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Lumbar spinal stenosis (LSS) is one of the most common indications for surgery in the USA. The addition of instrumented fusion to decompression for the treatment of LSS has become common, but recent randomized controlled trials (RCTs) have produced percieved conflicting results with unclear clinical implications. This review seeks clarity through an analysis of available RCTs. We performed a search of the PubMed database for RCTs that directly addressed decompression vs. decompression and fusion for the surgical treatment of LSS. RCTs were screened and reviewed to compare content such as patient selection, pathology, radiographic criteria, and operative technique. Five RCTs resulted from our search and were included in our analysis. Two studies yielded class I data while three yielded class III data due to study design related issues. Heterogeneity between these studies is emphasized with regard to patient selection, LSS definition, spondylolisthesis, instability, and surgical technique. Efforts to decipher which patients will truly benefit from instrumented fusion for the surgical treatment of LSS are still ongoing. Surgeon judgment will remain a crucial component for surgical decision making until future trials provide clarity. Instrumented fusion should be tailored to the individual patient rather than incorporated as a routine practice.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Stiftung Institut für Herzinfarktforschung Background The number of patients receiving cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices has been increasing in the last decades. Both CRT and ICD play an essential role in modern heart failure therapy. However, the implantation procedure might be ensued by serious complications. Therefore, knowledge about the prevalence of complications and identification of risk factors are key to improve patient care. Methods Between 2007-2014 the German DEVICE registry enrolled patients from 50 German centers undergoing ICD or CRT implantation. Patient characteristics, data on procedural outcome, adverse events and mortality during index hospitalization and follow-up at 1 year from discharge, were recorded. Patients who suffered from perioperative complications during or shortly after device implantation were identified for comparative analysis with patients without complications. Results Out of 4170 patients enrolled, 119 (2.9%) suffered from procedure related complications. The proportion of female patients suffering from perioperative complications was higher with 29.4%, compared to 18.5% of female patients without complications (p=0.003). There were neither any differences in age (66.3±13.6 vs. 65.4±12.5 years; p=0.13), nor in cardiac or non-cardiac comorbidities and in the indications for device implantation between groups. There was a trend towards a higher rate of complications with procedures on pre-existing devices (24,8 vs. 18.1%; p=0.064), than observed with de-novo implantations (75.2 vs. 81.9%; p=0.064). CRT implantations were more frequent among patients who suffered from complications (46.2 vs. 28.9%; p Conclusion The overall procedure-related complication rate following CRT or ICD implantation is low (2.9%). Among patients with complications female gender and patients receiving CRT devices were more prevalent. Perioperative device complications neither seem to translate into increased in-hospital mortality, nor in increased rates of further device-associated complications, rehospitalizations or death after 1-year follow-up.

Large-scale network analysis characterizes the brain as a complex network of nodes and edges to evaluate functional connectivity patterns. The utility of graph-based techniques has been demonstrated in an increasing number of resting-state functional MRI (rs-fMRI) studies in the normal and diseased brain. However, to our knowledge, graph theory has not been used to study the reorganization pattern of resting-state brain networks in patients with traumatic complete spinal cord injury (SCI). In the present analysis, we applied a graph-theoretical approach to explore changes to global brain network architecture as a result of SCI. Fifteen subjects with chronic (2 years) complete (American Spinal Injury Association [ASIA] A) cervical SCI and 15 neurologically intact controls were scanned using rs-fMRI. The data were preprocessed followed by parcellation of the brain into 116 regions of interest (ROI) or nodes. The average time series was extracted at each node, and correlation analysis was performed between every pair of nodes. A functional connectivity matrix for each subject was then generated. Subsequently, the matrices were averaged across groups, and network changes were evaluated between groups using the network-based statistic (NBS) method. Our results showed decreased connectivity in a subnetwork of the whole brain in SCI compared with control subjects. Upon further examination, increased connectivity was observed in a subnetwork of the sensorimotor cortex and cerebellum network in SCI. In conclusion, our findings emphasize the applicability of NBS to study functional connectivity architecture in diseased brain states. Further, we show reorganization of large-scale resting-state brain networks in traumatic SCI, with potential prognostic and therapeutic implications.

Lumbar spinal stenosis (LSS) is one of the most common indications for surgery in the USA. The addition of instrumented fusion to decompression for the treatment of LSS has become common, but recent randomized controlled trials (RCTs) have produced percieved conflicting results with unclear clinical implications. This review seeks clarity through an analysis of available RCTs. We performed a search of the PubMed database for RCTs that directly addressed decompression vs. decompression and fusion for the surgical treatment of LSS. RCTs were screened and reviewed to compare content such as patient selection, pathology, radiographic criteria, and operative technique. Five RCTs resulted from our search and were included in our analysis. Two studies yielded class I data while three yielded class III data due to study design related issues. Heterogeneity between these studies is emphasized with regard to patient selection, LSS definition, spondylolisthesis, instability, and surgical technique. Efforts to decipher which patients will truly benefit from instrumented fusion for the surgical treatment of LSS are still ongoing. Surgeon judgment will remain a crucial component for surgical decision making until future trials provide clarity. Instrumented fusion should be tailored to the individual patient rather than incorporated as a routine practice.

Background Resident applicants in neurosurgery often wonder what factors impact their chances of successfully matching. Using data published by the National Residency Match Program for 2009–2016, we examined which components of the Electronic Residency Application Service application correlated with successful residency matching. Methods Data were collected from the National Residency Match Program publication Charting Outcomes in the Match from all years it was available for neurosurgery (2009, 2011, 2014, 2016). Individual factors reported (number of contiguous ranks, research projects, publications and presentations, work experiences, volunteer experiences, United States Medical Licensing Examination Step 1 and 2 score deciles, categorical data about Alpha Omega Alpha status, Ph.D. degree, other degree, and strength of medical school National Institutes of Health funding) were aggregated for all 3 years. Categorical data were available only for U.S. seniors. Spearman correlation and χ2 were used for ranked data and categorical data, respectively. Separate analyses were run for U.S. seniors and independent applicants. Results For U.S. seniors applying to neurosurgery, number of contiguous ranks, United States Medical Licensing Examination Step 1 and 2 scores, research projects, Alpha Omega Alpha status, and medical school top 40 National Institutes of Health funding were significantly associated with successful matching of applicants. Number of volunteer experiences was nearly statistically significant. For independent applicants, only United States Medical Licensing Examination Step 1 and 2 scores and number of research projects were statistically significant. Conclusions This is the first study to analyze National Residency Match Program data for predictors of success in neurosurgical matching. Students applying to neurosurgery residency and their mentors should be aware of which baseline objective factors are associated with match success.

Network analysis based on graph theory depicts the brain as a complex network that allows inspection of overall brain connectivity pattern and calculation of quantifiable network metrics. To date, large-scale network analysis has not been applied to resting-state functional networks in complete spinal cord injury (SCI) patients. To characterize modular reorganization of whole brain into constituent nodes and compare network metrics between SCI and control subjects, fifteen subjects with chronic complete cervical SCI and 15 neurologically intact controls were scanned. The data were preprocessed followed by parcellation of the brain into 116 regions of interest (ROI). Correlation analysis was performed between every ROI pair to construct connectivity matrices and ROIs were categorized into distinct modules. Subsequently, local efficiency (LE) and global efficiency (GE) network metrics were calculated at incremental cost thresholds. The application of a modularity algorithm organized the whole-brain resting-state functional network of the SCI and the control subjects into nine and seven modules, respectively. The individual modules differed across groups in terms of the number and the composition of constituent nodes. LE demonstrated statistically significant decrease at multiple cost levels in SCI subjects. GE did not differ significantly between the two groups. The demonstration of modular architecture in both groups highlights the applicability of large-scale network analysis in studying complex brain networks. Comparing modules across groups revealed differences in number and membership of constituent nodes, indicating modular reorganization due to neural plasticity.

Bordatella pertussis infection leads to a chronic, debilitating, and paroxysmal cough that can last for months to years. Incidence of B pertussis in the immunized adult population is rising nationwide, but many otolaryngologists are unfamiliar with the diagnosis and management of this disease. Adults often present late in the disease process when traditional diagnostic testing is ineffective and without the classic pediatric symptoms of whooping cough. As a result, B pertussis infections in adults are often overlooked or misdiagnosed as asthma exacerbations or viral bronchitis, leading to increased morbidity, unnecessary testing, and additional exposure of vulnerable populations to the pathogen. This commentary describes 3 adult cases of B pertussis confirmed with serum testing in the ambulatory population and describes varied presentations based on time from initial infection. Specific emphasis is presented on the physical manifestations of the disease in laryngeal structures, methods of diagnosis, and recommendations for treatment.

Currently, a complete understanding of post-ventriculostomy hemorrhagic complications in subarachnoid hemorrhage due to ruptured aneurysms remains unknown. The present study evaluates the impact of periprocedural risk factors on rates of external ventricular drain (EVD)-associated hemorrhage in the setting of endovascular treatment of intracranial aneurysms. A retrospective chart review of 107 patients who underwent EVD placement within 24 h of endovascular coiling was performed. CT of head without contrast was obtained after drain placement and before endovascular treatment. Post-procedural CT was also obtained within 48 h of embolization and was reviewed for new/worsened track hemorrhages. Chi-squared test was used in evaluation. Ninety-three of the 107 patients reviewed met the inclusion criteria. Four (25%) of the 16 patients on antiplatelet medications at presentation experienced post-EVD hemorrhage compared to 11 (14.3%) of 77 that were not (p = 0.29). Of the 13 patients given intraprocedural antiplatelets, 3 (23.1%) demonstrated hemorrhage compared to 12 (15%) of 80 not administered these medications (p = 0.46). Further, of 36 patients with intraprocedural anticoagulation, 6 (16.7%) exhibited hemorrhage compared to 9 (15.8%) of 57 in those without (p = 0.91). In 17 patients who received DVT prophylaxis, 2 (11.8%) exhibited hemorrhage compared to 13 (17.1%) of 76 who did not (p = 0.59). No post-EVD hemorrhage had attributable neurologic morbidity. Our results, demonstrating no significant risk factor related to EVD-associated hemorrhage rates, support the safety of EVD placement in the peri-endovascular treatment period.

Anamnese und klinischer Befund: Bei einem 28-jahrigen Patienten mit Sichelzellerkrankung kam es nach einem Alkoholexzess zu einer vasookklusiven Krise mit akutem Thoraxsyndrom und Entwicklung eines schweren Lungenversagens. Therapie und Verlauf: Nach einer partiellen Austauschtransfusion konnte er erfolgreich mit einer venovenosen extrakorporalen Membranoxygenierung (ECMO) therapiert werden. 12 Tage nach Ubernahme wurde der Patient von der ECMO getrennt, 2 Tage spater konnte der tracheotomierte Patient dekanuliert werden. 19 Tage nach dem Ereignis erfolgte die Ruckverlegung des vollstandig genesenen Patienten in sein Heimatkrankenhaus nach Paris. Folgerung: Auch wenn es fur den Einsatz der ECMO zur Behandlung eines lebensbedrohlichen akuten Thoraxsyndroms bei Sichelzellerkrankung noch keine ausreichenden Daten gibt, scheint der Therapieansatz Erfolg versprechend und in dieser Situation eine bedenkenswerte Option zu sein.

Die aktuelle Leitlinie der ESC stellt ein hilfreiches und im klinischen Alltag praktikables Instrument in der Risikostratifizierung von Patienten im Kontext eines geplanten operativen Eingriffes als auch im perioperativen Management dar. Besonders wertvoll erscheinen die klare Strukturierung der Risikostratifizierung von Patienten und geplantem operativem Eingriff in den 3 Risikokategorien niedrig, mittel und hoch und die sich daraus ableitenden Konsequenzen im medikamentosen als auch diagnostischen und interventionellen pra-, peri- und postoperativen Management. Der grundlegende Algorithmus und Entscheidungsbaum wird auch in den parallel zu diesem Kommentar publizierten Pocket-Leitlinien der Deutschen Gesellschaft fur Kardiologie eine zentrale Stellung einnehmen.

Neben den klassischen kardiovaskularen Risikofaktoren werden prothrombogene Veranderungen des Gerinnungssystems als wichtige Marker fur ein erhohtes Atheroskleroserisiko angesehen. Erworbene Storungen der Hamostase sind haufig bei alteren Patienten anzutreffen und stehen im Zusammenhang mit der erhohten Pravalenz chronischer Erkrankungen in diesem Kollektiv. Pathophysiologisch ist eine Verknupfung von Krankheiten, die mit einer Hyperinsulinamie einhergehen, wie dem Diabetes mellitus, dem metabolischen Syndrom und der arteriellen Hypertonie, und einem veranderten Gleichgewicht der hamostaseologischen Faktoren gut belegt. Die Hyperinsulinamie ist als Indikator peripherer Insulinresistenz ein unabhangiger Risikofaktor der koronaren Herzkrankheit. Plasminogenaktivatorinhibitor wird als pathophysiologisches Bindeglied dieser Assoziation betrachtet. Chronische Entzundungsprozesse, die im Alter haufig sind, konnen uber eine Hyperfibrinogenamie weiter zur Storung des hamostaseologischen Gleichgewichts beitragen. Schlieslich ist denkbar, dass diese prothrombogenen Veranderungen die Progression der Atherosklerose im Alter beschleunigen und das Auftreten akuter Koronarsyndrome begunstigen. Diese Zusammenhange unterstreichen, dass die optimierte Behandlung von chronischen Begleiterkrankungen ein wichtiger Aspekt der Primar- und Sekundarpravention atherosklerotischer Manifestationen im Alter ist. Daruber hinaus bietet die prothrombogene Aktivierung des Gerinnungssystems einen vielversprechenden Ansatzpunkt fur spezifische Therapienkonzepte.

More than 25 years ago it was demonstrated that an improvement in various parameters of blood flow in patients who have an hyperviscosity syndrome improves coronary blood flow. Hyperfibrinogenemia with resulting increase in plasma viscosity and erythrocyte aggregation has been demonstrated in patients with coronary heart disease. Poiseuille's law, which describes the interaction between vascular resistance, vessel geometry and blood viscosity, indicates--when applied to coronary artery disease--that an increase in the viscosity of blood, especially of plasma, can in the poststenotic microcirculation be a flow-limiting factor and a critical determinant of oxygen supply to myocardium that is at risk of ischaemia. An increased concentration of fibrinogen, which is the substance that causes the increase in plasma viscosity, has been shown to correlate prospectively with the risk of serious cardiovascular events. Patients with multiple-vessel coronary heart disease and treatment-refractory angina pectoris have clearly increased fibrinogen values. Chronic intermittent urokinase administrations--given with the aim of achieving fibrinogenolysis of the elevated fibrinogen concentration at a dose of 500 000 IU urokinase three times weekly -improves the rheological parameters and achieves an impressive decrease in symptoms. It is thus important in clinical practice to take into account that patients with atherosclerosis and a fibrinogen concentration of more than 300 mg may develop perfusion disorders and worsening of their symptoms.

The effect of fenofibrate (a clofibrate derivative) on fibrinogen concentration, blood viscosity and myocardial microcirculation was examined in 35 patients with coronary heart disease (n = 27) or hypertension (n = 8). After eight weeks' administration of 250 mg fenofibrate daily cholesterol and triglycerides levels decreased significantly, as did the fibrinogen concentration, from a mean of 300.7 +/- 75.1 mg/dl to 252.3 +/- 61.2 mg/dl (P less than 0.01). Plasma viscosity and erythrocyte aggregation were also significantly lowered (from 1.43 +/- 0.09 to 1.37 +/- 0.07 mPas and 15.0 +/- 3.1 to 13.5 +/- 2.2, respectively; P less than 0.01). In eight of twelve subjects selected from the whole group thallium myocardial scintigraphy demonstrated, after eight weeks of treatment with fenofibrate, a global (in two) or regional (in six) increase in blood flow. Reduction of fibrinogen concentration may in coronary heart disease achieve an improvement in myocardial microcirculation with decreased myocardial ischaemia.

Der rechte Ventrikel toleriert Volumenbelastungen durch Rekrutierung von Kapazitatsgefasen und Kapillaren des Lungenkreislaufs ohne wesentliche Drucksteigerung, besitzt aber nur geringe kontraktile Reserven und reagiert nichtadaptiert auf Druckbelastungen mit einer rechtsventrikularen Dysfunktion. Seine Grose und Druckbelastung sind prognoserelevant bei allen Formen pulmonaler Hypertonie und insbesondere bei Linksherzinsuffizienz. Von hoher Bedeutung ist die Differenzierung der pulmonalen Hypertonie nach der Venedig-Klassifikation. Ein insuffizienter rechter Ventrikel verschlechtert die linksventrikulare Hamodynamik infolge reduzierter Auswurfleistung, aber auch rechts-linksventrikularer Interaktionen mit Auslosung einer diastolischen linksventrikularen Dysfunktion bei noch intakter systolischer linksventrikularer Funktion. Eine rechtsventrikulare Ejektionsfraktion

Background: Syringomyelia results from obstruction of cerebrospinal fluid (CSF) flow due to a multitude of causes. Often symptoms of pain, weakness, and sensory disturbance are progressive and require surgical treatment. We present here a rare technique for syringosubarachnoid shunting. Case Description: We present the case of a 38-year-old male who suffered a traumatic cervical spinal cord injury due to a motor vehicle accident. With progressive pain and motor decline, a magnetic resonance imaging was obtained and showed a new syrinx extending cervical multiple segments. A unique surgical procedure using a myringotomy tube to shunt CSF into the subarachnoid space was employed in this case. The patient's examination stabilized postoperatively, and at 2 months and 6 months follow-up visits, his strength and sensation continued to improve. Conclusion: We used a myringotomy tube for syringosubarachnoid shunting for the surgical management of a posttraumatic syrinx with good results. This technique minimizes suturing and may minimize shunt-related complications.

Die Pravention des plotzlichen Herztodes ist aufgrund der Haufigkeit dieses prognostisch gravierenden Ereignisses von hoher Bedeutung. Stand bisher die sekundare Pravention nach uberlebten, nahezu fatalen Arrhythmien im Vordergrund der Behandlung, so werden zunehmend Risikogruppen definiert, bei denen eine primare Prophylaxe sinnvoll ist. Die wichtigste therapeutische Masnahme ist die Behandlung der kardialen Grunderkrankung, wobei die medikamentose Herzinsuffizienztherapie und die Behandlung einer ischamischen Herzerkrankung entscheidend sind. Die medikamentose antiarrhythmische Therapie tritt wegen ihrer Wirkungslosigkeit und der Gefahr von proarrhythmogenen Effekten zunehmend in den Hintergrund. Eine weitere Therapieoption ist die Implantation von Cardioverter-Defibrillatoren (ICDs). Aufgrund der kostenintensiven Therapie muss hier jedoch insbesondere bei der primaren Prophylaxe die Indikation kritisch gestellt werden. Der wesentliche Risikofaktor fur das Auftreten einer fatalen Arrhythmie ist die Storung der linksventrikularen Funktion, die somit ein zentrales Kriterium zur Indikationsstellung einer ICD-Implantation ist. In view of the frequency of sudden cardiac death, prevention of this grave event is a high priority. While secondary prevention after survival of almost fatal arrhythmias previously constituted the core treatment, risk groups for whom primary prophylaxis makes good sense are now increasingly being defined. The major therapeutic measure is treatment of the underlying cardiac disease, with pharmacotherapy of cardiac insufficiency and treatment of ischaemic heart disease being of decisive importance. Antiarrhythmic drugs are now increasingly being abandoned as ineffective and potentially leading to proarrhythmogenic effects. A further therapeutic option is the use of implantable cadioverter defibrillators (ICDs). Owing to the high costs of this option, however, the indication must be strictly applied, in particular in the area of primary prophylaxis. The major risk factor for the occurrence of a fatal arrhythmia is disordered left ventricular function, which is thus a central criterion for establishing the indication for an ICD.

Besides classical, modifiable risk factors (hypercholesterolemia, hypertension, smoking) abnormalities of the glucose metabolism (diabetes mellitus, impaired glucose tolerance) are strong emerging cardiovascular risk factors. Epidemiological data indicate that 8 % of the population and up to 60 % of patients with coronary artery disease have abnormalities of glucose metabolism. The prevalence of these abnormalities will increase as the population ages and the mean body weight increases. An abnormal glucose concentration damages the endothelium in several ways: increased oxidative stress, inflammatory processes and an activation of procoagulant factors all impair endothelial function. A blood glucose normalising therapy is thought to decrease the incidence of cardiovascular events in these patients. In patients with an acute myocardial infarction and diabetes mellitus an early intensive insulin therapy improves the outcome of these patients. In summary, the early detection and treatment of abnormalities of glucose metabolism reduces cardiac events.

Das Reaktionsverhalten von P(C6H4CH2NMe2-2)3 (1) gegenuber unterschiedlichen Kupfer(II)- und Kupfer(I)-Salzen CuX2 (2a: X = BF4, 2b: X = PF6, 2c: X = ClO4, 2d: X = NO3, 2e: X = Cl, 2f: X = Br, 13: X = O2CMe) und CuX (5a: X = ClO4, 5b: X = NO3, 5c: X = Cl, 5d: X = Br) wird vorgestellt. In Abhangigkeit von X werden die Komplexe [P(C6H4CH2NMe2-2)3Cu]X2 (3a: X = BF4, 3b: X = PF6), {[P(C6H4CH2NMe2-2)3]CuX}X (4: X = ClO4, 11a: X = Cl, 11b: X = Br, 14: X = O2CMe), {[P(C6H4CH2NMe2-2)3]Cu}ClO4 (6), [P(C6H4CH2NMe2-2)3]CuX (7a: X = Cl, 7b: X = Br, 10: X = ONO2), [P(C6H4CH2NMe2-2)2(C6H4CH2NMe2H+NO3--2)]CuONO2 (9), sowie [P(C6H4CH2NMe2-2)3]CuCl}CuCl2 (12) erhalten. Wahrend das Phosphan 1 in 3a, 3b und 6 bevorzugt als tetrapodaler Ligand wirkt, koordiniert es in den anderen Verbindungen mit dem Phosphoratom und zwei der drei Stickstoffatome der C6H4CH2NMe2-Seitenarme an das jeweilige Kupferion. In Losung liegen dynamische Spezies vor. Die Koordinationseigenschaften von X geben sich dadurch zu erkennen, dass in 3a, 3b und 6 nicht-koordinierende Anionen X- vorliegen. In 4 bildet eines der beiden Perchlorationen eine koordinative Sauerstoff-Kupfer-Bindung aus, wahrend das zweite Perchloration als Gegenion zu {[P(C6H4CH2NMe2-2)3]CuOClO3}+ wirkt. In 7, 9 und 10 liegen Kupfer-X-σ-Bindungen (X = Cl, Br, ONO2) vor. Der Acetatrest in 14 ist laut IR-spektroskopischen Untersuchungen uber beide Sauerstoffatome des Acetatrestes an das Kupfer(II)-Ion gebunden. Alle neu dargestellten kationischen oder neutralen Kupfer(I)- bzw. Kupfer(II)-Verbindungen reprasentieren stabile Komplexe. Redoxprozesse sind fur die Entstehung von 9 und 12, ausgehend von 1 und 2, verantwortlich und werden vorgestellt. Die Kristallstrukturen der Komplexe 4, 6, 9 und 10 werden beschrieben. In diesen Komplexen liegt ein Kupfer(II)- (4) bzw. Kupfer(I)-Ion (6, 9, 10) mit der Koordinationszahl 4 vor. Diese wird erreicht, indem das Phosphoratom und zwei der drei Stickstoffatome des Phosphanliganden P(C6H4CH2NMe2-2)3 (4, 9, 10) bzw. alle drei Me2NCH2-Seitenarme und das Phosphoratom (6) an das jeweilige Kupferion binden und der Rest X als Anion vorliegt (6), oder eine koordinative (4) bzw. σ-Bindung (9, 10) mit dem Kupferatom ausbildet. Dadurch weisen die Kupfer(II)- und Kupfer(I)-Ionen eine verzerrt tetraedrische Koordinationssphare auf. Wahrend in 4 und 10 ein freier, neutraler Me2NCH2-Seitenarm vorliegt, der in Losung schnelle Austauschprozesse mit den koordinativ gebundenen Me2NCH2-Fragmenten zeigt, ist dieser in 9 protoniert. Als Gegenion zur CH2NMe2H+-Einheit wirkt NO3-. Als weiteres Charakteristikum liegen in allen strukturanalytisch untersuchten Spezies wannenformige sechsgliedrige CuPNC3-Ringe vor. Reaction Behaviour of Copper(I) and Copper(II) Salts Towards P(C6H4CH2NMe2-2)3 - the Solid-State Structures of {[P(C6H4CH2NMe2-2)3]CuOClO3}ClO4, {[P(C6H4CH2NMe2-2)3]Cu}ClO4, [P(C6H4CH2NMe2-2)3]CuONO2 and [P(C6H4CH2NMe2-2)2(C6H4CH2NMe2H+NO3--2)]CuONO2 The reaction behaviour of P(C6H4CH2NMe2-2)3 (1) towards different copper(II) and copper(I) salts of the type CuX2 (2a: X = BF4, 2b: X = PF6, 2c: X = ClO4, 2d: X = NO3, 2e: X = Cl, 2f: X = Br, 13: X = O2CMe) and CuX (5a: X = ClO4, 5b: X = NO3, 5c: X = Cl, 5d: X = Br) is discussed. Depending on X, the transition metal complexes [P(C6H4CH2NMe2-2)3Cu]X2 (3a: X = BF4, 3b: X = PF6), {[P(C6H4CH2NMe2-2)3]CuX}X (4: X = ClO4, 11a: X = Cl, 11b: X = Br, 14: X = O2CMe), {[P(C6H4CH2NMe2-2)3]Cu}ClO4 (6), [P(C6H4CH2NMe2-2)3]CuX (7a: X = Cl, 7b: X = Br, 10: X = ONO2), [P(C6H4CH2NMe2-2)2(C6H4CH2NMe2H+NO3--2)]CuONO2 (9) and [P(C6H4CH2NMe2-2)3]CuCl}CuCl2 (12) are accessible. While in 3a, 3b and 6 the phosphane 1 preferentially acts as tetrapodale ligand, in all other species only the phosphorus atom and two of the three C6H4CH2NMe2 side-arms are datively-bound to the appropriate copper ion. In solution a dynamic behaviour of the latter species is observed. Due to the coordination ability of X in 3a, 3b and 6non-coordinating anions X- are present. However, in 4 one of the two perchlorate ions forms a dative oxygen-copper bond and the second perchlorate ion acts as counter ion to {[P(C6H4CH2NMe2-2)3]CuOClO3}+. In 7, 9 and 10 the fragments X (X = Cl, Br, ONO2) form a σ-bond with the copper(I) ion. The acetate moiety in 14 acts as chelating ligand as it could be shown by IR-spectroscopic studies. All newly synthesised cationic and neutral copper(I) and copper(II) complexes are representing stable species. Redox processes are involved in the formation of 9 and 12 by reacting 1 with 2. The solid-state structures of 4, 6, 9 and 10 are reported. In the latter complexes the copper(II) (4) or copper(I) ion (6, 9, 10) possesses the coordination number 4. This is achieved by the formation of a phosphorus- and two nitrogen-copper- (4, 9, 10) or three (6) nitrogen-copper dative bonds and a coordinating (4) or σ-binding (9, 10) ligand X. In 6 all three nitrogen and the phosphorus atoms are coordinatively bound to copper, while X acts as non-coordinating counter-ion. Based on this, the respective copper ion occupies a distorted tetrahedral coordination sphere. While in 4 and 10 a free, neutral Me2NCH2 side-arm is present, which rapidly exchanges in solution with the coordinatively-bound Me2NCH2 fragments, this unit is protonated in 10. NO3- acts as counter ion to the CH2NMe2H+ moiety. In all structural characterized complexes 6-membered boat-like CuPNC3 cycles are present.

The electronic interaction between homo- and heterotransition metals of Group 11 in bimetallic complexes of the type [(R3P)M←NN→M'(R3P)](X)2 (R=C6H4CH2NMe2-2; M=M', M≠M', M=Cu, M'=Ag; NN=NC5H4CN-4, 1,4-(CN)2C6H4, 4,4'-bipy; X=ClO4, OTf, PF6), employing phosphanes as chelating ligands at the metal centers and various symmetric as well as asymmetric complexing molecules as bridging ligands between M and M', has been studied by cyclic voltammetry. Based on the shift of the reduction potentials of the metal atoms, various degrees of intramolecular electronic communication have been identified. They are correlated with the type, the symmetry and the molecular structure of the bridging ligand.

Zahlreiche Untersuchungen haben einen Zusammenhang zwischen rheologischen Determinanten und fortgeschrittenen Stadien der koronaren Herzkrankheit und arteriellen Verschlusskrankheit, aber auch der chronisch-obstruktiven Lungenerkrankung nachweisen konnen. Diese rheologischen Veranderungen konnen bei der koronaren Herzkrankheit in der poststenotischen Mikrozirkulation zur kritischen Sauerstoffversorgung des Myokards fuhren. Rheologische Therapieansatze zielen auf die Flussverbesserung mittels Reduktion des viskosen Widerstands durch Beeinflussung erhohter Fibrinogenwerte. So gelang die Etablierung der chronisch-intermittierenden Urokinasetherapie bei refraktarer Angina pectoris. Eine Verbesserung der Mikrozirkulation konnte auch unter Fibrattherapie in Folge einer verminderten hepatischen Fibrinogensynthese gezeigt werden. Ebenso konnen CSE-Hemmer durch Beeinflussung des Lipidprofils zu einer verbesserten Mikrozirkulation fuhren. Bei Patienten mit chronisch-obstruktiver Lungenerkrankung und Cor pulmonale, die haufig eine Polyglobulie, Hypoxie und pulmonale Mikrozirkulationsstorung aufweisen, kann eine isovolamische Hamodilutionstherapie zur Abnahme des pulmonal-arteriellen Mitteldrucks mit Steigerung des Herzzeitvolumens und der Belastungskapazitat einschlieslich Erhohung der Sauerstoffpartialdruckwerte fuhren.

The synthesis of the mononuclear and homobimetallic silver(I) complexes [P(C 6 H 4 CH 2 NMe 2 -2) 3 ]AgL 2 [L 2 =acetylacetonate, acac ( 5a ); tropolonate, trop ( 5b ); 3-hydroxy-2-methyl-γ-pyranoate, pyro ( 5c )], [P(C 6 H 4 CH 2 NMe 2 -2) 3 ]AgOC(O)Me ( 8 ) and [P(C 6 H 4 CH 2 NMe 2 -2) 3 ]AgL 4 Ag[P(C 6 H 4 CH 2 NMe 2 -2) 3 ] [L 4 =2,5-dihydroxy- p -benzochinoate, benz ( 6a ); 1,4-dihydroxy-anthrachinoate, anthra ( 6b )] can be achieved by the reaction of the silver(I) salts [AgL 2 ] [L 2 =acac ( 3a ), trop ( 3b ), pyro ( 3c )], [Ag 2 L 4 ] [L 4 =benz ( 3d ), anthra ( 3e )] or [AgCO 2 Me] ( 7 ) with P(C 6 H 4 CH 2 NMe 2 -2) 3 ( 4 ) in a 1:1 or 1:2 molar ratio. The respective silver(I) salts 3a – 3e are accessible by treatment of [AgNO 3 ] ( 1 ) with HL 2 or H 2 L 4 ( 2a – 2d ), respectively. In 5a – 5c , 6a and 6b the silver atom possesses a pseudotetrahedral environment caused by the chelate-bound ligands acac, trop, pyro, benz or anthra and the bidentate coordinated phosphane 4 . In homobimetallic 6a and 6b the appropriate transition metals are spanned by the benz or anthra units, respectively. While in 5a – 5c , 6a and 6b the silver metal possesses the coordination number 4, in 8 a T-shaped arrangement is set-up with a linear PAgO unit. The chemical and physical behaviour of complexes 5a – 5c , 6a , 6b and 8 is reported. Spectroscopic studies reveal that on the NMR time-scale the phosphane group with its Me 2 NCH 2 built-in arms is dynamic.

The synthesis of the silver(I)–carboxylate complexes [(R′ 3 P) n AgO 2 CR] ( n =1, R′= n Bu: 3a , R=CF 3 ; 3b , R=C 2 F 5 ; R′=C 6 H 4 CH 2 NMe 2 -2: 3c , R=CF 3 ; 3d , R=C 2 F 5 ; n =2, R′= n Bu: 4a , R=CF 3 ; 4b : R=C 2 F 5 ) succeeds, when [AgO 2 CR] ( 1a , R=CF 3 ; 1b , R=C 2 F 5 ) is reacted with n equivalents of PR′ 3 ( 2a , R′= n Bu; 2b , R′=C 6 H 4 CH 2 NMe 2 -2) ( n =1, 2); the yield amounts to 83–98%. Complexes 3 and 4 can be used for the deposition of silver on titaniumnitride-coated SiO 2 -wafers by the chemical vapour deposition (CVD) process, which could be shown by applying 4a as suitable precursor. REM studies show that closed silver layers were formed with a silver particle size between 50 and 100 nm.

The electronic interaction between datively bonded phosphanes, 2,2′-bipyridine and 1,10-phenanthroline ligands, and copper(I) and silver(I) ions has been studied with cyclic voltammetry. Based on the shifts of reduction potentials of the metals, various degrees of interactions have been identified. They are correlated with the type and molecular structure of the bridging ligand.

Die Reaktion von [(η2-Me3SiC≡CSiMe3)CuBr]2 (1) mit zwei Aquivalenten an [M(O∩O)] [M = Na, Ag; O∩O = Acetylacetonat, acac, 2a/ 3a; = 1, 1, 1, 5, 5, 5-Hexafluoroacetylacetonat, hfac, 2b/ 3b; = 2, 2, 6, 6-Tetramethyl-3, 5-heptandionat, tehe, 2c/ 3c; = 1, 3-Diphenyl-1, 3-propandionat, dipa, 2d/ 3d; = 2-Methyl-4-pyronat, mepy, 2e/ 3e; = Troponolat, trop, 2f/ 3f) fuhrt zu [(η2-Me3SiC≡CSiMe3)Cu(O∩O)] (4a, acac; 4b, hfac; 4c, tehe; 4d, dipa; 4e, mepy; 4f, trop), welche durch Umsetzung mit PR3 (R = C6H4CH2NMe2-2)3 (5) unter Verdrangung von Me3SiC≡CSiMe3 die Phosphan-Kupfer(I)-β-Diketonato-Komplexe [(R3P)Cu(O∩O)] (O∩O = acac, 6a; = hfac, 6b; = tehe, 6c; = dipa, 6d; = mepy , 6e; = trop, 6f) ] ergeben. Die Komplexe 6a — 6f werden auch gebildet, wenn man 5 mit aquimolaren Mengen an CuCl (7) und dann mit Na(O∩O) (2) zur Reaktion bringt. Verwendet man an Stelle von 2 bzw. 3 das Silbersalz Ag2(O2∩O2) (O2∩O2 = 1, 4-Benzochinoat, benz, 9a; = 1, 4-Anthrachinoat, anth, 9b), so werden homobimetallische Komplexe des Typs [(R3P)CuO2∩O2Cu(PR3)] (O2∩O2 = benz, 10a; = anth, 10b) erhalten, in denen zwei Kupfer(I)-Phosphan-Bausteine uber π-konjugierte organische O2∩O2-Brucken miteinander verknupft sind. Die Reaktion von 3 mit 5 im Verhaltnis von 1:1 ergibt die entsprechenden phosphanstabilisierten Silber(I)-Komplexe [(R3P)Ag(O∩O)] (O∩O = acac, 11a; = mepy , 11b; = trop, 11c)]. Bringt man dagegen 5 mit 0.5 Teilen an Ag2(O2∩O2) (9) zur Umsetzung, so sind die zu 10 isostrukturellen zweikernigen Komplexe [(R3P) AgO2∩O2Ag(PR3)] (O2∩O2 = benz, 12a; = anth, 12b) zuganglich. Wahrend die Kupfer(I)-Komplexe 6 und 10 in Losung und im Festkorper bestandig sind, beobachtet man fur die isostrukturellen Silber(I)-Spezies 11 und 12, das sie sich unter Einwirkung von Licht unter Abscheidung von elementarem Silber zersetzen. Die Verwendung von 4a und 6c als Ausgangsverbindungen zur Abscheidung von Kupferfilmen auf TiN-beschichteten SiO2-Wafern durch die chemische Gasphasenabscheidung wird vorgestellt. Die Kristallstruktur von 6f wird beschrieben. Einkerniges 6f kristallisiert zusammen mit [(R3P)CuCl] (8) (Verhaltnis 6f : 8 = 85 : 15) in der triklinen Raumgruppe P1¯ mit den Zellparametern a = 8.962(2), b = 10.753(3), c = 17.037(5)A, α = 78.29(2), β = 77.12(2), γ = 81.220(10), V = 1557.3(7)A3, Z = 2 mit 4703 beobachteten unabhangigen Reflexen (R1 = 0.0661). Das Kupfer(I)-Ion in 6f weist die Koordinationszahl 4 auf. Es liegt eine wannenformige Konformation fur die sechsgliedrigen CuPNCH2C2/Phenyl-Ringe vor und der Troponolat-Ligand bindet uber beide Sauerstoffatome symmetrisch an das Kupfer(I)-Ion. Mono- and Bimetallic Copper(I)- and Silver(I)-Phosphane Complexes with β-Diketonate Units The reaction of [(η2-Me3SiC≡CSiMe3)CuBr]2 (1) with two equivalents of [M(O∩O)] [M = Na, Ag; O∩O = acetylacetonate, acac, 2a/ 3a; = 1, 1, 1, 5, 5, 5-hexafluoroacetylacetonate, hfac, 2b/ 3b; = 2, 2, 6, 6-tetramethyl-3, 5-heptanedionate, tehe, 2c/ 3c; = 1, 3-diphenyl-1, 3-propandonate, dipa, 2d/ 3d; = 2-methyl-4-pyronate, mepy, 2e/ 3e; = troponolate, trop, 2f/ 3f) affords [(η2-Me3SiC≡CSiMe3)Cu(O∩O)] (4a, acac; 4b, hfac; 4c, tehe; 4d, dipa; 4e, mepy; 4f, trop), which further reacts with PR3 (R = C6H4CH2NMe2-2)3 (5) to give the phosphane copper(I) β-diketonato complexes [(R3P)Cu(O∩O)] (O∩O = acac, 6a; = hfac, 6b; = tehe, 6c; = dipa, 6d; = mepy , 6e; = trop, 6f) ] via replacement of Me3SiC≡CSiMe3. Complexes 6a — 6f are also formed, when 5 is reacted with equimolare amounts of CuCl (7) and than with Na(O∩O) (2). Using the silver salt Ag2(O2∩O2) (O2∩O2 = 1, 4-benzochinoate, benz, 9a; = 1, 4-anthrachinoate, anth, 9b) instead of 2 or 3, than homobimetallic complexes of type [(R3P)CuO2∩O2Cu(PR3)] (O2∩O2 = benz, 10a; = anth, 10b) are accessible in which two copper(I) phosphane building blocks are spanned by the π-conjugated organic bridging unit O2∩O2. The reaction of 3 with 5 in the ratio of 1:1 produces the phosphane-stabilized silver(I) complexes [(R3P)Ag(O∩O)] (O∩O = acac, 11a; = mepy , 11b; = trop, 11c)]. Homobimetallic [(R3P) AgO2∩O2Ag2(PR3)] (O2∩O2 = benz, 12a; = anth, 12b), which is isostructural to 10, is accessible by treatment of 5 with 0.5 equivalent of Ag2(O2∩O2) (9). While the respective copper(I) complexes 6 and 10 are stable in solution and in the solid-state, it appeared that the appropriate silver(I) complexes 11 and 12 decompose upon precipitation of silver on their exposure to light. The application of 4a and 6c as precursors in the CVD process (CVD = Chemical Vapour Deposition) for the deposition of copper films on TiN-coated SiO2 wafers is discussed. The solid-state structure of 6f is reported. Mononuclear 6f crystallizes together with [(R3P)CuCl] (8) (ratio 6f : 8 = 85 : 15) in the triclinic space group P1¯ with the cell parameters a = 8.962(2), b = 10.753(3), c = 17.037(5)A, α = 78.29(2), β = 77.12(2), γ = 81.220(10), V = 1557.3(7)A3, Z = 2 with 4703 observed unique reflections (R1 = 0.0661). The copper(I) ion in 6f possesses the coordination number 4. A boat-like conformation for the six-membered CuPNCH2C2/Phenyl cycle is found and the troponolate ligand is symmetrical chelate-bound via both oxygen atoms to the copper(I) ion.

Die Reaktion von [P(C6H4CH2NMe2-2)3]AgX (1a, X = OTf; 1b, X = OClO3) mit aquimolaren Mengen an LcapL (2a, LcapL = 2, 2′-Bipyridin, bipy; 2b, LcapL = 4, 4′-Dimethyl-2, 2′-bipyridin, bipy′; 2c, LcapL = 1, 10-Phenanthrolin, phen) fuhrt zu den kationischen Komplexen {[P(C6H4CH2NMe2-2)3]Ag(LcapL)}+X— (LcapL = bipy: 3a, X = OTf; 3b, X = ClO4; LcapL = bipy′: 3c, X = OTf; 3d, X = ClO4; LcapL = phen: 3e, X = OTf; 3f, X = ClO4), in denen die Bausteine LcapL und P(C6H4CH2NMe2-2)3 als zweizah nige Chelatliganden an das Silberatom koordinativ gebunden sind. Laut spektroskopischen Befunden zeigt die Phosphangruppe P(C6H4CH2NMe2-2)3 in Losung dynamisches Verhalten, wobei auf der NMR-Zeitskala ein schneller Austausch der Me2NCH2-Seitenarme stattfindet. Wahrend 3e im Festkorper bestandig ist, beobachtet man fur Losungen von 3e, dass diese sich beim Erwarmen oder unter Einwirkung von Licht zersetzen. Unter Abscheidung von kolloidalem Silber last sich nach entsprechender Aufarbeitung neben dem Phosphan P(C6H4CH2NMe2-2)3 (5) der Komplex [Ag(phen)2]OTf (4) isolieren. Die Kristallstrukturen der neutralen bzw. kationischen Komplexe 1a und 4 werden beschrieben. Einkerniges 1a kristallisiert in der monoklinen Raumgruppe P21/c mit den Zellparametern a = 16.7763(2), b = 14.7892(2), c = 25.44130(10)A, β = 106.1260(10), V = 6063.83(11)A3, Z = 4 mit 8132 beobachteten unabhangigen Reflexen (R1 = 0.0712), wahrend 4 in der monoklinen Raumgruppe C2/c mit den Zellparametern a = 26.749(3), b = 7.1550(10), c = 26.077(3)A, β = 113.503(2), V = 4576.8(10)A3, Z = 4 mit 6209 beobachteten unabhangigen Reflexen (R1 = 0.0481) kristallisiert. Die Elementarzelle von 1a enthalt zwei unabhangige Molekule. In beiden Molekulen weist das Silberatom eine verzerrt tetraedrische Umgebung auf und es liegt eine wannenformige Konformation fur die sechsgliedrigen AgPNCH2C2/Phenyl-Ringe vor. In 4 hat das Silberatom, wie in 1a, die Koordinationszahl 4. Die beiden phen-Liganden sind um 40.63° zueinander verdreht. Der OTf-Rest liegt als nicht-koordinierendes Anion vor.

The title compounds 3-5 are accessible by treatment of P(C6H4CH2NMe2)3(1) with CuX (2a: X = Cl, 2b: X = Br, 2c: X = I) in the ratio of 1:1 or 1:2 in very good yields. Reaction of 1 with equimolar amounts of 2a affords the copper(I) chloride [P(C6H4CH2NMe2)3]CuCl (3). With a further equivalent of 2a homobimetallic [P(C6H4CH2NMe2)3]Cu2Cl2 (4) is formed, which also can be synthesized by the reaction of 1 with two equivalents of 2a. Complex 3 reacts with CuX (X = Br, I)to afford [P(C6H4CH2NMe2)3]Cu2ClX (5a: X = Br; 5b: X = I) in which mixed halides are present. The newly synthesized complexes 3-5 were characterized by elemental analyses, by their IR-, 1H-, 13C{1H}- and 31P{1H}-NMR spectra as well as by mass spectrometrical studies. The solid-state structures of complexes 3 and 4 are reported. Mononuclear 3 crystallizes in the monoclinic space group P21/c with the cell parameters a = 14.285(2), b = 10.853(2), c = 17.425(2) A , β = 103.310(10)?, V = 2628.9(7) A 3 and Z = 4 with 4053 observed unique reflections; R1 = 0.0314. The crystal structure of 3 consists of monomeric molecules with planar coordinated copper(I) centres (CuClNP). Homobimetallic 4 crystallizes in the monoclinic space group P21/n with a = 23.905(4), b = 10.874(3), c = 25.314(5), β = 99.130(10)?, V = 6497(2) /Aring; 3 and Z = 4 with 9021 observed unique reflections; R1 = 0.0480. In 4 one of two copper(I) centres possesses a distorted trigonal-pyramidal environment, while the other one is almost square-pyramidal coordinated. The Cu2Cl2 segment resembles to a building block which is set up by a contact ion pair consisting of Cu+ and [CuCl2]- , respectively.

The reaction of cis-(2,2′-bipyridine) Pt(CCPh)2cis-(4,4′-dimethyl-2,2′-bipyridine) Pt-(CCPh)2 and trans-(Ph3P)2Pt(CCPh)2 towards different group 11 transition-metal salts [M′X] (M′ = Cu, Ag; X = inorganic ligand) to give heterobimetallic or linear oligomeric and polymeric transition metal complexes is described. Different coordination modes for M′, PhCC, PPh3, and X were found in these species. The structural aspects as well as the preference for one coordination mode over another is discussed. © 2002 Wiley Periodicals, Inc. Heteroatom Chem 13:521–533, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/hc.10097

Treatment of P(C6H4CH2NMe2-2)3 (1) with 2 equiv. of CuX (2a X=Cl, 2b X=Br) produces the novel dicopper complexes [P(C6H4CH2NMe2-2)3]Cu2X2 (3a X=Cl, 3b X=Br) in high yields. The X-ray structure of 3b was determined. Crystals of 3b are orthorhombic, space group Pna21, with a=19.280(4) A, b=15.717(3) A, c=11.201(2) A, V=3394(1) A3, Z=4, and final R1=0.0573 [I≥2σ(I)] for 2301 reflections used (1621 reflection with I≥2σ(I)) and 340 variables. The structure of 3b consists of two copper(I) centers of which one copper atom possesses a heavily distorted trigonal-pyramidal environment, while the other one is almost square-pyramidal coordinated; the Cu2Br2 segment gives rise to a situation, which may be considered as a contact ion pair between Cu+ and CuBr2 −.

Die Umsetzung des tetrapodalen Phosphans P(C6H4CH2NMe2-2)3 (1) mit aquivalenten Mengen der Silber(I)-Halogenide AgX (2 a: X = Cl, 2 b: X = Br) in Tetrahydrofuran bei 25 °C fuhrt zu den monomeren Silber(I)-Komplexen [P(C6H4CH2NMe2-2)3]AgX mit planarer Umgebung an den Ag-Atomen (3 a: X = Cl, 3 b: X = Br) in sehr guter Ausbeute. Von Komplex 3 b wurde eine Einkristall-Rontgenstrukturanalyse angefertigt. Einkerniges 3 b kristallisiert in der monoklinen Raumgruppe P21/c mit den Zellparametern a = 14.504(6), b = 11.034(3), c = 17.604(5) A, β = 102.86(4)°; V = 2746.6(16) A3; Z = 4; 2953 beobachtete unabhangige Reflexe, R1 = 0.0805. Aufgebaut ist 3 b aus monomeren Untereinheiten mit planarer, T-formiger Anordnung vorgegeben durch die Atome Ag1, N1, P1 sowie Br1, wobei das Segment P1–Ag1–Br1 nahezu linear angeordnet ist. Synthesis of Monomeric T-Shaped Silver(I) Halide Complexes – Crystal Structure Analysis of [P(C6H4CH2NMe2-2)3]AgBr Treatment of the tetrapodal phosphane P(C6H4CH2NMe2-2)3 (1) with equimolar amounts of the silver(I) halides AgX (2 a: X = Cl, 2 b: X = Br) produces in tetrahydrofuran at 25 °C the monomeric silver(I) complexes [P(C6H4CH2NMe2-2)3]AgX with planar coordination at the Ag atoms (3 a: X = Cl, 3 b: X = Br) in excellent yields. From complex 3 b a single X-ray crystal structure analysis was carried out. Mononuclear 3 b crystallizes in the monoclinic space group P21/c with the cell parameters a = 14.504(6), b = 11.034(3), c = 17.604(5) A, β = 102.86(4)°; V = 2746.6(16) A3; Z = 4; 2953 observed unique reflections, R1 = 0.0805. Complex 3 b consists of monomeric sub-units with a planar T-shaped arrangement formed by the atoms Ag1, N1, P1 as well as Br1, whereby the P1–Ag1–Br1 array is almost linear orientated.

Systemic capillary leak syndrome is a rare idiopathic disorder characterized by recurrent episodes of hypotension and hemoconcentration due to sudden transient extravasation of up to 70% of plasma. Less than 40 cases have appeared in the literature. Mortality rates 5 years after diagnosis have been reported to be up to 75%. Clinical findings are generalized edema and intravasal fluid deficiency. Laboratory features include hypoalbuminemia and extreme hemoconcentration. A common finding is a monoclonal gammopathy. Rare manifestation of this syndrome is rhabdomyolysis due to increased compartment pressure and ischemic myonecrosis. Early diagnosis and exclusion of other clinical disorders like rheumatic myopathies and myositis are critical concerning prognosis and therapy. We describe a 46-year-old woman with rhabdomyolysis and systemic capillary leak syndrome whose condition is stable for a total of 30 months under a prophylactic regimen with oral terbutaline plus theophylline. A brief survey of the literature is given.

Functional magnetic resonance imaging (fMRI) studies have demonstrated alterations during task-induced brain activation in spinal cord injury (SCI) patients. The interruption to structural integrity of the spinal cord and the resultant disrupted flow of bidirectional communication between the brain and the spinal cord might contribute to the observed dynamic reorganization (neural plasticity). However, the effect of SCI on brain resting-state connectivity patterns remains unclear. We undertook a prospective resting-state fMRI (rs-fMRI) study to explore changes to cortical activation patterns following SCI. With institutional review board approval, rs-fMRI data was obtained in eleven patients with complete cervical SCI (>2 years post injury) and nine age-matched controls. The data was processed using the Analysis of Functional Neuroimages software. Region of interest (ROI) based analysis was performed to study changes in the sensorimotor network using pre- and post-central gyri as seed regions. Two-sampled t-test was carried out to check for significant differences between the two groups. SCI patients showed decreased functional connectivity in motor and sensory cortical regions when compared to controls. The decrease was noted in ipsilateral, contralateral, and interhemispheric regions for left and right precentral ROIs. Additionally, the left postcentral ROI demonstrated increased connectivity with the thalamus bilaterally in SCI patients. Our results suggest that cortical activation patterns in the sensorimotor network undergo dynamic reorganization following SCI. The presence of these changes in chronic spinal cord injury patients is suggestive of the inherent neural plasticity within the central nervous system.

Cationic heterobimetallic {[P(C6H4CH2NMe2-2)3]Ag-bipy-Cu[P(C6H4CH2NMe2-2)3]}2+(OTf−,PF6−) (5) (bipy = 4,4′-bipyridine, OTf=OSO2CF3) is accessible by the subsequent reaction of [P(C6H4CH2NMe2-2)3]AgOTf (1) with bipy (2) to afford {[P(C6H4CH2NMe2-2)3]Ag(bipy)}+(OTf−) (3), which on treatment with equimolar amounts of {[P(C6H4CH2NMe2-2)3]Cu}+(PF6−) (4) produces 5. In 5 the respective group-11 metal(I) centres are bridged by the π-conjugated organic ligand bipy. The electrochemical behaviour of 5 is reported.

We report a successful pregnancy in a patient with longstanding LAM on treatment with sirolimus. During temporary discontinuation fo sirolimus in early pregnancy, lung function declined but recovered after resumption of sirolimus. Pregnancy was complicated by a persistent pneumothorax which was treated surgically postnatally. The child has had a normal development despite exposure to low dose sirolimus intermittently during early embryonal and mid-fetal life.

A 28-year-old male patient with sickle cell disease developed a vasoocclusive crisis with an acute chest syndrome and severe lung failure.After partial substitution transfusion the patient was successfully treated extracorporeal membrane oxygenation (ECMO). After 12 days he was weaned from the ECMO, 2 days later the patient's tracheostoma was removed. 19 days after the event the patient had recovered completely and was moved to a hospital in Paris from where he came.Apparently data is sparse regarding the use of ECMO for treatment of a life-threatening acute chest syndrome in sickle cell disease. However, the therapy approach seems to be promising and is worth considering in this particular situation.

ZusammenfassungIn der Northwick-Park-Heart-Studie konnte erstmals für Individuen mit erhöhten Fibrinogenwerten und erhöhter Faktor-VII-Aktivität eine signifikant erhöhte Inzidenz an koronarer Herzkrankheit nachgewiesen werden. Zwischen Fibrinogenwerten und Cholesterin- wie auch Triglyzeridwerten ließ sich eine signifikante Korrelation berechnen. Bei Patienten mit Hypercholesterinämie wurden erhöhte Fibrinogenwerte, ein vermindertes Fibrinolysepotential und eine vermehrte Thrombozytenaggregationsneigung nachgewiesen. Die Atherogenität des Fibrinogens wird auf eine gesteigerte Proliferationsrate der glatten Gefäßmuskulatur, eine vermehrte Gefäßwandakkumulation des Fibrinogens sowie eine erhöhte Gerinnungsneigung mit abnorm veränderter Blutrheologie zurückgeführt. Hyperlipidämie und Hyperfibrinogenämie können bei der koronaren Herzkrankheit zu einer myokardialen Mikrozirkulationsstörung führen.

Commonly, pulmonary hypertension is clinically suspected because of unexplained exertional dyspnoea or as a chance finding in clinical examination revealing signs of right heart failure. The systematic diagnostic approach and exact classification is based on the Venice classification. Basic investigations include ECG, chest radiograph, lung function studies and echocardiography. Echocardiography is the most important investigation for the diagnosis of pulmonary hypertension. It also serves as non invasive control during treatment and as the main screening test for pulmonary hypertension. Echocardiographic criteria of pulmonary hypertension are a dilated and hypertrophied right ventricle, paradoxic septum movement, a dilated right atrium, and a distended inferior Vena cava. Using Doppler echocardiography, the right ventricular and thus pulmonary arterial systolic pressure can be determined from the tricuspid regurgitant jet velocity. CT of the chest serves to exclude pulmonary embolism and interstitial lung disorders. Cardiac MRI is increasingly being used for analysis of right ventricular morphology, function and haemdynamics. The 6 minute walk test and cardiopulmonary exercise test are used to assess severity and response to treatment and give prognostic information. For the definite diagnosis of pulmonary hypertension, right heart catheterisation is required for the determination of the pulmonary vascular resistance and pharmacological testing of "reversibility".

More than 25 years ago it was demonstrated that an improvement in various parameters of blood flow in patients who have an hyperviscosity syndrome improves coronary blood flow. Hyperfibrinogenemia with resulting increase in plasma viscosity and erythrocyte aggregation has been demonstrated in patients with coronary heart disease. Poiseuille's law, which describes the interaction between vascular resistance, vessel geometry and blood viscosity, indicates--when applied to coronary artery disease--that an increase in the viscosity of blood, especially of plasma, can in the poststenotic microcirculation be a flow-limiting factor and a critical determinant of oxygen supply to myocardium that is at risk of ischaemia. An increased concentration of fibrinogen, which is the substance that causes the increase in plasma viscosity, has been shown to correlate prospectively with the risk of serious cardiovascular events. Patients with multiple-vessel coronary heart disease and treatment-refractory angina pectoris have clearly increased fibrinogen values. Chronic intermittent urokinase administrations--given with the aim of achieving fibrinogenolysis of the elevated fibrinogen concentration at a dose of 500 000 IU urokinase three times weekly -improves the rheological parameters and achieves an impressive decrease in symptoms. It is thus important in clinical practice to take into account that patients with atherosclerosis and a fibrinogen concentration of more than 300 mg may develop perfusion disorders and worsening of their symptoms.

Whereas the right ventricle tolerates volume loads without any substantial increase of the pressure in the pulmonary circulation by recruiting capacitance vessels and capillaries, it possesses only small contractile reserves and reacts unadapted with right ventricular dysfunction. Its size and pressure load are relevant factors for prognosis of all forms of pulmonary hypertension, in particular if linked to left-sided heart failure. Differentiation of pulmonary hypertension according to the Venice classification is highly important. Right-sided ventricular heart failure worsens left ventricular hemodynamics due to reduced ejection fraction and in addition due to direct diastolic ventricular interaction in which left ventricular diastolic dysfunction increases even though the left ventricular systolic function is still intact. Right ventricular ejection fraction40% is an important predictor of prognosis after myocardial infarction or chronic stages of left ventricular heart failure. The most important noninvasive diagnostic method is transthoracic echocardiography with determination of the Tei index and Doppler echocardiographic estimation of pulmonary artery pressure. Chronic obstructive pulmonary disease is the most frequent cause of cor pulmonale. While long-term oxygen therapy in patients with COPD and cor pulmonale and for example the administration of endothelin receptor antagonists in patients with idiopathic pulmonary hypertension is beneficial, the therapeutic use of drugs effective for left-sided heart failure is very limited in patients with right ventricular dysfunction.