[Intraoperative transesophageal echocardiography for emergency diagnostics in noncardiac surgery patients]. / Intraoperative transösophageale Echokardiographie als Notfalldiagnostik bei nichtkardiochirurgischen Patienten.

Due to the development of compact and mobile devices, transesophageal echocardiography (TEE) is now being used as one important point-of-care diagnostic method in emergency rooms, intensive care units and operating rooms. In the first part of this advanced training series, general aspects of the examination method and the procedure as well as indications and contraindications were outlined. In addition, an overview of application areas beyond cardiac surgery in which TEE can be used to monitor the patient or to assist with the operative procedure was provided. In the second part, the main findings during intraoperative TEE in the event of hemodynamic instability or unexplained hypoxemia are presented. A shortened emergency examination as proposed by Reeves et al. is outlined. The article concludes with an outlook on semiautomatic interpretation software and computer-aided image acquisition.

[Intraoperative transesophageal echocardiography as monitoring procedure in noncardiac surgery patients]. / Intraoperative transösophageale Echokardiographie als Monitoring-Verfahren bei nichtkardiochirurgischen Patienten.

Transesophageal echocardiography (TEE) is firmly established in cardiac surgery for diagnostics, hemodynamic monitoring and as a guiding tool. Dynamic and (patho)physiological processes of the heart can be immediately depicted. Ideally, therapeutic changes can be derived. For this reason, TEE is increasingly used in high-risk non-cardiac surgery interventions and in the interventional setting. In the first part of this advanced training series, general aspects regarding TEE examinations as well as indications and contraindications are presented. Clinical fields of application, where TEE can play a role in hemodynamic monitoring are outlined. The second part focusses on an emergency examination pathway and differential diagnoses, which can be made in the event of intraoperative hemodynamic instability or unexplained hypoxemia using TEE. The article concludes with an outlook on the use of computer-aided evaluation of TEE images.

[Near-infrared spectroscopy : Technique, development, current use and perspectives]. / Nahinfrarotspektroskopie : Technik, Entwicklung, aktueller Einsatz und Ausblick.

Near-infrared spectroscopy (NIRS) has been available in research and clinical practice for more than four decades. Recently, there have been numerous publications and substantial developments in the field. This article describes the clinical application of NIRS in relation to current guidelines, with a focus on pediatric and cardiac anesthesia. It discusses technical and physiological principles, pitfalls in clinical use and presents (patho)physiological influencing factors and derived variables, such as fractional oxygen extraction (FOE) and the cerebral oxygen index (COx). Recommendations for the interpretation of NIRS values in connection with influencing factors, such as oxygen transport capacity, gas exchange and circulation as well as an algorithm for cardiac anesthesia are presented. Limitations of the method and the lack of comparability of values from different devices as well as generally accepted standard values are explained. Technical differences and advantages compared to pulse oxymetry and transcranial Doppler sonography are illuminated. Finally, the prognostic significance and requirements for future clinical studies are discussed.

[Treatment of diabetes mellitus in perioperative medicine-an update]. / Therapie des Diabetes mellitus in der perioperativen Medizin ­ ein Update.

Patients with diabetes who undergo a surgical intervention have an increased risk of metabolic derailment, anesthesiological complications, postoperative infections and cardiovascular events. The treatment of diabetes mellitus is subject to a continuous further development due to pharmaceutical and technical innovations. This article presents the implications of the current concepts of diabetes treatment for perioperative medicine, particularly the changes due to new oral antidiabetic agents and insulin pump treatment. Some of the currently available guidelines are discussed with respect to the care of diabetes patients in childhood and adulthood in connection with an operation. Finally, possible perspectives in the field of monitoring and treatment of diabetes patients are discussed.

Confinement and inhomogeneous broadening effects in the quantum oscillatory magnetization of quantum dot ensembles.

We report on the magnetization of ensembles of etched quantum dots with a lateral diameter of 460 nm, which we prepared from InGaAs/InP heterostructures. The quantum dots exhibit 1/B-periodic de-Haas-van-Alphen-type oscillations in the magnetization M(B) for external magnetic fields B > 2 T, measured by torque magnetometry at 0.3 K. We compare the experimental data to model calculations assuming different confinement potentials and including ensemble broadening effects. The comparison shows that a hard wall potential with an edge depletion width of 100 nm explains the magnetic behavior. Beating patterns induced by Rashba spin-orbit interaction (SOI) as measured in unpatterned and nanopatterned InGaAs/InP heterostructures are not observed for the quantum dots. From our model we predict that signatures of SOI in the magnetization could be observed in larger dots in tilted magnetic fields.

Interruption of classic CD40L-CD40 signalling but not of the novel CD40L-Mac-1 interaction limits arterial neointima formation in mice.

The co-stimulatory immune molecule CD40L figures prominently in a variety of inflammatory conditions including arterial disease. Recently, we made the surprising finding that CD40L mediates atherogenesis independently of its classic receptor CD40 via a novel interaction with the leukocyte integrin Mac-1. Here, we hypothesised that selective blockade of the CD40L-Mac-1 interaction may also retard restenosis. We induced neointima formation in C57/BL6 mice by ligation of the left carotid artery. Mice were randomised to daily intraperitoneal injections of either cM7, a small peptide selectively inhibiting the CD40L-Mac-1 interaction, scM7, a scrambled control peptide, or saline for 28 days. Interestingly, cM7-treated mice developed neointima of similar size compared with mice receiving the control peptide or saline as assessed by computer-assisted analysis of histological cross sections. These data demonstrate that the CD40L-Mac-1 interaction is not required for the development of restenosis. In contrast, CD40-deficient mice subjected to carotid ligation in parallel, developed significantly reduced neointimal lesions compared with respective wild-type controls (2872 ± 843 µm² vs 35469 ± 11870 µm²). Flow cytometry in CD40-deficient mice revealed reduced formation of platelet-granulocyte and platelet-inflammatory monocyte- aggregates. In vitro, supernatants of CD40-deficient platelet-leukocyte aggregates attenuated proliferation and increased apoptosis of smooth muscle cells. Unlike in the setting of atherosclerosis, CD40L mediates neointima formation via its classic receptor CD40 rather than via its recently described novel interaction with Mac-1. Therefore, selective targeting of CD40L-Mac-1 binding does not appear to be a favorable strategy to fight restenosis.

[Clinically controlled study of success of lateral and thermo-mechanical Gutta-percha condensation]. / Klinisch kontrollierte Studie zur Erfolgsbewertung der lateralen und thermomechanischen Guttaperchakondensation.

76 root canal treated teeth were followed up within 2 years after treatment with the help of the periapical index PAI and the root canal filling index WKF-I. The root canals were obturated with gutta-percha and Sealer according to lateral or thermom chanical condensation. Treatment was successful in 26 of the lateral condensated and in 25 of the thermomechanical condensated cases. The thermomechanical condensation method represents an alternative method for filling root canals for those endodontists who are well practiced in this method and ensures a high success rate at exact indication positions. Intense practice on extracted teeth prior to clinical application is a strong prerequisite. The lateal condensation method is the root canal filling technique of choice for the general dental practice.