A single German center experience with intermittent inotropes for patients on the high-urgent heart transplant waiting list.

AIM: Currently, more than 900 patients with end-stage heart failure are listed for heart transplantation in Germany. All patients on the Eurotransplant high-urgent status (HU) have to be treated in intensive care units and have to be relisted every 8 weeks. Long-term continuous inotropes are associated with tachyphylaxia, arrhythmias and even increased mortality. In this retrospective analysis, we report our single center experience with HU patients treated with intermittent inotropes as a bridging therapy. METHODS AND RESULTS: 117 consecutive adult HU candidates were treated at our intensive care heart failure unit between 2008 and 2013, of whom 14 patients (12 %) were stabilized and delisted during follow-up. In the remaining 103 patients (age 42 ± 15 years), different inotropes (dobutamine, milrinone, adrenaline, noradrenaline, levosimendan) were administered based on the patient's specific characteristics. After initial recompensation, patients were weaned from inotropes as soon as possible. Thereafter, intermittent inotropes (over 3-4 days) were given as a predefined weekly (until 2011) or 8 weekly regimen (from 2011 to 2013). In 57 % of these patients, additional regimen-independent inotropic support was necessary due to hemodynamic instabilities. Fourteen patients (14 %) needed a left- or biventricular assist device; 14 patients (14 %) died while waiting and 87 (84 %) received heart transplants after 87 ± 91 days. Cumulative 3 and 12 months survival of all 103 patients was 75 and 67 %, respectively. CONCLUSION: Intermittent inotropes in HU patients are an adequate strategy as a bridge to transplant; the necessity for assist devices was low. These data provide the basis for a prospective multicenter trial of intermittent inotropes in patients on the HU waiting list.

Ontogenetic trajectories in the ornithischian endocranium.

Understanding ontogenetic and developmental patterns is critical for reconstructing the life history of fossil vertebrates. In dinosaurs, ontogenetic studies have nearly exclusively focused on changes in the cranial and post-cranial skeleton, whereas ontogenetic changes in the endocranium have received little attention. Here, we present digital reconstructions of the brain and inner ear anatomy of two ontogenetic stages of the Jurassic ornithischian dinosaur Dysalotosaurus lettowvorbecki. Results show that the endocranial anatomy underwent considerable changes during growth, including a rostrocaudal elongation of the olfactory apparatus, a reduction in the cephalic and pontine flexure and an increase in cerebellum size. Functional elements, such as the cerebral hemispheres and the inner ear, were already well developed in early ontogenetic stages, indicating a large degree of precociality. The anisotropic pattern of size and shape changes in the endocranium further indicates that ontogenetic trajectories may be controlled by functional and environmental demands in the different growth stages in Dysalotosaurus lettowvorbecki. The occurrence of similar ontogenetic patterns in the endocranial anatomy of derived ornithopod dinosaurs suggests a more widespread distribution of this growth trajectory.

[Knotting of a catheter in the plexus brachialis. A rare complication]. / Der Knoten im axillären Plexus-brachialis-Katheter. Eine seltene Komplikation.

For the repair of an open injury to the hand, a continuous axillary block was performed in a 40- year-old male patient. Slight resistance was experienced during advancement of the catheter. Adequate surgical anaesthesia developed after the injection of 40 ml of a bupivacaine/prilocaine mixture. For postoperative analgesia an infusion of bupivacaine 0.25% was started. Three days later the removal of the catheter proved to be difficult due to a knot in the distal part of the catheter. This seems to be the first report of a knot in a catheter used for continuous axillary plexus block.

[Efficiency of alfalfa and reed in the phytoremediation of hydrocarbon polluted soil]. / Ispol'zovanie liutserny i trostnika dlia fitoremidiatsii zagriaznennogo uglevodorodami grunta.

The efficacy of plants as means of decontaminating hydrocarbon-polluted soil has been studied. Ditch reed (Phragmites australis) and alfalfa (Medicago sativa) markedly intensified processes of pollutant destruction, the effect being particularly pronounced in the case of polycyclic aromatic hydrocarbons (PAHs). Comparative analysis of microflora in soils (including those devoid of plants and rhizosphere) demonstrated that, in addition to preventing the pollutant-induced decrease in the amount of heterotrophic microorganisms, the plants stimulated their development, significantly increasing the population of destructors. Effects of plants on major physiological groups of soil microorganisms under conditions of pollution were ambiguous. The rhizosphere consortium of alfalfa was less susceptible to effects of pollutants than that of reed.

Matrix-metalloproteinases and their inhibitors in plasma and tumor tissue of patients with renal cell carcinoma.

Matrix-metalloproteinases (MMPs) are associated with invasive and metastatic behavior of several human malignant tumors. We have determined MMP-2 and MMP-9 and tissue inhibitors of MMPs (TIMP-1 and TIMP-2) in blood plasma and in renal tissue samples of patients with renal cell carcinoma (RCC) from cancerous and non-cancerous parts of the same kidney. In tumor tissue, MMP-9 and TIMP-1 were significantly higher than in normal counterparts. MMP-2 was not different between tumor tissue and normal counterparts. TIMP-2 values could not be measured. In plasma, MMP-9 concentrations were significantly higher in RCC patients than in healthy controls, MMP-2 and TIMP-2 concentrations were higher in healthy controls and TIMP-1 concentrations were not different.