Lumbar spinal stenosis: methods of treatment with emphasis on epidural steroid injections

Background and Purpose: The aim of the study was to compare two techniques of steroid application into epidural space to patients with lumbar spinal stenosis (LSS), a chronic degenerative spine disorder. Patients and Methods: Sixty LSS patients have been distributed into 2 groups: “BLIND” (n=30, interlaminar epidural steroid injection without RTG control) and “RTG” (n=30, transforaminal epidural injection with RTG control). All patients have received 80 mg of triamcinolon (Kenalog) into epidural space on L4/L5 level, together with 0,5% lidocain (patients in RTG group 3 ml and those in BLIND group 10 ml) in 3 week intervals. They were asked to describe the pain using visual analogue scales (VAS) at the beginning of treatment (VAS-0), after the first (VAS-1), the second (VAS-2) and the third epidural injection (VAS-3). The differences between groups were shown using t-test (age) and c2-test (gender). Medians of VAS scores were statistically described using non parametrial methods. P<0.05 was considered as a statistically significant. Results: There is no statistical difference among patients regarding to age (P=0.93), gender (P=0.12) and VAS-0 score before the first injection (P=0.27). There is a statistically significant reduction of pain in relation to VAS-0 in both groups (P<0.001). Both groups do not statistically differ when it comes to their effectiveness in regards to VAS scores. Conclusions: We did not find any statistical difference in postinterventional VAS scores among two groups of patients. Choice of technique depends on the experience of the anesthesiologist, as well as on the local technical possibilities (availibility of RTG devices)

Reconstructive Procedures after Total Gastrectomy for Gastric Cancer

Till this day, there are more than 60 described surgical procedures of the intestinal reconstructions after a total gastrectomy. In 1897, Schlatter reconstructed the digestive tract by creating a termino-lateral esophagojejunostomies that was the first successful total gastrectomy. Many of the total gastrectomy pioneers did the reconstruction by esophagoduodenostomy or by forming a loop esophagojejunostomy. The main reconstruction modalities after a total gastrectomy are a restitution of the intestinal continuity, without a preservation of the duodenal food passage (esophagojejunostomy with a Roux-en-Y configuration) and a restitution of the intestinal continuity with a preservation of the duodenal passage (esophagojejunostomy with Roux-en-Y configuration and forming of the lateral-terminal jejunoduodenal anastomosis double tract and jejunal interposition by Longmire). The surgeries in these categories can be combined with forming of an enteral pouch or a stomach reservoir which would simulate a reservoir of a normal intact stomach. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. Preservation of duodenal transit with replacement of the jejunal segment, the so-called physiological route, is now believed to be preferential for postoperative nutritional condition, prevents persistent postgastrectomy syndrome, and improves the quality of life. Reconstructive procedures which allow duodenal passage should be regarded as a key to physiological reconstruction

Stability of Electric Characteristics of Solar Cells for Continuous Power Supply

This paper investigates the output characteristics of photovoltaic solar cells working in hostile working conditions. Examined cells, produced by different innovative procedures, are available in the market. The goal was to investigate stability of electric characteristics of solar cells, which are used today in photovoltaic solar modules for charging rechargeable batteries which, coupled with batteries, supply various electronic systems such as radio repeaters on mountains tops, airplanes, mobile communication stations and other remote facilities. Charging of rechargeable batteries requires up to 25 % higher voltage compared to nominal output voltage of the battery. This paper presents results of research of solar cells, which also apply to cases in which continuous power supply is required

Das vaskuläre Trauma: Analyse der Versorgungsrealität in einer deutschlandweiten Umfrage

Hintergrund und Ziel der Arbeit Die vaskuläre Beteiligung im Rahmen von Traumen ist selten. Für die Versorgung der Verletzungen gibt es nur wenige konkrete Handlungsempfehlungen, sodass von einer großen Varianz auszugehen ist. Ziel der vorliegenden Umfrage war die Statuserhebung der aktuellen Versorgungsrealität des Gefäßtraumas in Deutschland sowie die Eruierung des Bedarfs und der Form von entsprechenden Fortbildungsangeboten. Material und Methoden Es wurde eine Online-Umfrage über SurveyMonkey® mit den Mitgliedern der Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG) durchgeführt. Ergebnisse An der Umfrage haben sich 10,6 % der angeschriebenen Mitglieder der DGG beteiligt. Hieraus ergab sich, dass die meisten Kliniken 5–10 traumatische Gefäßverletzungen pro Jahr versorgen, wobei die höchsten Behandlungszahlen erwartungsgemäß in den überregionalen Traumazentren erreicht werden. Die Versorgung des Gefäßtraumas ist nicht einheitlich, sondern findet abhängig von der anatomischen Lokalisation durch unterschiedliche Fachabteilungen statt. Kliniken für Gefäßchirurgie sind selten an der Versorgung beteiligt. Bei den meisten Befragten bestand der Wunsch nach Fortbildungen zum Erlernen von gefäßtraumatologischen Techniken. Diskussion Gefäßchirurgische Kliniken sind nach den vorliegenden Umfrageergebnissen selten an der Versorgung des vaskulären Traumas beteiligt. Mögliche Erklärungen hierfür liegen in lokalen und infrastrukturellen Gegebenheiten. Eine aktive Einbindung von gefäßchirurgisch ausgebildeten Ärztinnen und Ärzten in die Diagnostik und Therapie der vaskulären Traumata ist wünschenswert und sollte aktiv angeboten werden. Das Erlernen der hierfür notwendigen Techniken kann beispielsweise im Rahmen praktischer Kurse stattfinden

Viral macrophage inflammatory protein-II improves acute rejection in allogeneic rat kidney transplants

During rejection, leukocytes are recruited from the peripheral circulation into the graft leading to the damage of endothelial cells, capillary perfusion failure and graft loss. Chemokines play a pivotal role in the recruitment of leukocytes to the endothelium. Viral macrophage inflammatory protein-II (vMIP-II), a human herpes virus-8 DNA-encoded protein, is a broad-spectrum chemokine antagonist. The aim of the study was to prove the beneficial activity of vMIP-II treatment on acute rat kidney allograft damage. Heterotopic rat kidney transplantation was performed in the Fischer 344 to Lewis transplantation model and animals were treated with vMIP-II (2 x 15 A mu g or 100 A mu g/day) for 7 days. Rejection-induced damage was analyzed by histology, and microcirculatory changes within the graft were analyzed by in vivo microscopy. Viral macrophage inflammatory protein-II significantly improved acute glomerular damage and tubulointerstitial inflammation and lowered the extent of vascular and tubulointerstitial damage of the treated allografts. Functional microcirculation of peritubular capillaries was significantly improved in vivo, and the firm adherence of leukocytes was significantly reduced by vMIP-II treatment. The administration of the broad-spectrum antagonist vMIP-II improved acute renal allograft damage, mainly by a reduction in leukocyte recruitment with a subsequently improved renal cortical microcirculation in vivo.[SFB 405]; [B10

Extravascular perivenous fibrin support leads to aneurysmal degeneration and intimal hyperplasia in arterialized vein grafts in the rat

Abstract Background and aims External support of vein grafts by fibrin glue possibly prevents overdistension, vascular remodeling, and neointimal hyperplasia. Previous animal models of neointimal hyperplasia showed conflicting results. Here, long-term effects of external fibrin glue support were studied in a new rat model of jugular vein to abdominal aorta transposition. Materials and methods and methods In male Wistar rats (250-300 g) right jugular vein (1.0-1.5 cm) was transposed to the infrarenal aorta. Fibrin glue (0.25 ml) covered the vein before releasing the vascular clamps (n=6). Control vein grafts were exposed directly to blood pressure. After 16 weeks vein grafts were pressure-fixed for histology

STAT-1 decoy oligodeoxynucleotide inhibition of acute rejection in mouse heart transplants

During acute rejection of cardiac transplants endothelial cell–leukocyte interaction fuelled by co-stimulatory molecules like CD40/CD154 may ultimately lead to graft loss. One key player in up-regulating the expression of such pro-inflammatory gene products is the interferon-γ-dependent transcription factor STAT-1. Hence down-regulating interferon-γ-stimulated pro-inflammatory gene expression in the graft endothelial cells by employing a decoy oligodeoxynucleotide (dODN) neutralising STAT-1 may protect the graft. To verify this hypothesis, heterotopic mouse heart transplantation was performed in the allogeneic B10.A(2R) to C57BL/6 and syngeneic C57BL/6 to C57BL/6 strain combination without immunosuppression. Graft vessels were pre-treated with STAT-1 dODN, mutant control ODN (10 μM each) or vehicle (Ringer solution). Cellular rejection (vascular and interstitial component) was graded histologically and CD40, ICAM-1, VCAM-1, MCP-1, E-selectin and RANTES expression in the graft monitored by real time PCR 24 h and 9 days post-transplantation. Nine days after transplantation both rejection scores were significantly diminished by 85 and 70%, respectively, in STAT-1 dODN-treated allografts as compared to mutant control ODN-treated allografts. According to immunohistochemistry analysis, this was accompanied by a reduced infiltration of monocyte/macrophages and T cells into the graft myocardium. In addition, pro-inflammatory gene expression was strongly impaired by more than 80% in STAT-1 dODN-treated allografts 24 h post-transplantation but not in mutant control ODN or vehicle-treated allografts. This inhibitory effect on pro-inflammatory gene expression was no longer detectable 9 days post-transplantation. Single periprocedural treatment with a STAT-1 dODN thus effectively reduces cellular rejection in mouse heart allografts. This effect is associated both with an early decline in pro-inflammatory gene expression and a later drop in mononuclear cell infiltration

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat