A promising approach in laser vitrectomy executed by plasma-mediated removal of vitreous body via a diode-pumped Q-switched Nd:YAG laser.

To examine the applicability of plasma-mediated vitreous body removal, a diode-pumped Q-switched Neodymium:YAG laser was used for a possible application in eye surgery/vitrectomy. On a total of 1500 porcine vitreous bodies, removal rates were evaluated by comparing different LaserVit-tip designs (Mark I/II Gauge 19 and Mark III Gauge 22). The Nd:YAG laser, operating at a wavelength of 1064 nm and a pulse duration of 4 ns, was utilized for vitreous body removal with respective settings of 2, 3 and 4 mJ and pulse repetition rates (cut rates) from 5 to 25 Hz (300-1500 /min) in 5 Hz-steps as well as for 100 Hz (6000 cuts/min). The exposure times were selected at 10, 20, 40 and 60 s, respectively. Comparative measurements were carried out with mechanical cutters (Gauge 20 and Gauge 23), applying a fixed cut rate of 800 /min (13.33 Hz) at identical exposure times. The LaserVit-tips showed successful vitreous body removal for all laser settings and exposure times (Mark I: 6.2 g/min, Mark II: 8.2 g/min at 1500 cuts/min and 3 mJ, Mark II: 10.1 g/min, Mark III: 3.6 g/min at 6000 cuts/min at 3 mJ). Similar tip-dimensions (Gauge 22laser and Gauge 23cutter) showed comparable removal rates of 3.6 g/minlaser and 1.3 g/mincutter with settings of 6000 cuts/min at 3 mJ (laser) and 800 cuts/min for the mechanical cutter. A diode-pumped Q-switched Nd:YAG laser can successfully and gently remove vitreous body. The efficiency of the laser was comparable to that of mechanical cutters in terms of quantity of material removed per time unit.

The Taussig-Bing anomaly: long-term results.

OBJECTIVES: The arterial switch operation (ASO) is the method of choice for the Taussig-Bing heart. The aim of the study was to analyse the long-term outcome of correction of the Taussig-Bing heart. METHODS: Between 1986 and 2011, 44 infants, including 18 newborns, underwent an ASO. The staged and the primary approach were used in 9 and 35 patients, respectively. Aortic arch (AA) obstruction (n = 26) and right ventricle outflow tract obstruction (n = 34) were common. The mean age at corrective surgery was 112.9 days; the mean weight was 4.17 kg. RESULTS: There were 1 early and 4 late deaths. Overall survival was 88% at 15 years, with a mean follow-up of 9.2 years. Freedom from reoperation was 67% at 15 years of follow-up. Eight and 6 patients required right and left ventricular outflow tract surgery, respectively, including resection of the right ventricular outflow tract obstruction (n = 8), a transanular patch (n = 6), aortic valve reconstruction (n = 3), aortic valve replacement (n = 2) and AA reoperation (n = 4). Freedom from aortic regurgitation >mild or aortic valve replacement/reconstruction was 76% at 15 years of follow-up. Freedom from any event was 56% at 15 years of follow-up. All patients are in sinus rhythm, and biventricular function is well-preserved in 95% of patients. All patients are doing well; 86% of them are without medication. CONCLUSIONS: Corrective surgery offers excellent survival benefits and encouraging long-term functional outcomes, regardless of the coronary anatomy and associated lesions. Normal biventricular function is preserved in the vast majority of patients, and >3/4 of patients are without cardiac medication. Nevertheless, TBH associated with a complex anatomy continues to be a risk factor for long-term morbidity, and redos and reinterventions are equally common on both outflow tracts. Progressive neoaortic regurgitation and neoaortic root dilatation might be a problem in the future; therefore, close lifelong surveillance of patients is necessary.

Cisternal segments of the glossopharyngeal, vagus, and accessory nerves: detailed magnetic resonance imaging-demonstrated anatomy and neurovascular relationships.

OBJECT: The aim of this study was to determine whether high-resolution MR imaging is suitable for identifying and differentiating among the nerve root bundles of the glossopharyngeal (cranial nerve [CN] IX), vagus (CN X), and accessory nerves (CN XI) as well as any adjacent vessels. METHODS: Twenty-five patients (50 sides) underwent MR imaging using the 3D constructive interference in steady-state (CISS) sequence, as well as noncontrast and contrast-enhanced 3D time-of-flight (TOF) MR angiography. Two individuals scored these studies by consensus to determine how well these sequences displayed the neurovascular contacts and nerve root bundles of CNs IX and X and the cranial and spinal roots of CN XI. Landmarks useful for identifying each lower CN were specifically sought. RESULTS: The 3D CISS sequence successfully depicted CNs IX and X in 100% of the sides. Nerve root bundles of the cranial segment of CN XI were identified in 88% of the sides and those of the spinal segment of CN XI were noted in 93% of the sides. Landmarks useful in identifying the lower CNs included the vagal trigone, the choroid plexus of the lateral recess, the glossopharyngeal and vagal meatus, the inferior petrosal sinus, and the vertebral artery. The combined use of 3D CISS and 3D TOF sequences demonstrated neurovascular contacts at the nerve root entry or exit zones in 19% of all nerves visualized. CONCLUSIONS: The combined use of 3D CISS MR imaging and 3D TOF MR angiography (with or without contrast) successfully displays the detailed anatomy of the lower CNs and adjacent structures in vivo. These imaging sequences have the potential to aid the preoperative diagnosis of and the presurgical planning for pathology in this anatomical area.

Circulatory soluble endoglin and its predictive value for preeclampsia in second-trimester pregnancies with abnormal uterine perfusion.

OBJECTIVE: Soluble endoglin (sEng) is increased dramatically in preeclampsia and acts synergistically with soluble fms-like tyrosine kinase 1 (sFlt1) to promote the preeclamptic phenotype. The aim of this study was to investigate whether the sEng increase was present already in second-trimester pregnancies with abnormal uterine perfusion and whether the pregnancy was at risk for preeclampsia. STUDY DESIGN: This prospective study includes 77 second-trimester pregnant women with abnormal uterine perfusion. sEng and sFlt1 were measured with an enzyme-linked immunosorbent assay. RESULTS: Adverse pregnancy outcome was associated with higher sEng levels in the second trimester. SEng was highest in those pregnancies with early-onset preeclampsia. Combined analysis of sEng and sFlt1 is able to predict early-onset preeclampsia with a sensitivity of 100% and a specificity of 93.3%. CONCLUSION: Elevated sEng levels are detectable in second-trimester pregnancies with abnormal uterine perfusion and subsequent pregnancy complications. The concurrent measurement of uterine perfusion and angiogenic factors allows a highly efficient prediction of early-onset preeclampsia.

Cranial MRI of small rodents using a clinical MR scanner.

Increasing numbers of small animal models are in use in the field of neuroscience research. Magnetic resonance imaging (MRI) provides an excellent method for non-invasive imaging of the brain. Using three-dimensional (3D) MR sequences allows lesion volumetry, e.g. for the quantification of tumor size. Specialized small-bore animal MRI scanners are available for high-resolution MRI of small rodents' brain, but major drawbacks of this dedicated equipment are its high costs and thus its limited availability. Therefore, more and more research groups use clinical MR scanners for imaging small animal models. But to achieve a reasonable spatial resolution at an acceptable signal-to-noise ratio with these scanners, some requirements concerning sequence parameters have to be matched. Thus, the aim of this paper was to present in detail a method how to perform MRI of small rodents brain using a standard clinical 1.5 T scanner and clinically available radio frequency coils to keep material costs low and to circumvent the development of custom-made coils.