[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.

Uterus unicornis in two mares.

Two American Paint Horses, a 3-year-old nulliparous mare and a 7-year-old primiparous mare, presented for recent infertility and a pre-breeding examination, respectively. Examination of the internal reproductive tract of both mares using transrectal palpation and ultrasonography revealed the presence of the cervix, uterine body, left uterine horn and bilateral ovaries. The right uterine horn could neither be palpated nor imaged. The clinical diagnosis of uterus unicornis in one mare was confirmed at necropsy, which revealed combined aplasia of the right uterine horn and oviduct.

Susceptibility of common voles to experimental toxoplasmosis.

Common voles (Microtus arvalis) in groups of nine to 10 animals were inoculated per os with a dose of 1, 10, 1x10(2), 1x10(3), and of the K1 strain of Toxoplasma gondii. All the common voles inoculated with 1 to 1 x 10(3) oocysts remained subclinical and survived. Three of the 10 voles inoculated with 1 x 10(4) oocysts died between days 7 and 12 post inoculation (p.i.). Antibodies were demonstrated in all the infected voles killed on day 60 p.i. The highest antibody titres in voles detected by the dye test (DT) and latex agglutination test (LAT) were 1,024 and 1,280, respectively.

[Gamma-hydroxybutyric acid-ethanolamide (LK 544). The suitability of LK 544 for sedation of patients in intensive care in comparison with midazolam]. / Gammahydroxybuttersäure-Ethanolamid (LK 544). Die Eignung von LK 544 zur Sedierung von Intensivpatienten im Vergleich mit Midazolam.

OBJECTIVE: In this phase 2 study gammahydroxybutyric acid-ethanolamide (GHB-ethanolamide) was compared with midazolam for sedation of patients in the intensive care unit (ICU). GHB-ethanolamide is a new derivative of gammahydroxybutyric acid, a drug commonly used for sedation in intensive care patients. METHODS: A total of 29 non-intubated, spontaneously breathing patients following major surgery, were randomly assigned to 2 groups: group A (n = 14) received 150 mg/kg GHB-ethanolamide i.v. followed by 150 mg/kg/h. Group B (n = 15) received 0.025 mg/kg midazolam i.v. followed by 0.025 mg/kg/h. The degree of sedation was assessed over a 3-5 h period both clinically by the Ramsay Score and by the spectral frequency index (SFx), derived by continuous computerized EEG recording (CATEEM). RESULTS: EEG: the SFx showed a significantly deeper sedation compared to baseline values, 10, 60 and 120 min after start of sedation in the GHB-ethanolamide group. By contrast, no difference could be observed compared to baseline values in the midazolam group. A comparison between both groups showed a deeper sedation in the GHB group 60 and 120 min after start of sedation. The Ramsay Score increased from baseline values of 2.0 (2.0/2.0) to 3.0 (2.0/3.0) during sedation (Median (25th/75th percentile) and no significant differences could be observed between groups. In the Midazolam group the sedation of two patients had to be terminated because of side effects (Ramsay Score 6 and paradoxical, agitated reaction). CONCLUSIONS: GHB-ethanolamide produces adequate sedation for extubated and spontaneously breathing ICU patients. The drug might be safer than midazolam with regards to side effects such as respiratory depression.

To quantify experience? Methodological issues in the behavioural/psychological treatment of complex partial seizures.

This paper will attempt to identify some of the major methodological hurdles that are present when treating or researching seizure conditions using neurobehavioural approaches. An overview of the unique methodological problems that arise with behavioural/psychological treatments will be discussed. The author will focus on personal experiences with complex and simple partial seizures, looking into some methodological questions that arose after his seizure activity was reduced using a behavioural technique. Several main issues will be examined as they may apply to seizure and personality type, and how they can influence treatment and results. Finally, possible directions toward improving methodology will be suggested.

Fatal toxoplasmosis in brown hares (Lepus europaeus): possible reasons of their high susceptibility to the infection.

Brown hares (Lepus europaeus) trapped in the countryside and domestic rabbits were experimentally infected with Toxoplasma gondii (K7 strain) oocysts. Hares (n=12) were divided into groups of 4 and infected with 10, 10(3) and 10(5) oocysts. Rabbits (n=12) were infected in the same way. The experimentally infected animals were monitored for 33 days after infection (p.i.). Most of the infected hares demonstrated behavioural changes, and all of them died between 8 and 19 days p.i. Three of the rabbits demonstrated only clinical changes related to the concurrent pasteurellosis. The typical pathological finding in the hares were haemorrhagic enteritis, enlargement and hyperaemia of mesenteric lymph nodes, splenomegaly and multiple miliary necrotic lesions in the parenchyma of the liver and other organs. Pathological changes in the rabbits were less pronounced than in the hares. In rabbit brains, tissue cysts of the T. gondii were found. The incidence of T. gondii antibodies both in the hares and the rabbits was first ascertained on day 7 p.i. On day 12 p.i., antibodies were already found in all the animals infected. Antibody titres in indirect fluorescence antibody test (IFAT) using the anti-rabbit conjugate were markedly higher in rabbits than in hares. In all hares, T. gondii was isolated post mortem from the liver, brain, spleen, kidney, lung, heart and skeletal muscles. Although T. gondii was also isolated in all rabbits, it was not always isolated in all their organs. In all hares, parasitemia was demonstrated on days 7 and 12 p.i. The percentage of rabbits with detected parasitemia was lower. In hares, a decrease in the numbers of leukocytes during the infection was observed. No such decrease was observed in the rabbits. The lymphocyte activity after the stimulation with non-specific mitogens showed significant differences between the hares and the rabbits even before the infection. After the infection, the hares infected with 10(3) and 10(5) doses and in rabbits infected with a 10(5) dose showed a decrease of lymphocyte activity. Rabbits infected with a 10(3) dose showed an increase of the lymphocyte activity. While in hares toxoplasmosis was an acute and fatal disease, the infection in rabbits had subclinical manifestations only and easily passed to a latent stage. The different courses of toxoplasmosis in the hare and the rabbit may be due to the differences in the natural sensitivity of the two species to the T. gondii infection or a negative impact of stress to the immune status of hares.

Effects of rigid gas permeable contact lens solutions on the human corneal epithelium.

In this investigation, the effects of three rigid gas permeable (RGP) contact lens wetting and soaking solutions, Boston Advance Conditioning Solution, Boston Conditioning Solution, and Allergan Wet-N-Soak Plus, were tested on the human corneal epithelium. Thirty subjects participated in three experimental sessions, during which one eye received three drops of one of these RGP solutions, while the other eye served as a control. After 10 and 30 min, corneal staining was graded in 5 areas and the eyes were photographed for a digitized analysis of staining. Our results indicate that corneas exposed to Boston Advance Conditioning Solution demonstrated significantly more fluorescein staining than control eyes at both 10 and 30 min by both methods of analysis, whereas corneas treated with the other two solutions were not significantly different from controls. The increased corneal staining noted with Boston Advance Conditioning Solution may be caused by the presence and concentration of the preservative, 0.0015% polyaminopropyl biguanide. An unforeseen result of this experiment was the relatively large number of subjects exposed to Boston Conditioning Solution and Allergan Wet-N-Soak Plus who had more corneal staining in the control eye. This may suggest that the two RGP solutions served as a barrier to fluorescein, protecting the epithelial cells from staining.