without fibreoptic guidance. Primary outcome was blind intubation success rate. Times, airway leak pressure, fibreoptic view, and adverse events were recorded. To control for the influence of the TT, we compared data from 40 patients described in an accompanying study (sILMA™ with Magill TT and i-gel™ with sILMA™ TT). Results Blind intubation success rate through the sILMA™ (69%) was higher than with the i-gel™ (15%, P<0.001). Data from the other patient group excluded the TT type as the primary cause for the difference in success rate. Removal of SADs was without problems with no difference between the type of SAD. Conclusions Blind tracheal intubation using the sILMA™ tube through the sILMA™ is much more successful than blind intubation with a Magill PVC tube through the i-gel™. Because of its low success rate, we would not recommend blind intubation through the i-gel

Using Topological Statistics to Detect Determinism in Time Series

Statistical differentiability of the measure along the reconstructed trajectory is a good candidate to quantify determinism in time series. The procedure is based upon a formula that explicitly shows the sensitivity of the measure to stochasticity. Numerical results for partially surrogated time series and series derived from several stochastic models, illustrate the usefulness of the method proposed here. The method is shown to work also for high--dimensional systems and experimental time seriesComment: 23 RevTeX pages, 14 eps figures. To appear in Physical Review