Brain monoamine levels and behaviour of young and adult chickens genetically selected on feather pecking.

Severe feather pecking (SFP) in chickens is a detrimental behaviour with possibly neurochemical deficits at its base. Recent neurological studies depicted conflicting results on the role of serotonin (5-hydroxytryptamine, 5-HT) and dopamine (DA) in the development and display of feather pecking. We studied brain monoamine levels and behaviour in domestic chickens divergently genetically selected on feather pecking behaviour, the Low Feather Pecking (LFP) and High Feather Pecking (HFP) lines, both at a young age and when adult, to elucidate the role of 5-HT and DA in feather pecking. Also pecking behaviour and the behavioural response to challenging test situations was determined. At 8 weeks of age, HFP had lower 5-HT and DA turnover in several brain areas than LFP, whereas these differences had disappeared or were even reversed at 25 weeks of age. Line differences in central monoamine activity were found both in emotion-regulating and motor-regulating areas. As expected from previous generations, HFP exceeded LFP in most types of pecking at other birds, including severe feather pecking. Furthermore, HFP responded more actively in most behavioural tests conducted, and seem more impulsive or (hyper)active in their way of coping with challenges. This paper shows different developmental trajectories of the neurochemical systems (5-HT and DA) for chickens divergently selected on feather pecking behaviour, and a remarkable reversion of differences in monoamine activity at a later stage of life. Whether this is a cause or consequence of SFP needs further investigation.

Irreversible electron attachment--a key to DNA damage by solvated electrons in aqueous solution.

The TYT and TXT trimeric oligonucleotides, where X stands for a native nucleobase, T (thymine), C (cytosine), A (adenine), or G (guanine), and Y indicates a brominated analogue of the former, were irradiated with ionizing radiation generated by a (60)Co source in aqueous solutions containing Tris as a hydroxyl radical scavenger. In the past, these oligomers were bombarded with low energy electrons under an ultra-high vacuum and significant damage to TXT trimers was observed. However, in aqueous solution, hydrated electrons do not produce serious damage to TXT trimers although the employed radiation dose exceeded many times the doses used in radiotherapy. Thus, our studies demonstrate unequivocally that hydrated electrons, which are the major form of electrons generated during radiotherapy, are a negligible factor in damage to native DNA. It was also demonstrated that all the studied brominated nucleobases have a potential to sensitize DNA under hypoxic conditions. Strand breaks, abasic sites and the products of hydroxyl radical attachment to nucleobases have been identified by HPLC and LC-MS methods. Although all the bromonucleobases lead to DNA damage under the experimental conditions of the present work, bromopyrimidines seem to be the radiosensitizers of choice since they lead to more strand breaks than bromopurines.

Murine solid tumours as a novel model to study bacterial biofilm formation in vivo.

Bacteria of many species are able to invade and colonize solid tumours in mice. We have focused on Salmonella enterica serovar Typhimurium. Detailed analysis revealed that such tumour-invading Salmonella form biofilms, thus providing a versatile in vivo test system for studying bacterial phenotypes and host-pathogen interactions. It appears that biofilm formation by S. typhimurium is induced as a defence against the immune system of the host, and in particular against neutrophils. Further, we extended our work to the clinically more relevant biofilm infection by Pseudomonas aeruginosa. The induction of P. aeruginosa biofilms in neoplastic tissue appears to be elicited as a reaction against the immune system. Reconstitution experiments reveal that T cells are responsible for biofilm induction. Isogenic mutants that are no longer able to form biofilms can be used for comparison studies to determine antimicrobial resistance, especially therapeutic efficacy against P. aeruginosa located in biofilms.

CRF1 receptor antagonists do not reverse pharmacological disruption of prepulse inhibition in rodents.

RATIONALE: As enhanced corticotropin-releasing factor (CRF) transmission is associated with induction of sensorimotor gating deficits, CRF1 receptor antagonists may reverse disrupted prepulse inhibition (PPI), an operational measure of sensorimotor gating. OBJECTIVES: To determine the effects of CRF1 receptor antagonists in pharmacological models of disrupted PPI and to determine if long-term elevated central CRF levels alter sensitivity towards PPI disrupting drugs. METHODS: CP154,526 (10-40 mg/kg), SSR125543 (3-30 mg/kg) and DMP695 (40 mg/kg) were tested on PPI disruption provoked by D-amphetamine (2.5, 3 mg/kg), ketamine (5, 30 mg/kg) and MK801 (0.2, 0.5 mg/kg) in Wistar rats, C57Bl/6J and CD1 mice, and on spontaneously low PPI in Iffa Credo rats and DBA/2J mice. PPI-disrupting effects of D-amphetamine (2.5-5 mg/kg) and MK801 (0.3-1 mg/kg) were examined in CRF-overexpressing (CRFtg) mice, which display PPI deficits. Finally, we determined the influence of CP154,526 on D-amphetamine-induced dopamine outflow in nucleus accumbens and prefrontal cortex of CRFtg mice using in vivo microdialysis. RESULTS: No CRF1-antagonists improved PPI deficits in any test. CRFtg mice showed blunted PPI disruption in response to MK801, but not D-amphetamine. Further, D-amphetamine-induced dopamine release was less pronounced in CRFtg versus wild-type mice, a response normalized by pretreatment with CP154,526. CONCLUSION: The inability of CRF1 receptor antagonists to block pharmacological disruption of sensorimotor gating suggests that the involvement of CRF1 receptors in the modulation of dopaminergic and glutamatergic neurotransmission relevant for sensory gating is limited. Furthermore, the alterations observed in CRFtg mice support the notion that long-term elevated central CRF levels induce changes in these neurotransmitter systems.

[Differential diagnosis and treatment of cramps]. / Differenzialdiagnose und Therapie von Muskelkrämpfen (Crampi).

Cramps are painful sensations caused by intense involuntary contractions of skeletal muscles, mostly in the calves, usually lasting from a few seconds to several minutes. Although cramps are mostly idiopathic, theycan bea symptom of other forms of myalgia, restless legs syndrome or spasticity. Especially nocturnal cramps can cause considerable distress for patients requiring fast pain reduction and effective prophylaxis. Stretching the calf muscles helps preventing nocturnal cramps. Pharmacological treatment of leg cramps includes magnesium and quinine.

The potential and limitations of DOV 216,303 as a triple reuptake inhibitor for the treatment of major depression: a microdialysis study in olfactory bulbectomized rats.

DOV 216,303 belongs to a new class of antidepressants, the triple reuptake inhibitors (TRIs), that blocks serotonin, norepinephrine and dopamine transporters and thereby increases extracellular brain monoamine concentrations. The aim of the present study was to measure extracellular monoamine concentrations both in the prefrontal cortex (PFC) and dorsal hippocampus (DH) after chronic administration of DOV 216,303 in the OBX animal model of depression and to compare the effects with acute drug treatment. OBX animals showed lower dopamine levels in PFC upon acute administration of DOV 216,303 than sham animals for up to five weeks after surgery. No such changes were observed in the DH. Unexpectedly, a DOV 216,303 challenge in chronic DOV 216,303 treated sham animals resulted in a blunted dopamine response in the PFC compared to the same challenge in vehicle treated animals. This blunted response probably reflects pharmacokinetic adaptations and/or pharmacodynamic changes, since brain and plasma concentrations of DOV 216,303 were significantly lower after chronic administration compared to acute administration. Surprisingly, and in contrast what we have reported earlier, chronic DOV 216,303 treatment was unable to normalize the hyperactivity of the OBX animals. Interestingly, by measuring the drug plasma and brain levels, it was demonstrated that at the time of behavioral testing (24 h after last drug treatment) DOV 216,303 was not present anymore in either plasma or brain. This seems to indicate that this putative antidepressant drug has no lasting antidepressant-like behavioral effects in the absence of the drug in the brain.

Local repeated corticotropin-releasing factor infusion exacerbates anxiety- and fear-related behavior: differential involvement of the basolateral amygdala and medial prefrontal cortex.

Increased central corticotropin-releasing factor (CRF) signaling has been associated with various psychiatric symptoms, including anxiety, depression and psychosis. CRF signaling in both the basolateral amygdala (BLA) and medial prefrontal cortex (mPFC) has been implicated in anxiety-like behavior. In addition, repeated activation of CRF receptors within the BLA induces a chronic anxious state. Here we studied the effects of local repeated CRF infusion in the BLA and mPFC on different forms of anxiety, as assessed during light-enhanced startle (LES, general anxiety) and acquisition of fear-potentiated startle (FPS, cue-conditioned fear). In addition, as CRF has been implicated in sensorimotor gating, prepulse inhibition (PPI) was assessed to determine if local CRF infusion within the BLA or mPFC would interfere with the processing of sensory information. To this end, canulas were placed bilaterally in either the BLA or mPFC of Wistar rats. After recovery, animals were infused with h/rCRF (200 ng/side) or vehicle for five consecutive days. Long term effects of local CRF infusion on LES and acquisition of FPS were measured 4 and 10 days post-treatment, respectively. In addition, the acute (day 1), sub-chronic (day 5) and long-term (7 days post treatment) effects on PPI were measured in the same animals. A clear regional differentiation was found on the long lasting effect of CRF on anxiety-like behavior: infusion into the BLA only enhanced acquisition of FPS, whereas infusion into the mPFC only enhanced LES. Sub-chronic CRF infusion into the BLA, but not the mPFC, disrupted PPI. This disturbed PPI was normalized 7 days post-treatment. Together, the current study shows that local repeated CRF receptor activation in the BLA and mPFC is differentially involved in anxiety- and fear-related behavior. In addition, the BLA may be involved in CRF-induced sensorimotor gating deficits. The absence of a long-term effect on these PPI deficits suggests that lasting activation of CRF receptors is a prerequisite for CRF-mediated effects on sensorimotor gating. The long-term effects of repeated CRF infusion on LES and acquisition of FPS on the other hand, show that in case of anxiety-related processes repeated CRF infusion may have lasting effects.

Cutaneous human papillomavirus E7 type-specific effects on differentiation and proliferation of organotypic skin cultures.

BACKGROUND: A role for cutaneous human beta-papillomavirus (HPV) types as co-factors in the development of non-melanoma skin cancer has been postulated. Here we have investigated the effects of E7 expression on keratinocyte differentiation, proliferation and cell-cycle proteins in organotypic skin cultures. METHODS: Recombinant retroviruses containing the E7 genes from cutaneous HPV types 1, 4, 5, 8, 20, 38 and RTRX7 were produced that include types associated with benign and malignant lesions. Adult human primary keratinocytes were transduced with these recombinant retroviruses and differentiated into skin-equivalents using de-epidermalised human dermis. RESULTS: Expression patterns of the basal keratinocyte marker cytokeratin 14 (CK14) were not altered by any of the viral E7 types analysed. However, expression of the early and late differentiation markers CK10 and involucrin were markedly altered in HPV 1, 4 and 38 cultures. The highest proliferation rates in basal cell layers, as judged by BrdU and Ki67 staining, were observed in HPV 1, 4 and 38 cultures. Interestingly, co-expression of cyclin E and p16(INK4a) within the same cell of the suprabasal cell layers was observed only in cultures generated using E7 of HPV 5 or HPV 8. CONCLUSION: HPV types associated with either benign or malignant lesions perturb keratinocyte proliferation and differentiation in different ways. Moreover, expression of E7 from HPV 5 or HPV 8 seem able to overcome p16(INK4a) induced cell cycle arrest in a subset of keratinocytes.

Olfactory bulbectomy induces rapid and stable changes in basal and stress-induced locomotor activity, heart rate and body temperature responses in the home cage.

BACKGROUND: Olfactory bulbectomy (OBX) in rats causes several behavioral and neurochemical changes. However, the extent and onset of physiological and behavioral changes induced after bulbectomy have been little examined. METHODS: Male Sprague-Dawley rats received telemetric implants. Before and immediately after OBX surgery, basal and stress-induced heart rate, body temperature, and locomotor activity were measured in the home cage in sham (n=9) and OBX animals (n=11). Stress was induced using novel cage stress or witness stress. RESULTS: Bulbectomized animals differed physiologically and behaviorally from shams. Nocturnally, OBX animals were significantly more active compared with shams, had a higher core body temperature and displayed a decreased heart rate variability. During the light period, OBX animals had a significantly lower basal heart rate and a reduced heart rate variability. These effects became apparent 2-3 days after OBX surgery, and were stable over time. After witness stress, OBX animals showed smaller autonomic (body temperature and heart rate) responses compared with shams, but showed no difference in locomotor responses. In contrast, novel cage stress led to increased locomotor responses in OBX rats compared with sham rats, while no differences were found in autonomic responses. CONCLUSION: Removal of the olfactory bulbs results in rapid, stable and persistent changes in basal locomotor activity, body temperature, heart rate and heart rate variability. Although the sleep-wake cycle of these parameters is not altered, increases in circadian amplitude are apparent within 3 days after surgery. This indicates that physiological changes in the OBX rat are the immediate result of olfactory bulb removal. Further, stress responsivity in OBX rats depends on stressor intensity. Bulbectomized rats display smaller temperature and heart rate responses to less intense witness stress compared with sham rats. Increased locomotor responses to more intense novel cage stress are present in the home cage as well as the open field. The present study shows that olfactory bulbectomy has rapid and persistent influence on basal and stress-induced physiological parameters.

[The functional sport shoe parameter "torsion" within running shoe research--a literature review]. / Der funktionelle Sportschuhparameter "Torsion" in der Laufschuhforschung - ein Literaturüberblick.

Within the sport shoe area torsion is described as the twisting and decoupling of the rear-, mid- and forefoot along the longitudinal axis of the foot. Studies have shown that running shoes restrict the torsion of the foot and thus they increase the pronation of the foot. Based on the findings, it is recommended to design running shoes, which allow the natural freedom of movement of the foot. The market introduction of the first torsion concept through adidas(R) took place in 1989. Independently of the first market introduction, only one epidemiological study was conducted in the running shoe area. The study should investigate the occurrence of Achilles tendon problems of the athletes running in the new "adidas Torsion(R) shoes". However, further studies quantifying the optimal region of torsionability concerning the reduction of injury incidence are still missing. Newer studies reveal that the criterion torsion only plays a secondary roll regarding the buying decision. Moreover, athletes are not able to perceive torsionability as a discrete functional parameter. It is to register, that several workgroups are dealing intensively with the detailed analysis of the foot movement based on kinematic multi-segment-models. However, scientific as well as popular scientific contributions display that the original idea of the torsion concept is still not completely understood. Hence, the "inverse" characteristic is postulated. The present literature review leads to the deduction that the functional characteristics of the torsion concept are not fully implemented within the running shoe area. This implies the necessity of scientific studies, which investigate the relevance of a functional torsion concept regarding injury prevention based on basic and applied research. Besides, biomechanical studies should analyse systematically the mechanism and the effects of torsion relevant technologies and systems.

A patient with a "good nose".

We report on a 33-year-old man who underwent an odyssey of doctors for investigation of dysphagia. Eventually, a nasopharyngeal mass was found by several otorhinolaryngologists who repeatedly recommended biopsy or excision, because a polyp or fibroma was assumed on nasal endoscopy and MR imaging. However, we finally diagnosed the nasopharyngeal mass to be an ectopic pituitary gland after thorough clinical (cleft lip and palate) and radiological re-examination. Literally, the patient had a "good nose", since he refused manipulations on the nasopharyngeal tumour and assumably prevented inadvertent hypopituitarism. We conclude that biopsy or excision of nasopharyngeal masses should always be considered carefully, especially in patients with facial anomalies.

Roflumilast, a once-daily oral phosphodiesterase 4 inhibitor, lacks relevant pharmacokinetic interactions with inhaled salbutamol when co-administered in healthy subjects.

OBJECTIVE: Roflumilast is an oral, once-daily phosphodiesterase 4 inhibitor under investigation for the treatment of chronic obstructive pulmonary disease and asthma. In clinical practice, the drug is likely to be co-administered with inhaled bronchodilating beta2-adrenoceptor agonists. Therefore, this study investigated the pharmacokinetic characteristics of roflumilast and its pharmacodynamically active metabolite roflumilast N-oxide when co-administered with orally inhaled salbutamol in healthy subjects. METHODS: In this open, randomized clinical study, 12 healthy male subjects received repeated doses of oral roflumilast 500 microg once daily, orally inhaled salbutamol 200 microg 3 times daily, and a combination of both drugs over 7 days according to a 3-period, changeover design with 14 days washout between treatments. RESULTS: Co-administration of roflumilast and salbutamol did not markedly change roflumilast or roflumilast N-oxide disposition. Point estimates (90% confidence intervals) of area under the curve from 0-24 h (AUC 0-24) and maximum plasma concentration in steady state (Cmax,ss) for roflumilast with salbutamol versus roflumilast alone were 1.05 (0.94, 1.17) and 0.97 (0.84, 1.10); the respective point estimates (90% confidence intervals) for AUC 0-24 and Cmax,ss of roflumilast N-oxide were 0.98 (0.91, 1.06) and 0.98 (0.92, 1.03). Roflumilast co-administration did not alter the pharmacokinetics of steady state salbutamol. The respective point estimates (90% confidence intervals) for AUC 0-6 and Cmax,ss of salbutamol with roflumilast versus salbutamol alone were 1.10 (0.99, 1.21), 1.08 (0.91, 1.28). The combination of both drugs was well tolerated. CONCLUSION: There were no relevant pharmacokinetic interactions between roflumilast and salbutamol at therapeutically effective doses.

[Postoperative occurrence of reversible posterior encephalopathy in a patient with Crohn's disease]. / Postoperativ aufgetretene reversible posteriore Enzephalopathie bei einem Patientin mit Morbus Crohn.

Posterior encephalopathy (PE) is a rare condition with different origins and unknown pathogenesis. We report on a case of a 16-year-old boy with Crohn's disease who developed PE after peridural anesthesia with ropivacain. A possible connection between PE, ropivacain and Crohn's disease is discussed on the basis of the current literature.

Mouse strain differences in autonomic responses to stress.

In humans, anxiety disorders are often accompanied by an overactive autonomic nervous system, reflected in increased body temperature (BT) and heart rate (HR). In rodents, comparable effects are found after exposure to stress. These autonomic parameters can give important information on stress and anxiety responses in mice. In the present experiments, stress reactivity of three frequently used mouse strains [129 Sv/Ev, Swiss Webster (SW) and C57 BL/6] was assessed using their autonomic stress responses. BT, HR and activity were telemetrically measured. Undisturbed circadian rhythms already showed clear differences between the mouse strains. Hereafter, autonomic responses to stressors with increasing intensity were measured. Strain differences were found in magnitude and duration of the stress responses, especially after high-intensity stressors. Generally, C57BL/6 mice showed the largest autonomic response, SW the lowest and the 129Sv/Ev the intermediate response. Interestingly, the observed ranking in autonomic stress response does not match the behavioral stress responsivity of these strains. Finally, sensitivity to the anxiolytic diazepam (0, 1, 2, 4 and 8 mg/kg) was tested using the stress-induced hyperthermia paradigm. Pharmacological sensitivity to diazepam differed between the strains with the 129Sv/Ev being most sensitive. These studies show that simultaneous measurement of behavioral and autonomic parameters under stressful conditions contributes considerably to a better interpretation of anxiety and stress levels in mice.

[Diagnosis of dementia in the doctor's office]. / Einfache Tests erhärten die Diagnose.

Alzheimer's dementia can readily be diagnosed by the general practitioner on the basis of the anamnestic data provided by the patient's relatives and quantified by MMST and DemTect. The diagnosis should be confirmed by a neurologist. EEG and mapping methods reveal slowing of alpha activity, increased theta activity and reduced reactivity reflecting the postulated cholinergic deficit. Toxic effects caused by medication, and the course of the disease can be monitored by means of the EEG. Magnetic resonance tomography and cranial computed tomography are necessary.

Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum.

BACKGROUND: Laparoscopic surgery usually requires the use of a pneumoperitoneum by insufflating gas in the peritoneal space. The gas most commonly used for insufflation is carbon dioxide. Increased intra-abdominal pressure causes cephalad displacement of the diaphragm resulting in compressed lung areas, which leads to formation of atelectasis, especially during mechanical ventilation. The aim of this prospective study was to investigate the effect of prolonged intraperitoneal gas insufflation on arterial oxygenation and hemodynamics during mechanical ventilation with and without positive end-expiratory pressure (PEEP). METHODS: Twenty patients undergoing totally endoscopic robot-assisted radical prostatectomy were randomly allocated to one of two groups. In the PEEP group (n = 10) a constant PEEP of 5 cmH(2)O was used, whereas in the ZPEEP group (n = 10) no PEEP was used. RESULTS: Application of PEEP (5 cmH(2)O) resulted in significantly higher P(a)O(2) levels after 3 h (182 +/- 49 vs. 224 +/- 35 mmHg) and 4 h (179 +/- 48 vs. 229 +/- 29 mmHg) of pneumoperitoneum; after desufflation, P(a)O(2) values decreased significantly below preinsufflation values. While there were no significant differences in heart rate, central venous pressure (CVP) and mean arterial blood pressure (MAP) during pneumoperitoneum between both groups, baseline values in CVP and MAP differed significantly between both groups with higher levels in the ZPEEP group. CONCLUSION: The application of a constant positive airway pressure of 5 cmH(2)O preserves arterial oxygenation during prolonged pneumoperitoneum.

Peri-operative complications during percutaneous tracheostomy in obese patients.

The safety of percutaneous tracheostomy in 73 obese patients (body mass index > or = 27.5 kg.m(-2)) in a cohort of 474 adults was studied. Four percutaneous techniques were employed (percutaneous dilational tracheostomy, n = 48; Ciaglia Blue Rhino, n = 157; guide wire dilating forceps, n = 62, translaryngeal tracheostomy, n = 207). The overall complication rate was 43.8% (n = 32) in the obese group compared to 18.2% (n = 73) in the control group (p < 0.001). Seven (9.6%) obese patients suffered life-threatening complications compared to three non-obese patients (0.7%, p < 0.001). Obese patients had a 2.7-fold increased risk for peri-operative complications, and a 4.9-fold increased risk for serious complications. The data suggest that percutaneous tracheostomy in obese patients is associated with a considerably increased risk for peri-operative complications, especially for serious adverse events.

Routine microbiological screening in septic patients in a cardiac surgical intensive care unit.

INTRODUCTION: Patients in a surgical intensive care unit (ICU) have a high incidence of nosocomial infections which often lead to septic shock and death. Since specific antibiotic treatment is often difficult, it is recommended that routine nose/throat swabs be obtained in order to have a better idea of the causative agent when a systemic inflammatory response occurs in a given patient. MATERIALS AND METHODS: In 1435 patients in a cardiac surgical ICU, routine nose/throat swabs were taken thrice a week and tested for microorganisms and systemic inflammation. Blood cultures were also obtained. Antibiotic treatment was given to cover the microbes from the nose/throat swabs. Alternatively, an empirical antibiotic therapy was given to patients whose swabs had tested negative. RESULTS: Of the 86 patients with systemic inflammation, 29 had blood cultures positive for microbes. Of these, 18 received a specific antibiotic therapy based on their positive nose/throat cultures prior to the return of the blood cultures from the laboratory. However, only 11 patients tested positive for the same microbes on routine swabs and blood cultures. While positive routine swabs are quite specific to sepsis when there is a systemic inflammatory response, routine swabs are not a suitable screening tool due to their low sensitivity. CONCLUSION: Routine nose/throat swabs led to earlier specific antibiotic treatment in only 22 % of patients with clinical signs of systemic inflammation. In 36 % of cases, the organisms detected in the routine swabs and blood cultures were not identical. Hence, we believe that routine swabs are of limited value in instituting earlier, specific antibiotic therapy in septic patients.

Prolonged intraperitoneal versus extraperitoneal insufflation of carbon dioxide in patients undergoing totally endoscopic robot-assisted radical prostatectomy.

BACKGROUND: Extraperitoneal laparoscopic prostatectomy is an alternative to the intraperitoneal method. However, the effects of extraperitoneal carbon dioxide (CO2) insufflation on hemodynamics and respiratory data have not been adequately studied. This study compared the effects of prolonged intra- and extraperitoneal CO2 insufflation on hemodynamics and gas exchange. METHODS: For this study, 20 patients were assigned to receive totally endoscopic robot-assisted radical prostatectomy (TERP) via the intra- or extraperitoneal approach. Hemodynamic parameters and respiratory data were obtained during 8 h of insufflation and analyzed for statistical differences. RESULTS: With both insufflation methods, arterial CO2 pressure increased rapidly, reaching higher levels with extraperitoneal insufflation. Therefore, patients managed with extraperitoneal insufflation required a significantly higher minute ventilation. Heart rate and central venous pressure increased in both groups, whereas mean arterial blood pressure and pH decreased. CONCLUSIONS: Prolonged intra- and extraperitoneal CO2 insufflation for TERP resulted in significant, but mostly clinically unimportant, hemodynamic alterations. Carbon dioxide absorption was more pronounced with extraperitoneal insufflation.

[PercuTwist dilational tracheostomy. Prospective evaluation of 54 consecutive patients]. / PercuTwist-Dilatationstracheotomie. Prospektive Evaluation an 54 konsekutiven Patienten.

BACKGROUND: Percutaneous dilational tracheostomy (PDT) is considered to be an accepted method in intensive care patients. In 2002 Frova and Quintel described a method of dilation that employed controlled rotation of the PercuTwist dilational device. The goal of the present study was to evaluate the new technique employed by an experienced team. PATIENTS AND METHODS: Prospective, observational clinical study in 54 intensive care patients who required PDT. All tracheostomies were accompanied by bronchoscopic control. Vital parameters and perioperative complications were registered. RESULTS: In all 54 consecutive PercuTwist tracheostomies no severe complications were noted. Accidental tracheal ring fracture was noted in 7 patients while bleeding that needed surgical care occurred in 1 patient. CONCLUSION: The PercuTwist tracheostomy is a safe procedure for intensive care patients. More prospective studies that would compare the PercuTwist tracheostomy with the other PDT methods are necessary.