Transcatheter Aortic Valve Replacement Without the Use of Contrast Medium: An Alternative Safe Implantation Technique.

BACKGROUND: New transcatheter equipment and accumulated experience have stimulated further refinements in implantation techniques. We aimed to compare the outcomes of transfemoral transcatheter aortic valve replacement (TF-TAVR) with and without the use of contrast medium (CM) in patients with glomerular filtration rate (GFR) <30 mL/min/1.73 m². METHODS: This single-center, retrospective study included all patients who underwent TF-TAVR procedure with Edwards Sapien balloon-expandable bioprostheses between September 2017 and September 2018 at the Zentralklinik Bad Berka Germany, and compared outcomes of TF-TAVR with and without the use of CM. RESULTS: A total of 98 consecutive patients were included in this study; 25 patients underwent TF-TAVR without the use of CM and 73 patients underwent TF-TAVR with the use of CM. Acute kidney injury was significantly higher in patients who received CM (15 patients [20.5%] in the control group vs 1 patient [4%] in the study group; P=.04). Other procedure-related complications were equally distributed between both groups. CONCLUSION: TF-TAVR without the use of CM can be considered a safe and reproducible alternative technique. Furthermore, it reduced the incidence of postoperative acute kidney injury in patients with GFR <30 mL/min/1.73 m².

Sexual dysfunction after rectal surgery: a retrospective study of men without disease recurrence.

INTRODUCTION: Sexual dysfunction is a frequent complication of visceral surgery after rectal resections as a result of carcinoma of the rectum. AIM: The purpose of our study is to assess the incidence and form of sexual dysfunction in our own population of patients. METHODS: The study comprised all patients who had undergone surgery for carcinoma of the rectum at the Erlangen Surgery University Hospital, Germany, in the period 2000-04. All male patients were retrospectively surveyed and asked to complete standardized (International Index of Erectile Function 15) questionnaires regarding their pre- and postsurgical sexual function. One hundred and forty-five questionnaires could be analyzed. The statistical evaluation was conducted with aid of the SPSS statistics program. The univariate analysis was carried out with the chi-square test and the U-test (Mann-Whitney Test). MAIN OUTCOME MEASURES: Erectile dysfunction, libido, and ability to have and sustain ejaculation and orgasm (both before and after surgery in each case) were among the dependent variables when compiling the data. The impact various surgical procedures and radiochemotherapy had on the severity of the sexual dysfunctions was analyzed. The scope of the postoperative urological care given was also assessed. RESULTS: Erectile dysfunction was confirmed in N=112 patients (77.3%) after surgery (P-value<0.001). Other parameters such as orgasm capacity (4.1% vs. 16.5%), ejaculation ability (1.4% vs. 12.4%) and libido (3.4% vs. 22%) also showed a marked deterioration postoperatively. Postoperative erectile dysfunction was present in 77% of the patients with a colostomy and in 88.5% of the patients who had received neoadjuvant radiation. CONCLUSIONS: Male erectile dysfunction is a frequent complication after rectal resection as a result of carcinoma of the rectum. The high incidence of sexual dysfunctions results from the radical nature of the procedure and from additional radiation or colostomy therapy. These patients need accompanying urological care for treatment of their sexual dysfunction.

Dynamic studies on the mobility of trace elements in soil and sediment samples influenced by dumping of residues of the flood in the Mulde River region in 2002.

In the analysis of soil samples, batch sequential extraction procedures are traditionally used for the fractionation of trace elements to access their mobility and potential risk for the contamination of groundwater. In the present work a continuous-flow technique has been used that enables not only the fast and efficient leaching of trace elements but as well as time-resolved studies on the mobilization of arsenic and selected heavy metals in different forms to be made. Rotating coiled columns (RCC) earlier used mainly in countercurrent chromatography have been successfully applied to the dynamic leaching of heavy metals from soils contaminated by flooding sludge's. The sample was retained in a PTFE rotating column as the stationary phase whereas aqueous solutions were continuously pumped through. The contents of elements were determined by on-line coupling of RCC and inductively coupled plasma atomic emission spectrometry (ICP-AES). This enables real-time data on the leaching process to be obtained. Dynamic and traditional batch procedures were compared. It has been shown that the aqueous elution under centrifugal forced conditions is much more effective for the mobilization of heavy metals. Hence, the dynamic leaching is characterized by a substantially more intensive interaction between solid and water and is besides substantially more time-saving than the conventional batch procedure. The RCC procedure was also employed for preliminary leaching studies with a simulated "acid rain". In comparison with the water leaching, the mobilization of heavy metals and arsenic from soil samples with employment of simulated acid rain as eluent was less effective.