Search

Summary Background Current literature suggests a positive influence of additive classical homeopathy on global health and well-being in cancer patients. Besides encouraging case reports, there is little if any research on long-term survival of patients who obtain homeopathic care during cancer treatment. Design Data from cancer patients who had undergone homeopathic treatment complementary to conventional anti-cancer treatment at the Outpatient Unit for Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria, were collected, described and a retrospective subgroup-analysis with regard to survival time was performed. Patient inclusion criteria were at least three homeopathic consultations, fatal prognosis of disease, quantitative and qualitative description of patient characteristics, and survival time. Results In four years, a total of 538 patients were recorded to have visited the Outpatient Unit Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria. 62.8% of them were women, and nearly 20% had breast cancer. From the 53.7% ( n =287) who had undergone at least three homeopathic consultations within four years, 18.7% ( n =54) fulfilled inclusion criteria for survival analysis. The surveyed neoplasms were glioblastoma, lung, cholangiocellular and pancreatic carcinomas, metastasized sarcoma, and renal cell carcinoma. Median overall survival was compared to expert expectations of survival outcomes by specific cancer type and was prolonged across observed cancer entities ( p Conclusion Extended survival time in this sample of cancer patients with fatal prognosis but additive homeopathic treatment is interesting. However, findings are based on a small sample, and with only limited data available about patient and treatment characteristics. The relationship between homeopathic treatment and survival time requires prospective investigation in larger samples possibly using matched-pair control analysis or randomized trials.

A uniformly resolvable design (URD) is a resolvable design in which each parallel class contains blocks of only one block size k, such a class is denoted k -pc and for ag ivenk the number of k-pcs is denoted rk. In this paper, we consider the case of block sizes 3 and 4 (both existent). We use v to denote the number of points, in this case the necessary conditions imply that v ≡ 0 (mod 12). We prove that all admissible URDs with v < 200 points exist, with the possible exceptions of 13 values of r4 over all permissible v. We obtain a URD({3, 4}; 276) with r4 = 9 by direct construction use it to and complete the construction of all URD({3, 4}; v) with r4 = 9. We prove that all admissible URDs for v ≡ 36 (mod 144), v ≡ 0 (mod 60), v ≡ 36 (mod 108), and v ≡ 24 (mod 48) exist, with a few possible exceptions. Recently, the existence of URDs for all admissible parameter sets with v ≡ 0 (mod 48) was settled, this together with the latter result gives the existence all admissible URDs for v ≡ 0 (mod 24), with a few possible exceptions. C � 2013 Wiley Periodicals, Inc. J. Combin. Designs 21: 481-523, 2013

Objectives:Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions.Methods:Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs.Results:Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs.Conclusion:The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations.

BACKGROUND AND PURPOSE: The initial angiographic occlusion rate is the strongest predictor of later rebleeding in previously ruptured coil-embolized cerebral aneurysms. Angiographic estimations of aneurysmal occlusion rates are, however, subjective in nature and confounded by methodologic problems. COR has been developed, and its superiority has been experimentally established to overcome subjective bias. The purpose of this study was to assess the clinical value of COR as a more objective predictor of aneurysm rebleeding when compared with SOR as described in the Raymond Classification. MATERIALS AND METHODS: We applied COR in a consecutive series of 249 patients. Two DSA projections were selected independently by 2 blinded investigators. In cases of disagreement on the selected projections, a consensus decision was obtained. SOR were determined by 2 independent observers according to the Raymond classification. COR was measured by 2 blinded investigators. Interobserver variations were determined for SOR and COR. COR results were compared with SOR results and stratified as 100%, 99.9%–90%, 89.9%–70%, and

Introduction Endotracheal intubation (ETI) is the most widespread method for emergency airway management. Several studies reported that ETI requires considerable skill and experience and if performed incorrectly, may result in serious adverse events. Unrecognized tube misplacement or oesophageal intubation is associated with high prehospital morbidity. This study investigates the usability of supraglottic airway devices compared to ETI and the skill retention of 41 previously inexperienced paramedics following training using a manikin model. Methods 41 paramedics participated in this study. None had prior experience in airway management, apart from bag-valve ventilation. After a standardised audio-visual lecture lasting 45min, the paramedics participated in a practical demonstration using the advanced patient simulator SimMan ® (Laerdal Medical, Stavanger, Norway). Afterwards, paramedics were instructed to perform airway-management using seven different techniques to secure the airway (ETI, Laryngeal mask unique [LMA], Proseal, Laryngeal tube disposable [LT-D ® ], I-Gel ® , Combitube ® , and EasyTube ® ) following a randomized sequence. Participants underwent reassessment after 3 months without any further training or practice in airway-management. Results During the initial training session, ETI was successfully performed in 78% of cases, while 3 months later the success rate was 58%. For the supraglottic airway devices, five out of six were successfully used by all paramedics at both time points, the exception being Proseal ® . Our data show successful skill retention (success rate: 100%) after 3 months for five out of six supraglottic airway devices. Time to ventilation (T3) was significantly less for LMA, LT-D ® and I-Gel ® at all time points compared to ETI. Conclusion ETI performed by inexperienced paramedics is associated with a low success rate. In contrast, supraglottic airway devices like LMA, LT-D ® , I-Gel ® , Combitube ® and EasyTube ® are fast, safe and easy-to-use. Within the limitations of a manikin-study, this study suggests that inexperienced medical staff might benefit from using supraglottic airway devices for emergency airway management.

Summary Aim: We compared and delineated possible differences of model-based analysis of ECGgated SPECT using 99mTc-sestamibi (Tc- SPECT) with ECG-gated 18F-fluorodeoxyglucose- PET (FDG-PET) for determination of enddiastolic (EDV) and end-systolic (ESV) cardiac volumes, left ventricular ejection fraction (LVEF), and myocardial mass (LVMM). Patients, methods: 24 patients (21 men; age: 54 ± 12years) with coronary artery disease underwent Tc-SPECT and FDG-PET imaging for evaluation of myocardial perfusion and viability. By using model-based analysis EDV, ESV, LVEF and LVMM were calculated from short axis images of both Tc-SPECT and FDGPET. Results: Left ventricular volumes by Tc- SPECT and FDG-PET were 176 ± 60 ml and 181 ± 59 ml for EDV, and 97 ± 44 ml and 103 ± 45 ml for ESV respectively, LVEF was 47 ± 8% by Tc-SPECT and 45 ± 9% by FDG-PET. The LVMM was 214 ± 40 g (Tc-SPECT) and 202 ± 43 g (FDG-PET) (all p = NS, paired t-test). A significant correlation was observed between Tc-SPECT and FDG-PET imaging for calculation of EDV (r = 0.93), ESV (r = 0.93), LVEF (r = 0.83) and LVMM (r = 0.72). Conclusion: ECG-gated Tc-SPECT and FDG-PET using two tracers with different characteristics (perfusion versus metabolism) showed close agreement concerning measurements of left ventricular volumes, contractile function and myocardial mass by using a model-based analysis.

Chronic thromboembolic pulmonary hypertension (CTEPH), subsequent to pulmonary embolism is a relatively frequent cause of pulmonary hypertension. Similar to patients with pulmonary arterial hypertension (PAH), CTEPH carries a poor prognosis. There is no hard evidence for any other therapy except pulmonary endarterectomy and none for those patients that are not eligible for this procedure.Fifty patients with confirmed, inoperable CTEPH receiving specific vasodilative therapy (prostanoids, endothelin receptor antagonists, PDE 5-inhibitors or combination) were included in this retrospective study (mean age 55 years, range 16-76 years; 36 female, 14 male). Kaplan-Meier plots of these patients were compared with Kaplan-Meier plots of two historical CTEPH patient groups without any specific vasodilative treatment by log rank tests.CTEPH patients treated with specific vasodilative compounds as used for therapy of PAH were followed up for 52 +/- 30 months and had a significantly improved survival compared with patients treated without PAH type vasodilators (por = 0.0002).Our data may generate the hypothesis that specific vasodilative treatment improves outcome in patients with inoperable CTEPH.

To evaluate the effectiveness, safety, ease of placement, and ventilatory parameters of a new alternate airway device, the EasyTube (EzT; Teleflex Ruesch, Research Triangle Park, NC), in comparison to the endotracheal tube (ETT).Prospective, randomized controlled trial.University Hospital.200 adult ASA physical status I and II patients scheduled for surgery.Patients were randomized to two groups, one to receive ventilation via the EzT (n = 100) or the ETT (n = 100). After preoxygenation and induction with fentanyl and propofol, patients received muscle relaxation. The respective airway device was then inserted and mechanical ventilation was instituted.Ease of insertion, number of insertion maneuvers, time until airtight seal of the airway was achieved, duration of surgery, leak pressure as well as arterial oxygen saturation (SpO(2)), and end-tidal carbon dioxide (ETCO(2)) data, were recorded.Mallampati airway class was higher in the EzT group (P0.029), while thyromental distance showed no difference between the two groups. Ease of insertion was noted in the EzT group (P0.043). Number of insertions was equal in both groups; insertion time was shorter with the EzT (15.5 +/- 3.6 sec vs. 19.3 +/- 4.6 sec; P0.0001). Leak pressure and SpO(2) were not significantly different, while ETCO(2) was lower with the ETT (P0.024). Adjustments had to be made for two EzT group patients. No difference in frequency of laryngo-pharyngeal discomfort was observed in either group.Insertion of an EzT appears to reduce time and facilitate placement of an airway device when compared with direct laryngoscopy and tracheal intubation.

OBJECTIVES The purpose of this study was to compare quantitative ECG-gated single-photon emission computed tomography (SPECT) (QGS) and model-based ECG-gated single-photon emission computed tomography (MBGS) for determination of end-diastolic cardiac volume (EDV), end-systolic cardiac volume (ESV), and left ventricular ejection fraction (LVEF). The accuracy of both methods was evaluated by measurements obtained from contrast left ventriculography (LVG). METHODS Forty-five patients (40 male, age: 55+/-11 years) with coronary artery disease were studied by angiography and ECG-gated SPECT using technetium-99m-sestamibi for the evaluation of myocardial perfusion and LVEF. Short axis SPECT images were analyzed by QGS and MBGS to estimate endocardial and epicardial surfaces and to derive EDV, ESV, and LVEF. RESULTS EDV by gated SPECT (QGS: 187+/-71 ml; MBGS: 191+/-76 ml) were lower than corresponding values by LVG (203+/-59 ml), whereas ESV by gated SPECT (QGS: 121+/-62 ml; MBGS: 108+/-54 ml) were higher than by LVG (105+/-49 ml). Thus, LVEFs by gated SPECT (QGS: 39+/-12%; MBGS: 45+/-9%) were significantly lower than by LVG (50+/-15%). LVEF by MBGS was significantly higher than by QGS (P

BACKGROUND AND PURPOSE: Computerized methods have been introduced for more objective quantification of angiographic occlusion rate and coil density as parameters of successful embolization. This study aimed 1) to evaluate this new computerized method for angiographic occlusion rating and coil density calculations by comparison with corresponding histometric parameters from retrieved human aneurysms, and 2) to compare the new computerized method with the present standard of subjective angiographic occlusion rating. MATERIALS AND METHODS: From 14 postmortem-retrieved human aneurysms, angiographic occlusion rate was determined by contrast medium attenuation-gradient distinction on digital subtraction angiographs after Guglielmi detachable coil (GDC) embolization. Angiographic coil density was calculated, approximating aneurysms as ellipsoid and coils as cylindric volumes. On surface-stained histologic ground sections of the respective aneurysms, the occluded aneurysm area and coil area were measured. Then, we calculated and compared the histometric occlusion rates and coil densities with the corresponding angiographic parameters by using the Wilcoxon paired signed-rank test and the Spearman rank correlation. RESULTS: Computerized angiographic occlusion rates (75%–100%) showed good correlation (r = 0.799; P < .01) with histometric occlusion-rates (61%–100%), resulting in no statistically significant differences (P = .2163). With 5.1% (±3.8), the mean difference between computerized angiographic occlusion rates and histometry was substantially lower compared with 10.7% (±8.7) mean difference between subjective angiographic estimations and histometry. Calculated angiographic coil density (13%–32%) significantly differed from histometric coil density (8%–35%; P < .05). CONCLUSIONS: For recanalized aneurysms, computerized angiographic occlusion rating showed better correspondence with histometry compared with subjective angiographic occlusion rating. Clinical application of this new tool may lead to more objective cutoff values for re-embolization indications. The value of coil density calculations seems limited by the approximation of the aneurysms as ellipsoid volumes.

For many clinical purposes various artificial devices are applied, which contact human tissue and can thus cause adverse reactions between prosthetic surfaces and body components. Of the many materials applied for orthopaedic joint replacements the most common are cobalt–chromium–molybdenum alloys. In these cases considerable amounts of cobalt–chromium–molybdenum wear particles are released from the prostheses which have to be regarded as a cause of long-time problems for the patient. Since these particles are dissolved in body fluids of the surrounding area they are distributed in the whole body via blood. Elevated metal concentrations have been found in blood and urine of persons with endoprostheses. Partly the metals are excreted via urine, but to some extend they accumulate in different organs. Therefore this study dealt with the development of an analytical method for the determination of seven relevant trace elements, namely Al, Co, Cr, Mo, Nb, Ni, and Ti in nine kinds of human tissue (brain, heart, kidney, liver, lung, muscle, lymphatic nodes, spleen, body fat) starting with drawing of the sample, sample work up and finally analysis by means of atomic spectrometry. The optimized method was then applied to determine the metal contents in organs of persons (post mortem) with total hip replacements with metal on metal bearing surfaces. Comparison of the data obtained with those of persons without hip-endoprostheses shows that brain and lung are the main targets for elemental accumulation in persons with hip-endoprostheses. Mo and Nb represent the elements with the highest tendency to be accumulated.

Background Data on mercury exposure of the Austrian population were inadequate. This study was performed to determine the causal factors underlying mercury exposure and selenium concentrations, and to estimate the gender-related health impacts. Methodology Venous blood samples of 78 women and 81 men were drawn at the Austrian Red Cross, Vienna. Mercury contents in acid-digested whole blood samples were measured after amalgam enrichment by CV-AAS, and selenium by AAS (heated quartz-cell) after hydrid formation. Results The average total mercury blood content of Austrians was low (2.38 ± 1.55 μgL− 1; N = 152). Mercury and selenium concentrations were not different between the genders (P > 0.05) but we observed discrepancies regarding the causal factors. Mercury levels in men were influenced not only by fish consumption but also by age, education level, and amalgam fillings, whereas in women, only the diet (fish/seafood, red wine consumption) determined blood mercury (P

Breast milk might be a source of potentially toxic metals such as cadmium (Cd). The purpose of the present study is to provide data pertaining to the influence of maternal lifestyles on Cd concentrations in breast milk in the Austrian setting. Breast milk was obtained from 124 Austrian women. Each participant provided 10 ml of milk. A second group of eight mothers were recruited to investigate changes in their milk cadmium levels at 1, 3, 5, 7 and 9 weeks post partum. The study participants filled a questionnaire concerning nutrition, supplementation, and smoking habits. The samples were analyzed using GF-Atomic Absorption Spectrophotometer (AAS). The mean Cd content in breast milk was among the lowest in Europe (0.086 +/- 0.085 microg/l, 95% CI: 0.07-0.10; n = 124). Increased Cd levels in breast milk were found to be significantly associated with frequent cereal consumption and smoking. Smokers had a two-fold higher concentration than did non-smokers (0.15 versus 0.07 microg/l; P = 0.000). In contrast, low Cd levels in breast milk were associated with the intake of supplements containing trace elements or vitamins and trace elements (P0.05). This protective effect of supplements on Cd levels was only observed in non-smokers. The Cd levels registered in the present investigation were far below critical levels. We conclude that the current maternal Cd levels in Austria signify no risk for the breastfed infant of a healthy mother. Further research will have to focus on the specific effects of supplementation and smoking on Cd concentrations.

Background High pressures exerted by balloons and cuffs of conventional endotracheal tubes, the Combitube (Tyco Healthcare Nellcor Mallinckrodt, Pleasanton, CA), the EasyTube (Teleflex Ruesch, Kernen, Germany), the Laryngeal Mask Airway (LMA North America, San Diego, CA), the Intubating Laryngeal Mask Airway (Fastrach; LMA North America), the ProSeal (LMA North America), and the Laryngeal Tube (LT; VBM Medizintechnik, Sulz, Germany) may traumatize the pharyngeal mucosa. The aim of this study was to compare pressures exerted on the pharyngeal, tracheal, and esophageal mucosa by different devices designed for securing the patient's airways. Methods Nineteen fresh cadavers were included. To measure mucosal pressures, microchip sensors were fixed on the anterior, lateral, and posterior surfaces of the proximal balloon and the distal cuff of the investigated devices. Depending on the respective airway device, the cuff volume was increased in 10-ml increments at the proximal balloon starting from 0 to a maximum of 100 ml, and in 2-ml increments at the distal cuff starting from 0 up to 12 ml. Results Tracheal mucosal pressures were significantly higher using the Combitube compared with the endotracheal tube and the EasyTube. Maximal esophageal pressures were significantly higher using the EasyTube compared with the Combitube. Using cuff volumes according to the manufacturers' guidelines, we found the highest pharyngeal pressures with the Intubating Laryngeal Mask Airway versus all other devices. At maximal volumes, the Laryngeal Mask Airway, the Intubating Laryngeal Mask Airway, and the ProSeal induced significantly higher pharyngeal pressures compared with all other devices. Using a pharyngeal cuff volume of 40 ml, the Intubating Laryngeal Mask Airway followed by the Laryngeal Mask Airway exerted significantly higher pressures compared with the other devices. Conclusions Although some devices exhibit a somewhat higher mucosal pressure when compared with others, the authors believe that the observed differences of the cuff pressures do not suggest a clinically relevant danger, because the investigated devices, except the endotracheal tubes, are not intended for prolonged use.

Bystanders are reluctant to perform basic life support (BLS) because of fear of failure and of infection, especially with mouth-to-mouth resuscitation (MTM). A possibility to enhance willingness could be the giving of MTM or BLS instructions at a very early age to the potential rescuers. The study aimed to investigate the effectiveness of MTM with respect to ventilation and the time needed for performing 5 ventilations. In this study, MTM was performed on a mannequin by 57 children and adolescents aged 10 and 14 years. This study showed that 14-year-olds effectively perform MTM, reaching the recommended tidal volumes. Ten-year-old children have already developed sufficient motor skills for MTM with no significant time differences compared with the 14-year-olds. However, physical demands may be rather high at this age. Further long-term studies are needed to investigate clinical benefits of early teaching of MTM or BLS that may lead to international guidelines with low age limits.

Background Percutaneous cricothyroidotomy is a lifesaving procedure for airway obstruction in trauma victims who need airway establishment and cannot be intubated or in whom intubation has failed. Methods The purpose of this study was to examine whether there is a training effect using Seldinger technique emergency cricothyroidotomy (group 1; Arndt Emergency Cricothyroidotomy Catheter Set; Cook Critical Care, Bloomington, IN) versus standard surgical cricothyroidotomy (group 2). Twenty emergency physicians performed five cricothyroidotomies with each method in a total of 200 human cadavers, comparing efficacy and safety (speed, success rate, and injuries). Results Seven attempts in group 1 and six in group 2 had to be aborted. Time intervals from the start of the procedure to location of the cricothyroid membrane were not significantly different between the groups. However, time to tracheal puncture (P < 0.01) and time to first ventilation (P < 0.001) were significantly longer in group 2. No time effect could be observed in both groups. The airway was accurately placed into the trachea through the cricothyroid membrane in 88.2% (82 of 93) of the cadavers in group 1 and in 84.0% (79 of 94) in group 2 (not significant). No injuries were observed in group 1, whereas there were six punctures of the thyroid vessels in group 2 (P < 0.05). Conclusions With respect to time needed for the procedure, the participants performed Seldinger technique emergency cricothyroidotomy significantly faster as compared with standard surgical cricothyroidotomy. Even if no training effect had been observed, the authors believe that it is important to train residents in different methods of cricothyroidotomy in cadavers in addition to training in mannequins to achieve a higher level of efficacy in real-life situations. The shorter time to first ventilation and the fact that no injuries could be observed favor the Seldinger technique.

Summary Micro array technology allows the simultaneous analysis of ten-thousands of genes. Most often, how- ever, the analysis is based on a few replications only. This causes problems in the application of classi- cal multivariate tests which require sample sizes exceeding the number of observed variables. To over- come these problems, a class of stable, multivariate procedures based on the theory of spherical distributions has been proposed by Luter, Glimm, and Kropf (1996). These methods allow the use of multivariate information of many genes for testing differential gene expression. Furthermore, multiple testing procedures based on these principles have been constructed (e.g., Kropf, Luter, 2002), which strictly keep the familywise type I error rate (FWE). In this paper, these methods have been generalized to allow for the use of full multivariate informa- tion on expression intensities of individual genes analysed by the Affymetrix GeneChip technology. In contrast to the usual strategy, which constructs an expression score for each gene, based on averaging of the different oligonucleotide (perfect- and miss-match) information, and then performs some test on these summarized expression values, we suggest using a test procedure based on the complete multi- variate perfect match information. We show that a multiple FWE-controlling procedure for normally distributed data proposed by Westfall, Kropf, and Finos (2004), can be generalised to a more powerful procedure based on left-spherically distributed scores derived from the perfect match information, with- out losing the FWE-controlling property. To illustrate the proposed test procedures, which have been implemented in the statistical program- ming environment R, we analyse two already published data sets, comparing gene expression of tumour and healthy tissues within identical patients and between two groups of different patients, respectively. Using these examples, we demonstrated that the incorporation of the multivariate perfect match infor- mation is superior to classical expression score based methods with respect to the number of identifi- able differentially expressed genes.

The use of hydroxyethyl starch (HES) solutions as a fluid replacement before peridural blockade may compromise blood coagulation, thus increasing the risk of neuraxial bleeding. In this prospective, double-blind, placebo-controlled, crossover study, we compared the influence of HES 130 (molecular weight in kilodalton), HES 200, and lactated Ringer's solution on platelet function and hemodynamics in chronic low back pain patients scheduled for peridural blockades. Patients received 3 test infusions of 10 mL/kg each administered IV for 30 min. Collagen/epinephrine and collagen/adenosine diphosphate were used as agonists for assessment of platelet function analyzer-closure times. Arterial blood pressure, heart rate, platelet counts, and hemoglobin levels were documented. Platelet function analyzer-closure times remained stable after lactated Ringer's solution but were significantly prolonged after HES. The platelet-inhibiting effect of HES 200 was more than that of HES 130. Hemodynamic stability was sufficiently maintained by all test infusions. In contrast to previous observations, a relevant antiplatelet effect of both low and medium molecular weight HES solutions was found in this study in chronic pain patients undergoing peridural anesthesia. Because hemostasiological competence is a prerequisite for safe neuraxial blockade, the decision of HES for intravascular fluid administration before blockade should be critically made.

This prospective randomised study was performed to compare the use of the Esophageal-Tracheal Combitube(R) (ETC; Tyco Healthcare, Mansfield, MA; http://www.combitube.org) with a conventional tracheal airway (ETA) for airway management by experienced physicians of the Emergency Medical Services System of the City of Vienna in the prehospital setting. Access to the patient's head, time of arrival of the ambulance, ease of insertion, time of insertion, potential substitution by the alternate airway, efficacy of adrenaline (epinephrine) administered via the airway, survival to the intensive care unit (ICU) ward and survival to discharge from the hospital were evaluated. One hundred and seventy-two non-traumatic cardiac arrest patients (131 males, 41 females) were enrolled in this study during a 12 months period. In 83 patients (48.3%), the conventional ETA (group 1) was used for the initial intubation attempt which was successful in 78 patients (94%). The remaining five patients of group 1 could not be intubated with an ETA, but were successfully managed with the ETC. Eighty-nine patients (51.7%) were intubated with the ETC (group 2) as first choice (79 in oesophageal position (89%); eight in tracheal position: (9%)), which was successful in 87 (98%) patients. The remaining two patients in group 2 (2%) were successfully managed with the ETA. Success of intubation and ventilation with ETC was comparable to the ETA. Recorded time of insertion was shorter with the ETC versus ETA (P0.05). The Combitube worked well in cases of difficult access to the patient's head and in bleeding and vomiting patients. Both devices served as successful substitutes for each other. Adrenaline (epinephrine) applied via ETC with a 10-fold dosage was as effective as via the conventional ETA. To our knowledge this is the first study using physicians comparing ETC and ETA in the prehospital setting.

Objective. Heavy metals are potentially toxic substances, especially for the susceptible infant. Exposure to mercury (Hg) and lead (Pb) may result in neurotoxic and nephrotoxic impairment and in anemia. Previous data on breast milk Pb and Hg contents are sparse or missing for the Austrian population. No evaluations of the influence of mothers’ lifestyles on Pb and Hg levels in breast milk are available. Methods. Five- to 10-mL individual samples of breast milk were provided from healthy mothers in Vienna (urban; n = 59), Linz (industrial; n = 47), and Tulln (rural; n = 59). A questionnaire about area of residence, maternal nutrition, smoking habits, and dental fillings was filled out by the lactating mothers. Milk samples and infant formulas were lyophilized, wet-ashed with nitric acid (65%), and analyzed with atomic absorption spectrophotometry. Spiked skim milk powder was used as reference material. Statistical analysis included the Kruskal-Wallis test and multiple robust regression analysis. Results. Breast milk showed low Hg and Pb concentrations (Hg: 1.59 ± 1.21 1g/l, n = 116; Pb: 1.63 ± 1.66 6g/l, n = 138). Eight percent of the breast milk samples marginally exceeded the screening level of 3.5 μg/L for Hg. Austrian Pb values declined strongly during the last 20 years. Bivariate comparison revealed that the factors significantly related to metal levels in breast milk were area of residence (Hg, Pb), prematurity (Hg), consumption of fish (Pb) and cereals (Hg), vitamin supplementation (Hg), and smoking (Pb). The Hg and Pb contents of cow milk and infant formulas were far below respective guideline values. Conclusions. Neither Hg nor Pb concentrations exceeded critical levels. There are no reports on infants harmed by the intake of milk from unexposed mothers. We conclude that even theoretical risks from current Hg or Pb levels for the breastfed infant of a healthy mother can be ruled out.

The 4G/5G polymorphism of the plasminogen activator inhibitor type I (PAI-I) gene is involved in coronary artery disease (CAD), with the highest risk in 4G/4G homozygotes. The role of PAI-I polymorphism in patients suffering from CAD and history of sudden cardiac death (SCD) has not been addressed yet. We studied the frequency distribution of the PAI-I gene to test the hypothesis that the 4G/4G genotype favors myocardial ischemia and, even in the absence of acute infarction, promotes SCD in patients with CAD. Methods: The PAI-I 4G/5G genotypes and PAI-I antigen plasma levels were determined in 97 patients with CAD and a history of SCD treated with an implantable cardioverter defibrillator (ICD) (defibrillator group) comparing to 113 patients with CAD but no history of SCD (control group). Results: The defibrillator group consisted of significantly more 4G/4G homozygotes and higher PAI-I levels than the control group (44% vs. 24%, 173±41 vs. 144±49 ng/ml; P

OBJECTIVE: To compare plasma concentrations and cardiovascular effects of epinephrine after application via a conventional endotracheal airway and via the esophageal lumen of a new emergency airway, the esophageal tracheal Combitube. DESIGN: Prospective, randomized study. SETTING: Center for Biomedical Research, University of Vienna. SUBJECTS: Fourteen juvenile swine received either an endotracheal tube (Group A) or a Combitube in esophageal position (Group B). INTERVENTIONS: In Part I of the study, epinephrine was administered during spontaneous beating of the heart; in Part II, epinephrine was administered during cardiopulmonary resuscitation, using a ten-fold higher dosage in Group B, respectively. MEASUREMENTS: Plasma epinephrine levels were measured 1, 2, 3, 5, 7, 10, 15, and 30 mins after application. Systolic arterial blood pressure and cardiac output in Part I, and end-tidal CO2 and coronary perfusion pressure in Part II were recorded. MAIN RESULTS: In Part I, increased levels of plasma epinephrine and systolic arterial pressure were maintained significantly longer in Group B when compared with Group A. In Part II, no significant differences between the groups were found with regard to plasma epinephrine levels and hemodynamic variables. CONCLUSION: Epinephrine applied via the esophageal lumen of the Combitube in a ten-fold higher dosage has similar effects on plasma epinephrine levels and hemodynamic variables compared to endotracheal administration.

A description is given of Austria's currently operational framework of training opportunities and post-doctoral courses in Medical Informatics. The description includes a brief outline of the currently valid curriculum in informatics and the methods on how to specialise in medical informatics within this framework.

112 Michael Frass, MD Department of Internal Medicine I, Medical University of Vienna, Institute for Homeopathic Research, Interdisciplinary College Graz Seggau, Austria Ernst Schuster, MD Department of Internal Medicine I, Medical University of Vienna, Institute for Homeopathic Research, Interdisciplinary College Graz Seggau, Austria Ilse Muchitsch, PhD Department of Internal Medicine I, Medical University of Vienna, Institute for Homeopathic Research, Interdisciplinary College Graz Seggau, Austria Beatrix Wulkersdorfer, MD Department of Internal Medicine I, Medical University of Vienna, Institute for Homeopathic Research, Interdisciplinary College Graz Seggau, Austria Helmut Friehs, MD Department of Internal Medicine I, Medical University of Vienna, Institute for Homeopathic Research, Interdisciplinary College Graz Seggau, Austria Michael Muellner Department of Internal Medicine I, Medical University of Vienna, Institute for Homeopathic Research, Interdisciplinary College Graz Seggau, Austria Menachem Oberbaum Department of Internal Medicine I, Medical University of Vienna, Institute for Homeopathic Research, Interdisciplinary College Graz Seggau, Austria Corresponding author. E-mail: michael.frass @meduniwien.ac.at

Spenderhornhaute konnen bis zu 4 Wochen in Organkultur (bei 31 °C) aufbewahrt werden, wobei sich das Kulturmedium aus einer modifizierten MEM-Losung zusammensetzt. Ein signifikanter Teil (ca. 20%) der Spenderhornhaute mus jedoch wegen eines erhohten Polymegathismus als Folge eines Endothelzellverlustes verworfen werden. Ziel der Studie ist es, zu untersuchen, ob der Zusatz von Insulin, Dextran und EGF [in Procell, Optisol und Optisol plus (CHIRON, USA)] die Viabilitat, Stabilitat und Homogenitat der Endothelzellen wahrend der Organkultur der Spenderhornhaute verbessert. Je 8 Spenderhornhautpaare wurden in den verschiedenen Medien (Pro-cell, Optisol, Optisol plus), sowie dem konventionellen modifizierten MEM fur 4 Wochen kultiviert, wobei das Endothel am Beginn der Kultur und nach 7, 14, 21 und 28 Tagen mittels “ECES” — einem „on-line“ Video Digital-Bildanalysesystem — quantitativ und qualitativ evaluiert wurde. In den ersten zwei Wochen konnte kein signifikanter Unterschied der Endothelbefunde zwischen den verschiedenen Medien festgestellt werden. Ab dem 14. Tag in Kultur war jedoch eine Stabilisierung des Endothelzellmusters bei Verwendung der neuen Nahrlosungen nachweisbar. Durch Einsatz dieser neuen Medien durfte einerseits ein hoherer Prozentsatz an Spenderhornhauten fur die Transplantation verwendbar sein und andererseits eine signifikante Verlangerung der Kulturzeit erreicht werden.

Summary In this study we investigated associations of the fibrinolytic parameters t-PA antigen and PAI-1 activity in 317 patients with angiographically proven coronary artery disease with gender, age classes, angiographic extent of disease, symptom class and history of myocardial infarction as clinical parameters, as well as with the established cardiovascular risk factors: smoking, arterial hypertension, cholesterol levels, triglyceride levels, obesity and diabetes mellitus, by use of univariate and multifactorial analysis, respectively. While PAI-1 activity was only associated with unstable angina, t-PA antigen was significantly associated with hypertriglyceridemia, unstable angina, and angiographic extent of disease.

The disadvantages of non-standardized and the advantages of standardized equivalence tests are demonstrated by an extreme example. This is the summary of a talk presented at the occasion of Statistical Computing '94 in Gunzburg, Germany, on June 21, 1994. (SSNinCSDA 19, 353–356 (1994))

Endovascular coil occlusion of ruptured cerebral aneurysms has a higher rate of rebleeding compared to surgical clipping. Initial aneurysm coil occlusion rate (OR) is the strongest available predictor of aneurysm rebleeding. Standard clinical subjective occlusion rating (SOR) is limited by subjective bias. Therefore, computerized occlusion rating (COR) was introduced. Its superiority was established for experimental and human aneurysms. In the present clinical study, we aimed to evaluate COR as a risk factor for postprocedural reruptures (PPRs) and intraprocedural reruptures (IPRs). In our series of 249 consecutive patients treated in our institution, we observed 7 (2.8%) cases with IPR and 7 (2.8%) cases with PPR. These patients were analyzed in the present study. Mean COR value was 85% (range 71-96%). In 12 (85.7%) cases, COR was lower than SOR. In aneurysms with a COR of 95% or higher, no PPR occurred. All patients with IPR harbored multiple aneurysms. In -conclusion, our data showed a distinct tendency of potentially dangerous overestimations when using SOR compared to the objectively measured COR values. IPR was always associated with multiple aneurysms.

Endovascular coil occlusion of ruptured cerebral aneurysms has a higher rate of rebleeding compared to surgical clipping. Initial aneurysm coil occlusion rate (OR) is the strongest available predictor of aneurysm rebleeding. Standard clinical subjective occlusion rating (SOR) is limited by subjective bias. Therefore, computerized occlusion rating (COR) was introduced. Its superiority was established for experimental and human aneurysms. In the present clinical study, we aimed to evaluate COR as a risk factor for postprocedural reruptures (PPRs) and intraprocedural reruptures (IPRs). In our series of 249 consecutive patients treated in our institution, we observed 7 (2.8%) cases with IPR and 7 (2.8%) cases with PPR. These patients were analyzed in the present study. Mean COR value was 85% (range 71–96%). In 12 (85.7%) cases, COR was lower than SOR. In aneurysms with a COR of 95% or higher, no PPR occurred. All patients with IPR harbored multiple aneurysms. In ­conclusion, our data showed a distinct tendency of potentially dangerous overestimations when using SOR compared to the objectively measured COR values. IPR was always associated with multiple aneurysms.

Within the framework of a cooperative research project, turkey health as well as numerous aspects of animal welfare were examined in various intensive commercial farms with varying rearing forms. The present study demonstrates the prevalence of skin injuries concerning living animals as well as carcasses of slaughtered turkeys of both sexes. Although all turkeys were debeaked, prevalences of skin injuries at a value of 12.8% with male turkeys and 13.8% with female turkeys could be found at the age of 16 weeks. Within the scope of medically inspections skin injuries were mainly established in the head region, especially the snood as well as in the region of the back. By means of their clinical picture pecking wounds and scratch injuries could be distinguished. Skin lesion produced primary as a result of scratching the skin surface, could be enlarged by the animal itself or by conspecifics by beak pecking, especially after bleeding, in spite of debeaked upper beak. Injuries in the head region, especially of the snood, could be explained mainly as a result of pecking by conspecifics by reason of their clinical picture and were found mainly in male turkeys. Skin injuries in the region of the back, especially at the coxal tuberosity, were identified primarily as scratch marks. They were found mainly in female turkeys. A statistically significant correlation of the injury prevalence to particular husbandry parameters discussed in the literature as "predisposing" or "limiting" factors (e.g., population density, light regime or offer of employment material) could not be established in this study. At the meat inspection fresh scratching injuries at the chest and the hind legs were diagnosed most often. Especially fresh injuries of the carcass point to a misguided behaviour of the staff concerning animal handling during loading and transport which is not conform to animal welfare.

OBJECTIVE To assess the influence of age on the outcome of patients receiving prolonged mechanical ventilation. DESIGN Retrospective study. SETTING Intensive care unit. PATIENTS A total of 1,141 patients in our ICU during a 32-month period. A total of 536 patients required mechanical ventilation. After exclusion of 171 patients ventilated for less than 24 hrs after surgery, 365 patients were investigated. MEASUREMENTS AND MAIN RESULTS Two hundred sixty-six (73%) patients were aged less than 70 yrs; 99 (27%) patients were greater than or equal to 70 yrs. There was no significant difference in mortality rate between the younger and the older age groups. There was no significant influence of other important factors, such as severity of illness, duration of mechanical ventilation, or length of ICU stay. The only factor showing a significant influence on patient outcome was the reason for mechanical ventilation. There were more survivors in the group being ventilated because of ventilatory insufficiency than in the group with oxygenation impairment (57.8% vs. 23.9%, p less than .001). CONCLUSION An influence of age on the outcome of mechanically ventilated patients in the ICU could not be ascertained in this study.

Within the framework of a cooperative research project, sponsored by the Federal Ministry of Food, Agriculture and Consumer Protection in Germany (BMELV), turkey health as well as numerous aspects of animal welfare in various intensive commercial farms with varying rearing forms were examined. For this purpose extensive documentation of flock management and health status information was conducted over the past two years at the farms. Additional information was ascertained from the carcasses at the slaughterhouse. The first results of this study, which look at flock management, will be presented here. Upon reviewing the questionnaires, it is clear that on one hand almost all farmers orientate there stocking rate upon the allowed limits, on the other hand, however, when considering national general requirements, which are very important parameters thatargely influence animal health (i. e. litter quality and care of sick/injured animals) farmer compliance lacks. Especially the litter quality, which, among other parameters, plays a very important role in food pad health, proved to be unsatisfactory. Unfortunately, no instruments are available that measure the litter quality, yet. The status of footpad health was a major problem in all the rearing systems. However, the prevalence of epithelial necrosis and deep skin lesions varied immensely among different flocks of the same age.

The interactions between infections, malnutrition and poor iron nutritional status in infants at weaning ages are poorly defined. Therefore, four groups of infants from an area with a high incidence of malnutrition (Lahore, Pakistan) were enrolled in a prospective, randomized nutritional intervention study. Between 122 and 365 days of age, the infants from one community received either a milk cereal without iron fortification (n = 29), a milk cereal fortified with ferrous fumarate (7.5 mg/100 g; n = 30), or a milk cereal fortified with ferric-pyrophosphate (7.5 mg/100 g; n = 27). Forty-four infants from a neighbouring community did not receive a nutritional supplement and served as the control group. Calculated mean daily energy- and protein intake with the cereals was between 259-287 kcal, and 9.6-10.6 g at 12 months of age, respectively. Mean daily iron intake with the fortified cereals was between 4.1-5.1 mg at corresponding age. Nutritional supplementation resulted in significantly lower incidence of malnutrition and higher weight gain. Incidence of acute diarrhoea was significantly (p less than 0.05) lower in the supplemented groups. The infants fed the iron-fortified milk cereals had significantly higher hemoglobin (mean 10.4 vs. 9.8 g.dl-1) and serum ferritin (mean 13.3 vs. 8.5 ng.ml-1) values than the infants fed the non-fortified milk cereals. However, no differences in the incidence of infections were found between the supplemented groups. It is concluded that poor nutritional intake between 122 and 365 days of age substantially contributed to the high incidence of diarrhoea and malnutrition in Pakistani infants.

In the present paper we discuss the indication and follow-up of 42 patients with iatrogenic tracheobrochial ruptures. Thirty-five patients were treated by operation and 7 patients were treated conservatively. In the operated patients, four developed an insufficiency of the tracheal closure and the rupture related mortality was 2.8%. A significant effect on suture dehiscence was seen for mediastinitis (P

The purpose of this study was to evaluate myocardial electrocardiography (ECG)-gated 13N-ammonia (13N-NH3) PET for the assessment of cardiac end-diastolic volume (EDV), cardiac end-systolic volume (ESV), left ventricular (LV) myocardial mass (LVMM), and LV ejection fraction (LVEF) with gated 18F-FDG PET as a reference method.ECG-gated 13N-NH3 and 18F-FDG scans were performed for 27 patients (23 men and 4 women; mean+/-SD age, 55+/-15 y) for the evaluation of myocardial perfusion and viability. For both 13N-NH3 and 18F-FDG studies, a model-based image analysis tool was used to estimate endocardial and epicardial borders of the left ventricle on a set of short-axis images and to calculate values for EDV, ESV, LVEF, and LVMM.The LV volumes determined by 13N-NH3 and 18F-FDG were 108+/-60 mL and 106+/-63 mL for ESV and 175+/-71 mL and 169+/-73 mL for EDV, respectively. The LVEFs determined by 13N-NH3 and 18F-FDG were 42%+/-13% and 41%+/-13%, respectively. The LVMMs determined by 13N-NH3 and 18F-FDG were 179+/-40 g and 183+/-43 g, respectively. All P values were not significant, as determined by paired t tests. A significant correlation was observed between 13N-NH3 imaging and 18F-FDG imaging for the calculation of ESV (r=0.97, SEE=14.1, P0.0001), EDV (r=0.98, SEE=15.4, P0.0001), LVEF (r=0.9, SEE=5.6, P0.0001), and LVMM (r=0.93, SEE=15.5, P0.0001).Model-based analysis of ECG-gated 13N-NH3 PET images is accurate in determining LV volumes, LVMM, and LVEF. Therefore, ECG-gated 13N-NH3 can be used for the simultaneous assessment of myocardial perfusion, LV geometry, and contractile function.

CONTEXT: In addition to heart massage, the primary goal of cardiopulmonary resuscitation is efficient oxygenation and ventilation. OBJECTIVE: To compare the ease of learning and handling of standard mouth-to-mouth resuscitation with the Combitube (Tyco Healthcare Nellcor, Pleasanton, CA) ventilation. METHODS: After a 30 minute theoretical introduction and demonstration of mouth-to-mouth resuscitation and use of the Combitube in mannequins, following American Heart Association guidelines, 26 adolescent school children (15 of them 14 years old, 11 of them 10 years old) undertook two ventilation trials, each consisting of five single ventilations, with each technique. Only the second trial with each technique was evaluated. Qualitative implementation (grades: very good, good, failed) was evaluated, several procedure-related time points were recorded, and tidal volumes (ml) were measured. RESULTS: With mouth-to-mouth resuscitation, the time interval until start of first ventilation was 36.5 seconds shorter than with the Combitube (P < 0.001). With the Combitube, the time needed for five single ventilations was 6.4 seconds less than with mouth-to-mouth resuscitation (P < 0.001) and mean tidal volumes were higher (mouth-to-mouth resuscitation, 450 ± 384 ml, versus Combitube, 735 ± 358 ml; P < 0.05). CONCLUSION: Most of the school children performed both techniques to a high qualitative level. The study shows that mouth-to-mouth resuscitation and use of the Combitube have equal ease of learning, a precondition for proficient retention of skills. Tidal volumes were significantly higher with the Combitube and, not surprisingly, the time interval until the start of first ventilation was significantly shorter with mouth-to-mouth resuscitation. Regardless of the ventilation technique or device, we believe that subsequent retraining of ventilation skills is very important.

Objective: Invasive diagnostic procedures such as bronchoalveolar lavage (BAL) with quantitative microbiological cultures are currently recommended for the diagnosis of nosocomial pneumonia. Commonly, in clinical practice, a threshold of ≥104 colony forming units/mL is used for therapeutic decisions. The use of these measurements in daily practice assumes that their repeatability is acceptable. However, many variations among the positive results have been noted. One of the most important is dilution of BAL, which may influence the quantitative results by minimizing bacterial counts. Knowledge of the extent of dilution may increase dramatically the value of quantitative cultures. The aim of this study was to determine to what extent specimens are diluted in BAL by measuring urea in BAL and blood. Furthermore, the impact of a potential dilution effect on the diagnosis of ventilator-associated pneumonia was studied. Patients and Setting: A total of 47 patients with ventilator-associated pneumonia in two medical intensive care units at the Vienna General Hospital, a university-affiliated facility. Design: Prospective study performed between January 2001 and July 2002. Methods: BAL fluid was divided immediately into two samples: one for direct microscopic examination of cytocentrifuge preparations for Gram staining to determine percentages of cells containing intracellular bacteria and one for quantitative cultures according to the Cumitech 7A guidelines. Epithelial lining fluid volume was calculated using urea as a marker of dilution and correlated with colony forming units per milliliter. Results: Nineteen out of 47 patients (40%) revealed significant bacterial growth (≥104 colony forming units/mL). Eight additional patients (17%) would have reached the cutoff level after correction of the dilution effect, which varied between 1.8- and 130-fold. Conclusions: Data suggest a great variation of dilution during BAL procedures, which influences quantitative results. Using urea to determine the dilution quotient could increase the value of bacterial thresholds in the diagnosis and therapeutic decision of ventilator-associated pneumonia.