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The 2017 World Health Organization (WHO) classification proposes to type and subtype primary adenohypophyseal tumours according to their cell lineages with the aim to establish more uniform tumour groups. The definition of atypical adenoma was removed in favour of high-risk adenoma, and the assessment of proliferative activity and invasion was recommended to diagnose aggressive tumours. Recently, the International Pituitary Pathology Club proposed to replace adenoma with the term of pituitary neuroendocrine tumour (PitNET) to better reflect the similarities between adenohypophyseal and neuroendocrine tumours of other organs. The European Pituitary Pathology Group (EPPG) endorses this terminology and develops practical recommendations for standardised reports of PitNETs that are addressed to histo- and neuropathologists. This brief report presents the results of EPPG's consensus for the reporting of PitNETs and proposes a diagnostic algorithm. [ABSTRACT FROM AUTHOR]

Diatoms are important ecological indicators in Antarctica, and paleolimnologists routinely apply transfer functions to fossil diatoms recovered from lake sediments to reconstruct past environments. However, living diatom communities may differ among the possible habitat types represented in sediment cores (both within lakes and their immediate proximity), hindering the full and accurate interpretation of fossil records. Therefore, an improved understanding of Antarctic diatom habitat preferences would substantially aid in interpreting regional paleo-material. To gain insights into habitat differences, we sampled epipelon, epilithon, Nostoc mats, lake-adjacent moss, and wet soil from > 30 lakes and ponds from Clearwater Mesa, James Ross Island, spanning a broad gradient in conductivity (a common basis for transfer functions). We found that diatom communities significantly differed between habitat types (although abundances were too low in Nostoc mats to characterize communities), with the clearest distinctions being between submerged (epipelon and epilithon) and exposed (moss and wet soil) groups. Submerged habitat types had greater abundances of attached aquatic taxa (i.e. Gomphonema spp.), while exposed habitats harboured more abundant aerophilic genera (e.g. Hantzschia, Luticola, and Pinnularia). Furthermore, only epilithon communities were significantly related to conductivity, and both epipelon and epilithon habitats showed conspicuous increases in Denticula jamesrossensis at greater conductivity values. Collectively, these results improve our knowledge of limno-terrestrial diatoms from the Maritime Antarctic Region, and further highlight the utility of incorporating knowledge of habitat preferences into (paleo)ecological research. [ABSTRACT FROM AUTHOR]

Acute subarachnoid hemorrhage (SAH) is a severe and acute life-threatening cerebrovascular disease. Approximately 80% of all acute non-traumatic SAHs are the result of a ruptured cerebrovascular aneurysm. Despite advances in diagnosis and treatment a high morbidity and mortality still exists. Apart from the primary cerebral damage there are also secondary complications, such as vasospasm, rebleeding, hydrocephalus, cerebral edema or hydrocephalus. For an appropriate therapy an understanding of the extensive pathophysiology, the options in diagnostics and therapy and the complications of the disease are essential. Anesthesiologists are decisively involved in the therapy of the primary and secondary damages and subsequently in the outcome as well. This article provides an overview of the perioperative and intensive care management of patients with SAH. [ABSTRACT FROM AUTHOR]

The use of volatile anaesthetics in intensive care medicine has so far been limited by the lack of equipment suitable for daily routine use and the need for an anaesthetic machine. The new Anaesthetic Conserving Device (AnaConDa) enables the routine use of volatile anaesthetics for long-term sedation via intensive care ventilators. The Anaesthetic Conserving Device replaces the common heat and moisture exchanger in the ventilation circuit. The volatile anaesthetic is continuously applied in liquid status via a syringe pump to a form of mini-vaporiser where the anaesthetic agent is vaporised. The expired anaesthetic gas is stored in the carbon filter and approximately 90% of the gas is resupplied into the breathing cycle. The current experiences suggest that volatile anaesthetics present an alternative for long-term sedation in intensive care units, providing optimised pathways, from a medical as well as from an economical point of view. It must, however, be emphasized that the use of volatile anaesthetics for longer periods of time is an off-label use and should only undertaken by medical professionals at their own risk. [ABSTRACT FROM AUTHOR]

The topic of this study is the optimization of the preparation procedure and chemical composition of a gas diffusion electrode (GDE) for utilization in high-temperature PEM fuel cells. A phosphoric acid-doped polybenzimidazole derivative membrane was used as a polymer electrolyte. The following parameters were studied: nature and content of the polymeric binder (PTFE-hydrophobic, PBI-hydrophilic) in the catalytic layer (CL) and concentration of platinum in catalytic powder (affecting the thickness of the CL). Brushing and spraying were selected as the most suitable techniques of CL deposition. Surprisingly, both polymeric binders investigated in the framework of this study were found to provide a similar GDE performance for CL deposited on the gas diffusion layer surface by spraying. [ABSTRACT FROM AUTHOR]

This paper presents the results of a study on the estimation of climatic conditions of dryness and drought in the Republic of Moldova. The evaluation of drought was based on data from 18 weather stations, which were selected according to the length of the period of measurement (1945–2006) and from the Chisinau observatory, which has the longest statistical series from Moldova (1891–2006). Some of the basic principles in the selection of the drought identification indices were: to characterize the same period of time, provide information on the regional hydrothermic regime, and not to rely on constants that are specific to certain physical/geographical regions. Firstly, the registers of the droughts for spring, summer and autumn have been identified and processed. Secondly, the frequency, duration and tendency of the dryness and drought phenomena have been evaluated. Thirdly, the manifestation of dryness and drought, as well as their spatial distribution, have been estimated with a probability of 95%. As a result of the analysis of the drought register for a period of over 100 years, an increase in tendencies of frequency and intensities of the given phenomena after the 1980s was revealed. The longest drought periods were noticed at the beginning of the 1950s and 1960s, reaching their highest points in the decades of 1981–1990 and 1991–2001, with the lowest point in the 1970s. Accordingly, during the past 20 years, in 11 cases of drought, 9 of them were registered as being of either a severe or extreme intensity degree. [ABSTRACT FROM AUTHOR]

Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Unlabelled: Cisatracurium (51W89, Nimbex, Glaxo-Wellcome), an intermediate-acting non-depolarizing neuromuscular blocking agent, is a stereoisomer of atracurium. Histamine releasing propensities and serum tryptase level have been investigated after administration of cisatracurium (3 x ED95, 5 x ED95) or vecuronium (3 x ED90) in surgical patients.Methods: After approval by our institutional review board, 62 patients (ASA I-II) were randomly assigned to three groups to receive either 3 x ED95 or 5 x ED95 cisatracurium, or 3 x ED90 vecuronium as a rapid bolus. A prick test was done the day before by scarification of the skin in the forearm. After premedication with 2 mg lormetazepam, anaesthesia was induced with thiopentone (4-12 mg/kg) and maintained with O2/N2O and isoflurane (1.5-2 vol.%). Six minutes after thiopentone, the patients received the relaxant and after further 6 min 0.1-0.2 mg fentanyl was given and the trachea was intubated. Heart rate (HR) and blood pressure (BP) were monitored every minute. Blood samples for histamine were withdrawn 5 min prior 3 and 5 min after each drug administration (thiopentone, relaxants). Plasma histamine was measured by radioimmunoassay (RIA) with a sensitivity of approximately 10 pg/ml. Additionally, serum tryptase was measured by RIA at baseline (-10 and -1 min) and 15 and 60 min after the relaxant administration. Levels for histamine > 1000 pg/ml and for tryptase > 2 micrograms/ml were considered significant. Cutaneous signs of histamine release were documented.Results: Ten patients showed a positive prick-test reaction. Only after thiopentone some cutaneous signs (4 flush, 1 erythema) of histamine release were observed. There were no cutaneous signs of histamine release correlating with cardiovascular changes. Analysis of the blood samples demonstrated no significant increase in the histamine level in all three groups. Only in 1 patient was a significant higher histamine level (1133 pg/ml) measured 5 min after 5 x ED95 cisatracurium. All measurements of serum tryptase were within the physiological limits.Discussion: In this study, with the particular time course of drug administration, neither cisatracurium nor vecuronium increased plasma histamine levels. Only after 5 x ED95 cisatracurium was 1 elevated histamine level documented after 5 min. In several studies increased histamine levels have been described, but without clinical manifestations. It is known that cutaneous signs can occur without increased plasma histamine levels due to the structural heterogeneity of mast cells. The cutaneous reactions in this study were caused by thiopentone. The tryptase values were within normal limits even in the patient with histamine release. No relationship between the positive results in the prick test and the incidence of cutaneous reactions and/or histamine release for drugs used in the induction of anaesthesia was observed. Whether cisatracurium has a potential for immunologic release is unknown. [ABSTRACT FROM AUTHOR]

Introduction: Recently, a compact multisensor device 0.5 mm in diameter has become available with a miniaturised Clark electrode for measuring blood oxygen tension and two optical fibres for measuring CO2 tension, pH, and temperature (Paratrend 7, Biomedical Sensors, High Wycombe, UK). We used this new probe for continuous blood gas monitoring in the jugular bulb as an alternative to the commonly used fiberoptic spectrophotometric oximetric measurement of haemoglobin saturation.Results: A 64-year-old patient was admitted for surgery of a right-sided intracranial aneurysm. During surgery, with no artefacts or evidence of catheter drift, a normal jugular venous pO2 (pjvO2) of 39 +/- 3 mmHg was measured. Over the period of weaning, two declines in pjvO2 occurred (22.5 and 18.7 mm Hg) associated with a decline in CO2 tension and a rise in pH. We treated these events successfully by analgosedation, controlled ventilation with an inspired oxygen fraction of 70%, and elevation of the mean arterial blood pressure to over 100 mmHg. Extubation was possible about 24 h later. Furthermore, 3 h after extubation pjvO2 values could be monitored without difficulty despite movement of the patient.Discussion: The technique of polarographically measuring pjvO2 with a Clark-type probe appears superior to fibreoptic jugular venous oximetry due to the clearly lower incidence of faulty measurements, especially in the intensive care unit, where patients undergo frequent nursing interventions and tend to awaken. We did not even observe artefacts due to patient movement after extubation. A limitation of the new multisensor system might be the distance of 4 cm between the sensor tip and the end of the insertion catheter, which makes samples drawn for in vitro blood gas analyses to control the continuous monitoring less comparable. Improvements in the construction of the probe are recommended. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Unlabelled: Cisatracurium-one of the ten stereoisomers of atracurium-is an intermediate long-acting non-depolarizing neuromuscular blocking agent. Cardiovascular reactions have been described after administration of cisatracurium or vecuronium in surgical patients.Methods: After approval by our institutional review board, 62 patients (ASA I-II) were randomly assigned to three groups to either receive 3xED95 or 5xED95 of cisatracurium or 3xED90 of vecuronium prior to intubation as a bolus. After oral premedication with 2 mg lormetazepam anaesthesia was induced with thiopental (4-12 mg/kg) and maintained with O2/N2O and isoflurane (1.5%-2%). Six minutes after administration of thiopental, patients received the muscle relaxant. Six minutes later 0.1-0.2 mg fentanyl was given and the trachea was intubated. Heart rate (HR) and blood pressure (BP) were monitored every minute. Changes of heart rate or blood pressure > 20% compared to baseline were defined as clinically significant.Results: After application of the study drug, median values of blood pressure and heart rate were stable. For each muscle relaxant, there were several patients who had statistically significant cardiovascular changes. After 3xED95 cisatracurium, 3 of 21 patients exhibited haemodynamic changes > 20% (2 exhibited hypotension and 1 tachycardia), while in the high-dose cisatracurium group 2 of 21 patients demonstrated a tachycardia that was predetermined to be statistically but not clinically significant. In the vecuronium group, 2 of 20 patients sustained statistically significant hypotension and 1 patient had statistically significant tachycardia. The frequency of all individual cardiovascular changes after the application of the muscle relaxant was not dose-dependent.Conclusion: After the administration of cisatracurium in two different doses (3xED95 and 5xED95) or vecuronium (3xED90) only minor cardiovascular changes were observed. Both drugs proved to be safe for use during induction of anaesthesia in patients ASA I-II. With regard to its cardiovascular effects, cisatracurium shares with vecuronium the requirements of an ideal muscle relaxant. [ABSTRACT FROM AUTHOR]

Unlabelled: Erythropoietin, the hematopoietic growth factor, is synthesised in the kidneys and liver and regulates red blood cell production. Within the last few years, recombinant DNA technology has produced synthetic erythropoietin (rhEPO). Some patients, especially Jehovah's Witnesses, will not accept blood transfusion. The perioperative administration of rhEPO increases the patients' hematocrit (HCt) to a higher than physiological level.Methods and Results: We report a case of a 66-year-old female Jehovah's Witness who refused blood transfusions and responded favourably to rhEPO treatment. A total hip arthroplasty was planned. A pretreatment hemoglobin level (Hb) of 13.7 g/dl and HCt of 43% were documented. After preoperative subcutaneous application of 5000 I.E. rhEPO three times per week and daily oral substitution of 300 mg ferrous sulfate over a period of 3 weeks, the Hb increased to 15.5 g/dl and the HCt to 49%. The operation was carried out after the ninth application of rhEPO. Postoperatively, the Hb concentration was 11.8 g/dl and the HCt 35%. Therefore, postoperative administration of rhEPO was not considered indicated. No side effects of rhEPO application were noted. The patient left hospital on the 10th postoperative day.Conclusions: The case report describes perioperative management using human rhEPO in Jehovah's Witnesses. Treatment with rhEPO increases preoperative Hb levels to a point making it possible to compensate for operative blood loss. RhEPO combined with daily iron substitution may be useful in patients who refuse transfusion based on religious convictions. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of treatment with erythromycin on the resolution of symptoms among adults with pharyngitis not caused by group A streptococcus (GAS).Design: Randomized, double-blind, placebo-controlled trial.Setting: Ambulatory setting (hospital-based general internal medicine practices, walk-in clinic, employee health service, and university health service).Patients: One hundred and eighty-six adults who met eligibility criteria and whose chief complaint included sore throat. Patients with positive cultures for GAS were excluded.Intervention: Ninety-three patients received erythromycin (333 mg three times daily for 10 days) and 93 control patients received placebo.Measurements and Main Results: Major outcome measurements included time to improvement in sore throat, time to improvement in cough, time to improvement in activity level, and subjective sense of well-being. The average age of the patients studied was 26.6 years; 35% were men. Patients given erythromycin had more rapid resolution of sore throat symptoms (hazard ratio 1.43: 95% confidence interval [CI] 1.00, 2.03: p = .049). Cough also resolved more rapidly in patients receiving erythromycin (hazard ratio 2.22: 95% CI 1.01, 4.88: p = .05). There were no differences between the two treatment groups in improvement of activity level or how sick patients felt in general. Most of the benefit in resolution of sore throat was conferred on patients who sought medical care within 2 days of onset.Conclusions: Our results suggest that the benefit of erythromycin treatment for patients with non-GAS pharyngitis is small and of borderline statistical significance. Because of the small size of the effect and because widespread use of erythromycin could promote drug resistance, we do not recommend routine use of erythromycin in adult patients with this type of pharyngitis. [ABSTRACT FROM AUTHOR]

The present paper deals with an investigation of the problem of the gradual release of nutritive ions bound on ion exchangers. Tomato plants were cultivated in a mixture of sand and ion exchanger fertilizer of different sized granulation. The check plants were watered with a nutritive solution. At five time intervals the following portions of nutrients were measured: a. consumed by plants; b. washed out by water; c. remaining on the ion exchanger. The following conclusions may be drawn: From the results obtained it is evident that for both physiological and economic reasons it will be generally feasible to apply the major nutrients - nitrogen, phosphorus, and potassium - by means of ion exchange fertilizers. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the sensitivity of a newly applied transoesophageal ultrasonic Doppler sensor for detection of air with the traditional precordial ultrasonic Doppler sensor in clinical use. Methods: We studied 16 patients undergoing neurosurgical procedures in a sitting position. Two ultrasonic Doppler devices were compared as to their ability to detect venous air embolisms (VAE): transoesophageal (ODM II, co. Abbott) versus a precordial ultrasonic Doppler sensor (Parks Medical Electronics Inc.). After establishing general anaesthesia and endotracheal intubation, we applied an ultrasonic Doppler sensor to the right sternal border of the patient’s chest and inserted an ultrasonic Doppler probe into the oesophagus. With the patient in the sitting position, microparticularly d-galactose was injected to verify the efficacy of both ultrasonic Doppler devices. Results: Using ODM II by positioning the probe toward the azygos vein, a dosage of 1 ml microparticularly d-galactose was dedected in every patient. When adjusting the ODM II-probe on the right myocardial wall or using the precordial ultrasonic Doppler sensor, the administration of microparticularly d-galactose was detected by the devices in only 11 patients. Conclusions: This study demonstrates that a transoesophageal ultrasonic Doppler sensor (ODM II) is more efficient than the precordial ultrasonic Doppler sensor for monitoring patients who are at risk of VAE by sonification of the azygos vein. [ABSTRACT FROM AUTHOR]