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Great advances in precision measurements in the quantum regime have been achieved with trapped ions and atomic gases at the lowest possible temperatures1–3. These successes have inspired ideas to merge the two systems4. In this way, we can study the unique properties of ionic impurities inside a quantum fluid5–12or explore buffer gas cooling of a trapped-ion quantum computer13. Remarkably, in spite of its importance, experiments with atom–ion mixtures have remained firmly confined to the classical collision regime14. We report a collision energy of 1.15(±0.23) times the s-wave energy (or 9.9(±2.0) μK) for a trapped ytterbium ion in an ultracold lithium gas. We observed a deviation from classical Langevin theory by studying the spin-exchange dynamics, indicating quantum effects in the atom–ion collisions. Our results open up numerous opportunities, such as the exploration of atom–ion Feshbach resonances15,16, in analogy to neutral systems17.

Zusammenfassung Ziel In einer retrospektiven Studie wurden die Sensitivität der Nebenschilddrüsenszintigraphie und der Sonographie bei Patienten mit primärem Hyperparathyreoidismus (pHPT) untersucht, die eine Voroperation der Schilddrüse aufwiesen bzw. nach einer Nebenschilddrüsenoperation einen persistierenden pHPT oder einen Rezidiv-HPT zeigten. Methoden Bei 65 erfolgreich operierten und 12 nicht erfolgreich operierten Patienten wurde präoperativ eine Sonographie des Halses und eine Nebenschilddrüsenszintigraphie mit einer kombinierten Zweiphasen/Doppelnuklid-Technik durchgeführt, die zusätzlich zur biphasischen Nebenschilddrüsenszintigraphie mit 300–600 MBq 99mTc-Sestamibi noch eine Schilddrüsenszintigraphie mit 80–100 MBq 99mTc-Pertechnetat beinhaltet. Ergebnisse Die Sensitivität der Nebenschilddrüsenszintigraphie betrug bei normaler Schilddrüse 86%, bei Z.n. Schilddrüsenoperation 77% und bei Z.n. Nebenschilddrüsenoperation 62%. Die Sonographie wies in den einzelnen Gruppen jeweils eine Sensitivität von 86%, 50% und 57% auf. Schlussfolgerung Nach Operationen im Halsbereich sinkt die Sensitivität der Nebenschilddrüsenszintigraphie und der Sonographie erheblich. Die Sensitivität der Nebenschilddrüsenszintigraphie liegt wesentlich unterhalb der bisher publizierten Ergebnisse. Dennoch sollte sie gerade in diesen Fällen zum Einsatz kommen, da zz. nur eingeschränkt eine validierte alternative Lokalisationsdiagnostik in Ergänzung zum Ultraschall zur Verfügung steht.

Objective: The purpose of this study was to develop a method for three-dimensional (3D) visualization of the whole vascular system of the carotid and vertebral arteries using spiral computed tomographic angiography (SCTA), that allows accurate, qualitative and quantitative evaluation, of anatomical abnormalities, including detection of additional lesions, and estimation of degree of stenosis. Materials and methods: Fifteen patients with anatomical and pathological abnormalities of the arterial vascular system detected by color-coded duplex ultrasound were studied using intraarterial digital subtraction angiography (IA-DSA) with aortic arch injection, and SCTA. The carotid and vertebral arteries were segmented using an interactive threshold interval density volume-growing method and visualized with a color-coded shaded-surface display (SSD) rendering method. The adjacent bone structures were visualized using a transparent volume rendering method. Results: In all cases, the entire volume of the vascular system of the carotid and vertebral arteries could be visualized on SCTA, and the anatomical and pathological abnormalities on 3D SCTA correlated well with that seen on IA-DSA. Conclusion: Results of 3D SCTA had a high degree of correlation with results of IA-DSA in the evaluation of the vascular system of the carotid and vertebral arteries. The 3D SCTA with a subsecond spiral CT scanner is useful for the visualization of anatomical and pathological abnormalities in the circulation in the carotid and vertebral arteries and offer a promising minimally invasive alternative compared with other diagnostic procedures.

Summary.: Patients suffering from long-untreated malignomas of the chest or abdominal wall may require plastic surgery due to extensive defects after tumor resection. Despite a variety of pedicled or free myocutaneous flaps, there are defects in which these reconstructional options may not be indicated. In these patients, the omental flaps are a valid alternative. Since a secondary split skin graft is mandatory with the omentum flap, antibacterial and granulation-enhancing xerodressings are required for wound bed conditioning. We report one patient in whom the omentum flap was used for coverage of an extensive defect after resection of a widespread basal cell carcinoma at the lateral thorax and abdominal wall. After wound conditioning with silver-impregnated activated charcoal xerodressing (Actisorb) in combination with a hydroactive polymer dressing (Allevyn), secondary skin grafting was performed. In this patient fibrosis and calcification of the omentum led to stable abdominal wall coverage even without the application of a synthetic mesh.

Objective:Colon interposition for esophageal replacement is indicated in patients with benign esophageal disease, in patients who require an esophago gastrectomy for a potential cure and in patients in whom the stomach is no longer available for replacement because of preceding surgery. Methods:In 30 patients we performed colon interposition grafts for esophageal replacement using a modified technique. This technique includes ligation of the middle and right colic artery, thereby creating an interposition graft of the whole ascending colon which receives blood exclusively from the left colic artery. The main advantage of this procedure is the length of the interposition graft. Preparation of the left colic flexure is no longer required. Nineteen patients had an esophagectomy, 11 patients an esophago-gastrectomy. Results:Minor complications in this unselected patient group occurred six times (20 %), and major complications were observed in seven patients (23.3 %). Frequency of anastomotic leakage amounted to 13.3 %, hospital mortality to 10 %. Conclusion:Frequency of postoperative complications and hospital mortality of patients in whom a modified colon interposition was done is comparable with published data of unselected patient groups, which had either a standard colon interposition graft for esophageal replacement or a gastric pull-through procedure. Einleitung:Der Hochzug des linksseitigen Colons ist heute das Standardverfahren zur Durchführung eines Coloninterponats. Methode:Wir führten bei 30 Patienten als Oesophagusersatz ein Coloninterponat mit einer modifizierten Technik durch. Dabei wird ein an der A. colica sinistra gestieltes Präparat des gesamten Colon ascendens gebildet. Vorteil dieses Verfahrens ist die Länge des Präparates, wodurch keine Präparation mehr im Bereich der linken Flexur erforderlich ist. Bei 19 Patienten führten wir so eine Oesophagektomie durch, 6mal mit intrathorakaler, 13mal mit cervicaler Anastomose, bei 11 Patienten eine Oesophagogastrektomie, 4mal mit intrathorakaler, 7mal mit cervicaler Anastomose. Ergebnisse:Kleinere Komplikationen in diesem nicht selektionierten Krankengut traten 6mal (20 %) auf, größere Komplikationen bei 7 (23,3 %) der Patienten. Die Nahtinsuffizienzrate betrug 13,3 %, die Hospitalletalität 10 %. Schlußfolgerung:Das von uns modifizierte Vorgehen bei der Bildung eines Coloninterponats ist bezüglich der Komplikationsrate wie auch der Letalität mit dem Standardvorgehen der Coloninterposition sowie mit den Ergebnissen nach Magenhochzug vergleichbar.

Summary.: Despite the widespread availability of antibiotics and a declining incidence, pleural empyema still represents a serious intrathoracic disease often requiring surgical treatment for successful therapy. 104 patients with complicated pleural empyema were treated at our hospital between June 1991 and June 1997. In this retrospective study the main causes for pleural empyema were pneumonia in 41.3 % and direct inoculation of the pleural space by major and minor thoracic surgery in 30.8 %. Further diseases leading to an empyma of the pleural space were oesophageal perforation (11.5 %), ARDS (8.7 %) and hematogenous infection (7.7 %). Eighty-four patients (80.8 %) underwent surgery, of whom 17 patients required multiple operations. Conservative therapy with chest tube drainage and systemic application of tested antibiotics was performed in 20 patients. The overall mortality of our patients was 19.2 %, but depending on the underlying disease differed considerably between 8.3 % and 44.4 %. Multiple operations caused by persisting empyema had a significantly higher mortality rate (58,8 %) than single operations (10.5 %).

Objective: Inhalation of high concentrations of nitric oxide (NO) has been shown to improve gas exchange and to reduce pulmonary vascular resistance in individuals with ischemia-reperfusion injury following orthotopic lung transplantation. We assessed the cardiopulmonary effects of low doses of NO in early allograft dysfunction following lung transplantion. Design: Prospective clinical dose- response study. Setting: Anesthesiological intensive care unit of a university hospital. Patients and participants: 8 patients following a single or double lung transplantation who had a mean pulmonary arterial pressure (PAP) in excess of 4.7 kPa (35 mmHg) or an arterial oxygen tension/fractional inspired oxygen ratio (PaO2/FIO2) of less than 13.3 kPa (100 mmHg). Interventions: Gaseous NO was inhaled in increasing concentrations (1, 4 and 8 parts per million, each for 15 min) via a Siemens Servo 300 ventilator. Measurements and results: Cardiorespiratory parameters were assessed at baseline, after each concentration of NO, and 15 min after withdrawal of the agent [statistics: median (25th/75th percentiles: Q1/Q3), rANOVA, Dunnett's test, p< 0.05]. Inhaled NO resulted in a significant, reversible, dose-dependent, selective reduction in PAP from 5.5(5.2/6.0) kPa at control to 5.1(4.7/5.6) kPa at 1 ppm, 4.9(4.3/5.3) kPa at 4 ppm, and to 4.7(4.1/5.1) kPa at 8 ppm. PaO2increased from 12.7(10.4/17.1) to 19.2(12.4/26.0) kPa at 1 ppm NO, to 23.9(4.67/26.7) kPa at 4 ppm NO and to 24.5(11.9/28.7) kPa at 8 ppm NO. All patients responded to NO inhalation (either with PAP or PaO2), all were subject to long-term inhalation (1–19 days). All were successfully weaned from NO and were discharged from the intensive care unit. Conclusion: The present study demonstrates that low-dose inhaled NO may be an effective drug for symptomatic treatment of hypoxemia and/or pulmonary hypertension due to allograft dysfunction subsequent to lung transplantation.

Zusammenfassung: Wir berichten über den Fall einer 73jährigen Patientin, die elektiv an einem Phäochromozytom operiert wurde. Eine präoperative alpha-Rezeptoren-Blockade mit Phenoxybenzamin konnte nicht durchgeführt werden, da sie von der Patientin abgelehnt wurde. Die präoperative antihypertensive Therapie erfolgte daher mit dem kompetitiven alpha-Rezeptor-Antagonisten Prazosin und dem beta-Rezeptoren-Blocker Metoprolol. Intraoperativ wurde zur Blutdruckkontrolle Natriumnitroprussid eingesetzt. Nach Entfernung des Primärtumors und Absetzen des Natriumnitroprussids kam es noch intraoperativ zu rezidivierenden Blutdruckspitzen, woraus sich die Verdachtsdiagnose eines multilokulären Phäochromozytoms ergab. Ein im makroskopisch unauffälligen Pankreasschwanz liegender Tumor konnte lediglich durch Blutdruckanstieg bei Palpation lokalisiert werden. Nach vollständiger Resektion aller Tumorherde traten keine weiteren hypertensiven Phasen mehr auf. Der postoperative Verlauf war unauffällig. Schlußfolgerung: In diesem Fall erleichterte vermutlich die alpha-Rezeptoren-Blockade mit Prazosin anstelle des längerwirksamen Phenoxybenzamin die intraoperative Tumorlokalisation sowie die Kontrolle über die vollständige Resektion aller Tumoranteile.

Summary Out of 14 reconstructions of the vena cava inferior and the pelvic veins, 9 patients showed good results with patient grafts. In addition, 6 out of 11 patients, operated upon for iliac vein thrombosis using crossover bypasses according to Palma, also showed good results. The graft material used mainly was expanded PTFE.

Summary During the last 2 years 1,035 patients have been subjected to directional continuous-wave Doppler ultrasonography. In all 248 severe stenoses of the internal carotid arteries were identified. Of these, 89 were checked by angiography and in 85 cases the diagnosis made with Doppler ultrasonography was confirmed. Another 106 stenoses were operated upon without preoperative Doppler diagnosis. Thus the reliability of the method proved to be 97%. It is concluded that patients with high angiography risk may be safely subjected to surgery on the basis of Doppler ultrasonography alone.