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Zusammenfassung Hintergrund Im Rahmen von Erweiterungsbaumaßnahmen am Uniklinikum Dresden war die Abschaltung der zentralen medizinischen Gasversorgung in einem Gebäude mit 3 intensivmedizinischen Teilstationen mit 22 Betten, einem OP-Trakt mit 5 OP und 6 Normalstationen mit je 28 Betten im laufenden Betrieb erforderlich. Damit bestand der Bedarf für die betroffenen Funktionseinheiten, für die Baumaßnahme eine interimistische dezentrale Gasversorgung mit Nullfehlertoleranz zu schaffen. Methodik Nach etablierten Verfahren der Risiko- und Fehlermöglichkeitsanalyse wurde durch den Notfall- und Katastrophenschutzbeauftragten des Klinikums eine Projektgruppe ins Leben gerufen, die einen Projektplan, eine Bedarfsabschätzung und einen Kommunikationsplan erarbeitete. Ergebnisse Eine Vielzahl von Risikofaktoren, für die geeignete Gegenmaßnahmen zu konzipieren waren, wurde systematisch ermittelt. Die Bedarfsabschätzung auf Basis physiologischer Parameter für die maximal 22 zu belegenden Beatmungsplätze über 4 h ergab je 26.000 l Sauerstoff und Druckluft. Sieben Einspeisungspunkte wurden mit je zwei 50-l-Flaschen Sauerstoff und Druckluft bestückt, mit einer Gesamtverfügbarkeit von je 175.000 l der beiden Gase. Je 8 weitere Flaschen waren zusätzlich in Reserve. Die Maßnahme wurde an einem Samstag ohne Elektivoperationsprogramm durchgeführt, sodass die betroffenen OP gesperrt werden konnten. Der Zeitpunkt wurde so gewählt, dass während des Nachmittagsschichtwechsels die doppelte Besetzung des Intensivpflegepersonals verfügbar war. Im Vorfeld wurden möglichst viele der Beatmungspatienten klinikintern verlegt. Neun Beatmungspatienten mussten allerdings verbleiben. Der technische Eingriff in die Gasversorgung dauerte lediglich 2 h, ohne Beeinflussung des Patientenzustands. Während der 2‑stündigen Interimsversorgung wurden auf den High-Care-Stationen 16.500 l Druckluft und 8000 l Sauerstoff verbraucht. Pro Beatmungspatient ergab sich rechnerisch ein Stundenverbrauch von 917 l Luft (15 l/min) und von 444 l Sauerstoff (7 l/min). Die vorausberechnete Menge auf Basis intensivmedizinischer Erfahrungswerte war deutlich geringer. Die 10fache Vorhaltung der Gasmenge und die vorhersehbar geringere Anzahl von Beatmungspatienten als die zugrunde gelegte Maximalbelegung haben dies mehr als kompensiert. Schlussfolgerung Für technische Eingriffe in Hochrisikobereichen ist eine sorgfältige Planung und Durchführung in einem effektiven Team erforderlich. Etablierte Verfahren des Projektmanagements und der Risikobewertung helfen in der Fehlervermeidung.

Background: In reconstructive surgery, loss of a microvascular free flap due to perfusion disorders, especially thrombosis, is a serious complication. In recent years, viscoelastic testing (VET) has become increasingly important in point-of-care (POC) anticoagulation monitoring. This paper describes a protocol for enhanced anticoagulation monitoring during maxillofacial flap surgery. Objective: The aim of the study will be to evaluate, in a controlled setting, the predictive value of POC devices for the type of flap perfusion disorders due to thrombosis or bleeding. VET, Platelet monitoring (PM) and standard laboratory tests (SLT) are comparatively examined. Methods/Design: This study is an investigator-initiated prospective trial in 100 patients undergoing maxillofacial surgery. Patients who undergo reconstructive surgery using microvascular-free flaps will be consecutively enrolled in the study. All patients provide blood samples for VET, PM and SLT at defined time points. The primary outcome is defined as free flap loss during the hospital stay. Statistical analyses will be performed using t-tests, including the Bonferroni adjustment for multiple comparisons. Discussion: This study will help clarify whether VET can improve individualized patient care in reconstruction surgery. A better understanding of coagulation in relation to flap perfusion disorders may allow real-time adaption of antithrombotic strategies and potentially prevent flap complications.

PURPOSE: The aim of this study was to investigate the diagnostic value of descriptive prostate perfusion parameters derived from signal enhancement curves acquired using golden-angle radial sparse parallel dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with high spatiotemporal resolution in advanced, quantitative evaluation of prostate cancer compared with the usage of apparent diffusion coefficient (ADC) values. METHODS: A retrospective study (from January 2016 to July 2019) including 75 subjects (mean, 65 years; 46–80 years) with 2.5-second temporal resolution DCE-MRI and PIRADS 4 or 5 lesions was performed. Fifty-four subjects had biopsy-proven prostate cancer (Gleason 6, 15; Gleason 7, 20; Gleason 8, 13; Gleason 9, 6), whereas 21 subjects had negative MRI/ultrasound fusion-guided biopsies. Voxel-wise analysis of contrast signal enhancement was performed for all time points using custom-developed software, including automatic arterial input function detection. Seven descriptive parameter maps were calculated: normalized maximum signal intensity, time to start, time to maximum, time-to-maximum slope, and maximum slope with normalization on maximum signal and the arterial input function (SMN1, SMN2). The parameters were compared with ADC using multiparametric machine-learning models to determine classification accuracy. A Wilcoxon test was used for the hypothesis test and the Spearman coefficient for correlation. RESULTS: There were significant differences (P < 0.05) for all 7 DCE-derived parameters between the normal peripheral zone versus PIRADS 4 or 5 lesions and the biopsy-positive versus biopsy-negative lesions. Multiparametric analysis showed better performance when combining ADC + DCE as input (accuracy/sensitivity/specificity, 97%/93%/100%) relative to ADC alone (accuracy/sensitivity/specificity, 94%/95%/95%) and to DCE alone (accuracy/sensitivity/specificity, 78%/79%/77%) in differentiating the normal peripheral zone from PIRADS lesions, biopsy-positive versus biopsy-negative lesions (accuracy/sensitivity/specificity, 68%/33%/81%), and Gleason 6 versus ≥7 prostate cancer (accuracy/sensitivity/specificity, 69%/60%/72%). CONCLUSIONS: Descriptive perfusion characteristics derived from high-resolution DCE-MRI using model-free computations show significant differences between normal and cancerous tissue but do not reach the accuracy achieved with solely ADC-based classification. Combining ADC with DCE-based input features improved classification accuracy for PIRADS lesions, discrimination of biopsy-positive versus biopsy-negative lesions, and differentiation between Gleason 6 versus Gleason ≥7 lesions.

To evaluate potential confounding factors in the quantitative assessment of liver fibrosis and cirrhosis using T1 relaxation times.The study population is based on a radiology-information-system database search for abdominal MRI performed from July 2018 to April 2019 at our institution. After applying exclusion criteria 200 (59 ± 16 yrs) remaining patients were retrospectively included. 93 patients were defined as liver-healthy, 40 patients without known fibrosis or cirrhosis, and 67 subjects had a clinically or biopsy-proven liver fibrosis or cirrhosis. T1 mapping was performed using a slice based look-locker approach. A ROI based analysis of the left and the right liver was performed. Fat fraction, R2*, liver volume, laboratory parameters, sex, and age were evaluated as potential confounding factors.T1 values were significantly lower in healthy subjects without known fibrotic changes (1.5 T MRI: 575 ± 56 ms; 3 T MRI: 857 ± 128 ms) compared to patients with acute liver disease (1.5 T MRI: 657 ± 73 ms, p 0.0001; 3 T MRI: 952 ± 37 ms, p = 0.028) or known fibrosis or cirrhosis (1.5 T MRI: 644 ± 83 ms, p 0.0001; 3 T MRI: 995 ± 150 ms, p = 0.018). T1 values correlated moderately with the Child-Pugh stage at 1.5 T (p = 0.01, ρ = 0.35).T1 mapping is a capable predictor for detection of liver fibrosis and cirrhosis. Especially age is not a confounding factor and, hence, age-independent thresholds can be defined. Acute liver diseases are confounding factors and should be ruled out before employing T1-relaxometry based thresholds to screen for patients with liver fibrosis or cirrhosis.

Francia, Bd. 28 Nr. 3 (2001)

Francia, Bd. 32 Nr. 3 (2005)

E. T. Francini, A. Heuss, G. Kreis, Fluchtgut - Raubgut. Der Transfer von Kulturgütern in und über die Schweiz 1933-1945 und die Frage der Restitution, 2001 (H. C. Löhr), Francia, Bd. 30 Nr. 3 (2003)

Francia, Bd. 29 Nr. 3 (2002)

Francia, Bd. 27 Nr. 3 (2000)

Francia, Bd. 25 Nr. 3 (1998)

Francia, Bd. 24 Nr. 3 (1997)

Detection of BRAF V600E has diagnostic, prognostic, and therapeutic relevance. The recently developed BRAF V600E mutation-specific antibody has evolved into a feasible alternative to DNA analysis. The plethora of immunohistochemical protocols makes implementation tedious and, here we tested a set of manual and automated protocols and compared test performance with sequencing results. For assays, we employed formalin-fixed, in part decalcified, and paraffin-embedded tissue samples. Empiric testing of manual protocols included 10 variables in 17 protocols. Automated immunohistochemical staining and BRAF pyrosequencing served as independent test methods. Test performance measures were compared without considering 1 method as a standard. Four well-fixed samples (2WT/2Mut) were used for testing of all protocols and indicated 2 correctly classifying procedures. Practical performance assessment employed 33 independent tissue samples, composed of 27 leukemias (by pyrosequencing: 8 wild-type; 18 mutated; 1 noninformative) and 6 melanomas (V600E; V600K; wild-type, 2 each). Manual V600E staining was positive in 20 cases (19 of 20 V600E-containing samples plus the 1 sample that was noninformative), whereas all wild-type and V600K cases were immunonegative. Manual or automated staining as well as pyrosequencing would have missed an equal number of V600E-mutated cases and the correlation coefficient for these methods was 0.75 to 0.93 (substantial to almost perfect); the Youden index was 0.95. Detection of V600E-mutated BRAF at the protein level in routine and decalcified tissue samples is possible, and the presented manual protocols should expedite implementation in routine diagnostic practice. Our results indicate that both molecular techniques should be considered complementary.

The most common cardiac tumors of heart muscle are rhabdomyomas, solitary or multiple benign tumors of striated muscle origin. While cardiac rhabdomyomas are well described in human medical literature, limited information depicting the occurrence of cardiac rhabdomyomas in veterinary species exists. A case of multiple firm white nonencapsulated nodules in the heart of a bearded seal is described. Microscopic findings included cytoplasmic vacuolization with formation of spider cells, glycogen vacuoles, and striated myofibrils. These cells expressed immunoreactivity for neuron-specific enolase and protein gene product 9.5, a marker for neuronal tissue and Purkinje fiber cells. Immunoreactivity for protein gene product 9.5 along with other microscopic findings substantiates Purkinje fiber cell origin of the cardiac rhabdomyoma in the bearded seal and use of the term purkinjeoma to describe this lesion.

Objective The purpose of this study was to determine the clinical outcome of isoimmunized pregnancies managed primarily by middle cerebral artery peak systolic velocity. Study design A retrospective chart review was conducted of isoimmunized pregnancies that underwent ultrasound examinations from January 1, 2001, through May 1, 2003. Ultrasound reports, laboratory tests, and maternal and neonatal charts were reviewed. Results Women with a clinically significant red blood cell antibody and titer value were included. The study population consisted of 39 women (40 pregnancies, 42 fetuses). Patients with a middle cerebral artery peak systolic velocity of ≥1.5 MoM were offered amniocentesis. Seven pregnancies had an abnormal middle cerebral artery peak systolic velocity. Three of these infants had significant anemia. Six of the 7 pregnancies required an exchange transfusion. None of the 33 pregnancies (35 neonates) with normal middle cerebral artery peak systolic velocity measurements resulted in a neonate with significant anemia or severe hyperbilirubinemia. Conclusion The clinical outcome of these pregnancies supports the use of middle cerebral artery peak systolic velocity measurements in the management of isoimmunized pregnancies.

T(3) has been shown to exert cardiovascular effects. These effects have not yet been defined with regard to the mode of action (nongenomic vs. genomic) and with regard to an interaction with the adrenergic system in humans. To address these issues we conducted a randomized, double blind, 6-fold cross-over trial in 18 healthy male volunteers. After pretreatment with the beta-agonist dobutamine, the beta-blocking agent esmolol, or placebo (0.9% NaCl), 100 microg T(3) or placebo were injected. Primary target variables were systemic vascular resistance (SVR) and cardiac output (CO) within 45 min after injection of T(3) vs. placebo after placebo pretreatment. Sympatho-vagal balance was assessed by measurement of heart rate variability. T(3) caused a lower SVR and a higher CO than placebo (P < 0.001) after pretreatment with placebo. An increased low frequency (LF)/high frequency (HF) ratio (power in LF/power in HF band) after T(3) compared with placebo (P = 0.004) suggests an increase in sympathetic tone. After pretreatment with dobutamine, the effects of T(3) on SVR and CO were abolished, and the effect on LF/HF ratio was reversed. After pretreatment with esmolol, the effects on SVR and LF/HF ratio were reversed. Our data show, for the first time, nongenomic cardiovascular effects of T(3) in humans.

Objective The objective of the study was to determine the value of serial ultrasonographic cervical length (CL) measurements after cerclage to predict preterm delivery. Study Design Retrospective ultrasonographic and outcome data from singleton pregnancies with cerclage were reviewed. Using transvaginal ultrasound (TVS), overall CL obtained before cerclage placement, 2 weeks after cerclage, and before delivery were compared between women who delivered preterm (less than 37 weeks) and term. The overall CL including CL above (CLA) and below the cerclage (CLB) were compared using the SAS program. Results Cerclage was placed at 15.7 ± 3.6 weeks (mean ± SD) in 57 women. The overall CL before cerclage, 2 weeks after cerclage, and the last TVS before delivery was not different in preterm and term births. The odds ratio of a measurable CLA for preterm delivery by TVS was 0.87 (0.78 to 0.95, 95% confidence interval). Thirty-two patients (56%) had absent CLA at 26.7 ± 4.4 weeks. Of these, 16 (50%) were delivered for preterm premature rupture of membranes (PPROM) and chorioamnionitis (sensitivity of 100%, specificity of 61%, positive predictive value of 50%, and negative predictive value of 100%). Conclusion Although the overall cervical length by serial TVS after cerclage did not predict preterm birth, absent CLA is associated with preterm delivery, chorioamnionitis, and PPROM.