Radiation furnace for synchrotron dark-field x-ray microscopy experiments.

We present a multi-purpose radiation furnace designed for x-ray experiments at synchrotrons. The furnace is optimized specifically for dark-field x-ray microscopy (DFXM) of crystalline materials at beamline ID06 of the European Synchrotron Radiation Facility. The furnace can reach temperatures above 1200 °C with a thermal stability better than 10 °C, with heating and cooling rates up to 30 K/s. The non-contact heating design enables samples to be heated either in air or in a controlled atmosphere contained within a capillary tube. The temperature was calibrated via the thermal expansion of an α-iron grain. Temperature profiles in the y and z axes were measured by scanning a thermocouple through the focal spot of the radiation furnace. In the current configuration of the beamline, this furnace can be used for DFXM, near-field x-ray topography, bright-field x-ray nanotomography, high-resolution reciprocal space mapping, and limited powder diffraction experiments. As a first application, we present a DFXM case study on isothermal heating of a commercially pure single crystal of aluminum.

[How safe is sedation in gastrointestinal endoscopy? A multicentre analysis of 388,404 endoscopies and analysis of data from prospective registries of complications managed by members of the Working Group of Leading Hospital Gastroenterologists (ALGK)]. / Wie sicher ist die Sedierung in der gastrointestinalen Endoskopie? Eine multizentrische Auswertung von 388 404 Endoskopien und Auswertung der Daten aus prospektiv geführten Komplikationsregistern von Mitgliedern der Arbeitsgemeinschaft leitender Gastroenterologen im Krankenhaus (ALGK).

BACKGROUND: Gastrointestinal endoscopies are increasingly being carried out with sedation. All of the drugs used for sedation are associated with a certain risk of complications. Data currently available on sedation-associated morbidity and mortality rates are limited and in most cases have substantial methodological limitations. The aim of this study was to record severe sedation-associated complications in a large number of gastrointestinal endoscopies. METHODS: Data on severe sedation-associated complications were collected on a multicentre basis from prospectively recorded registries of complications in the participating hospitals (median documentation period 27 months, range 9 - 129 months). RESULTS: Data for 388,404 endoscopies from 15 departments were included in the study. Severe sedation-associated complications occurred in 57 patients (0.01 %). Forty-one percent of the complications and 50 % of all complications with a fatal outcome (10/20 patients) occurred during emergency endoscopies. In addition, it was found that 95 % of the complications and 100 % of all fatal complications affected patients in ASA class ≥ 3. CONCLUSIONS: Including nearly 400,000 endoscopies, this study represents the largest prospective, multicenter record of the complications of sedation worldwide. The analysis shows that sedation is carried out safely in gastrointestinal endoscopy. The morbidity and mortality rates are much lower than previously reported in the literature in similar groups of patients. Risk factors for the occurrence of serious complications include emergency examinations and patients in ASA class ≥ 3.

[Patterns of injury in a combat environment. 2007 update]. / Kriegschirurgische Verletzungsmuster. UPDATE 2007.

BACKGROUND: Epidemiological analysis of injury patterns and mechanisms help in identifying the expertise that military surgeons need in a combat setting and also in adjusting training requirements accordingly. This paper attempts to assess the surgical specialties and skills of particular importance in the management of casualties in crisis areas. METHODS: MEDLINE (1949-2007) and Google search were used. Causes of death among casualties in Afghanistan and the Iraq war were analyzed. RESULTS: The leading causes of injury were explosive devices, gunshot wounds, aircraft crashes, and terrorist attacks. Of the casualties, 55% died in hostile action and 45% in nonhostile incidents. Chest or abdominal injuries (40%) and brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq was approximately half as high as in the Vietnam War. In contrast, the amputation rate was twice as high. Approximately 8-15% of the deaths appeared to be preventable. CONCLUSIONS: Military surgeons must have excellent skills in the fields of thoracic, visceral, and vascular surgery as well as practical skills in neurosurgery and oral and maxillofacial surgery. It also is of vital importance to ensure the availability of sufficient medical evacuation capabilities. Furthermore, there is a need for a standardized registration system for all injuries similar to the German Trauma Registry.

New cryogenic environment for beamline ID22 at the European Synchrotron Radiation Facility.

A compact minicryostat has been well adapted on the hard x-ray microprobe ID22 of the European Synchrotron Radiation Facility. For variable low-temperature investigations, its special technical design provides precise scanning microscopy and allows easy access for multiple detection modes. Based on x-ray excited optical luminescence technique on the micrometer scale, details of the equipment, its temperature calibration, and typical results are described. Data collections from InAs quantum heterostructures support the excellent thermal performance of the novel cryogenic device.

Managing trauma patients with abdominal compartment syndrome.

ACS is due to a rapid increase in intra-abdominal pressure. Although ACS may occur in both surgical and nonsurgical patients, patients who have abdominal or pelvic trauma and/or require massive fluid replacement are at increased risk. Critical care nurses are in a unique position to recognize early signs and symptoms of increased intra-abdominal pressure to ensure timely intervention. Aggressive hemodynamic, pulmonary, and operative management is essential for the optimal outcome of patients with ACS. Without definitive treatment, multisystem organ dysfunction and death ultimately ensue.

[Military surgery: an additional "emphasis" in surgery?]. / Einsatzchirurgie: Ein zusätzlicher "Schwerpunkt" in der Chirurgie?

The German armed forces and the civilian help organisations need competent and well-trained general surgeons to deal with the specific problems of war or other casualties. This is in contrast to the modern training modalities which are going into extreme specialisation. The term "mission surgery" comprises a very specific training for surgeons under the adverse conditions of war or catastrophe. It is not intended to create a new subset within the different surgical specialties, but to elucidate the skills which are needed for mission surgery. To achieve these objectives, the young surgeon should undergo basic training with a broad clinical spectrum. It is recommended that the requirements of trauma or orthopedic surgery should be fulfilled.

[Functional outcome of Eden-Hybinette-Lange operation in post-traumatic recurrent shoulder dislocation]. / Funktionelle Ergebnisse nach Eden-Hybinette-Lange-Operation bei posttraumatisch rezidivierender Schulterluxation.

OBJECTIVE: Post-traumatic recurrent dislocation is a major problem in the operative treatment of shoulder dysfunction in young athletes. This prospectively designed study evaluates the long-term results of a modified Eden-Hybinette procedure in young male athletes. The criteria were: capacity in sports, functional limit, and persistent pain. Genuine disorders of the glenoid or muscular imbalance of the shoulder joint were criteria for exclusion. PATIENTS AND METHODS: From 1982 to 1990, 143 patients underwent surgery. Seventy percent were reevaluated within a minimum period of 18 months after the operation. The functional results were calculated using the ROWE score as well as a visual analog scale (VAS). X-rays were done after the patient had given informed consent. RESULTS: VAS and ROWE score showed excellent/good results in 61%, fair results in 18%, and poor results in 21% of the documented cases. The rate of arthrosis was 25%. Redislocation occurred in 7%, mainly without any relevant trauma. The X-rays showed complete resorption of the bone graft in 30% of the cases. Best functional results and no redislocation were found in the patients who underwent surgery with fewer than 3 dislocations compared to those with more than 4 dislocation episodes. CONCLUSIONS: In cases of post-traumatic recurrent dislocation of the shoulder in young athletes, the modified Eden-Hybinette procedure is a good method of reestablishing sufficient stability of the shoulder. The operation should be performed prior to the 3rd dislocation episode. Four or more dislocation episodes show an increased tendency to redislocate and poor functional results.

[The use of bioresorbable implants (Biofix) in surgery. The indications, technic and initial clinical results]. / Die Verwendung bioresorbierbarer Implantate (Biofix) in der Chirurgie. Indikation, Technik, erste klinische Ergebnisse.

Carrying out osteosyntheses with absorbable implants is a dream cherished by traumatologists for a long time. The absorbable rods available on the medical market comply within narrow ranges with the necessary conditions with regard to stability, absorption time and biocompatibility. In our clinical department 38 osteosyntheses with Biofix rods were performed. The complication rate amounted to 13%-5 abacterial disturbances of wound healing and secretions. The indications assured so far are limited to refixation of chondral and osteochondral fragments as well as the fixation of cortical-cancellous bone grafts.

[Surgical treatment of distal fractures of the radius (author's transl)]. / Operative Behandlung distaler Radiusfrakturen.

We report 25 follow-up-examinations of 26 patients with operated fractures of the distal radius. After explanation of the op. indications by means of the preoperative x-ray-result the used operation-procedures and results are shown with regard to exact x-ray-anatomic position and function. Instable osteosynthesis should only be used in cases without violation of the joint or in cases with only 2-3 fragments. Decisive advantages of a single procedure of stable osteosynthesis cannot yet be demonstrated. But the relatively good functional results and the possibility of early mobilisation of T-plate-osteosynthesis justify a wider application, even if exact roentgenological anatomic position could not always be achieved. In conclusion operative procedures should be taken only in irreducible and prognostic disadvantageous fractures of the distal radius because even by operative procedures the late results of severe injuries of the wrist joint can only be slightly improved.