[Effect of X-ray protective visors on the eye lens dose during ureteroscopy]. / Effekt von Strahlenschutzvisieren auf die Augenlinsendosis bei der Ureterorenoskopie.

BACKGROUND AND OBJECTIVES: Eye lens radiation exposure during fluoroscopy-guided interventional procedures may result in occupational radiation-induced cataracts. We evaluated the eye lens radiation doses and the protective effect of X­ray protective visors during ureteroscopic procedures. MATERIALS AND METHODS: Eye lens doses were measured in front of and behind X­ray protective visors using eye lens dosemeters during ureteroscopic procedures done by 4 different endourologic surgeons within a 12-week period. Background radiation dose, simultaneously measured with transport dosemeters, was subtracted. Measured eye lens doses below the detection limit of the eye lens dosemeters were adjusted to the detection limit of 0.028 mSv. Correlating the eye lens doses (ELD) to the dose-area-product (DAP) an ELD/DAP ratio was calculated. Applying this ELD/DAP ratio the potential reduction of the eye lens radiation dose was retrospectively calculated for all ureteroscopic procedures done within one year. RESULTS: Within the 12-week period 76 ureteroscopies were done by the 4 endourologic surgeons. The accumulated eye lens radiation dose was 0.796 mSv in front of the X­ray protective visors, and 0.338 mSv behind the X­ray protective visors. Thus, the eye lens radiation exposure was reduced to at least 42% by using X­ray protective visors. Considering the 215 documented ureteroscopies in our clinic in the year before starting the study, occupational radiation exposure to the eye lens would have been reduced by X­ray protective visors from 4.090 to 1.737 mSv. CONCLUSION: X­ray protective visors can effectively reduce the radiation exposure to the eye lens during fluoroscopy-guided endourologic procedures and should be used especially by high-volume endourologic surgeons.

ISO 4037:2019 VALIDATION OF RADIATION QUALITIES BY MEANS OF HALF-VALUE LAYER AND HP(10) DOSIMETRY.

Radiation qualities were characterised and validated at the fully automated X-ray calibration facility of the Individual Monitoring Service at Helmholtz Zentrum München by using half-value layer and Hp(10) dosimetry approaches specified in the updated ISO 4037:2019 standard. As the ISO 4037 contains a somewhat vague description of the half-value layer procedure, we extended it to be more constrained and thus less subjective in its implementation. We specify both the measurement and data analysis steps performed in order to provide reproducible half-value layer results and compare the results with the Hp(10) dosimetry-based validation approach specified in the ISO 4037 as an alternative for field validation. Finally, we discuss the implications of our results and the extended procedure on validation and the recent changes to the ISO 4037.

Crotalus durissus terrificus (viperidae; crotalinae) envenomation: Respiratory failure and treatment with antivipmyn TRI® antivenom.

We report an envenomation to a professional herpetologist by a South American rattlesnake (Crotalus durissus terrificus) that resulted in respiratory failure, and therapeutic improvement following antivenom administration. A 56-year-old male was bitten on the left wrist by a Crotalus durissus terrificus (C. d. terrificus) while attempting to tube the snake for maintaining safe control while performing venom extraction. The patient was intubated due to rapidly ensuing respiratory failure and administration of Antivipmyn-TRI® was initiated while being transported via ambulance. The patient was admitted to the hospital unconscious and unresponsive. Mechanical ventilation was required until 5 h after completion of antivenom administration. No significant adverse effects were observed with antivenom administration. The patient was discharged approximately 55 h following envenomation. This is the first reported case in the United States of a patient following a C. d. terrificus envenomation with consequent respiratory failure, and in which Antivipmyn-TRI® was successfully administered.

SIMULATION OF OSL AND TLD DOSEMETER RESPONSE FOR THE DEVELOPMENT OF NEW EXTREMITY DOSEMETERS.

The individual monitoring service at the Helmholtz Zentrum München is currently developing a new eye lens dosemeter to be integrated in radiation protection glasses and a new ring dosemeter using a new BeOSL detector element for extremity dosimetry developed by Dosimetrics. In the design process for the new eye lens dosemeter, MCNP6 Monte Carlo simulations were used to model the energy and angular response of new dosemeters before ordering the expensive tools for injection molding. This study describes the simulation of the dosemeter and detector, and the involved calculations do obtain the response in terms of the radiation protection quantity Hp(3). Simulations were carried out also for existing whole body dosemeters and TLD rings in order to verify the MC tools. With the final dosemeter prototypes becoming available earlier this year, all MC models could be verified and show very good agreement with experimental data.

A FULLY AUTOMATED SECONDARY STANDARD X-RAY CALIBRATION FACILITY FOR PERSONAL DOSEMETERS.

The individual monitoring service at the Helmholtz Zentrum München has extended the calibration facilities provided at the Munich IAEA/WHO secondary standard dosimetry laboratory with a new fully automated X-ray calibration facility for the calibration of personal dosemeters according to the ISO 4037 standard series. This work describes the X-ray irradiation system and the automated dosemeter transport system as well as the measurements performed to characterize the photon fields and to ascertain conformity to the ISO standard. Standard uncertainties of the radiation quantities provided by the system are given together with a discussion of some of the problems that are encountered in fulfilling the requirements of a matched field according to the latest drafts of the ISO 4037-1 standard.

LX4211, a dual SGLT1/SGLT2 inhibitor, improved glycemic control in patients with type 2 diabetes in a randomized, placebo-controlled trial.

Thirty-six patients with type 2 diabetes mellitus (T2DM) were randomized 1:1:1 to receive a once-daily oral dose of placebo or 150 or 300 mg of the dual SGLT1/SGLT2 inhibitor LX4211 for 28 days. Relative to placebo, LX4211 enhanced urinary glucose excretion by inhibiting SGLT2-mediated renal glucose reabsorption; markedly and significantly improved multiple measures of glycemic control, including fasting plasma glucose, oral glucose tolerance, and HbA(1c); and significantly lowered serum triglycerides. LX4211 also mediated trends for lower weight, lower blood pressure, and higher glucagon-like peptide-1 levels. In a follow-up single-dose study in 12 patients with T2DM, LX4211 (300 mg) significantly increased glucagon-like peptide-1 and peptide YY levels relative to pretreatment values, probably by delaying SGLT1-mediated intestinal glucose absorption. In both studies, LX4211 was well tolerated without evidence of increased gastrointestinal side effects. These data support further study of LX4211-mediated dual SGLT1/SGLT2 inhibition as a novel mechanism of action in the treatment of T2DM.

[Mental disorders in the peripartum period--early detection and multi-professional cooperation]. / Peripartale psychische Störungen - Früherkennung und multiprofessionelle Kooperation.

Given the great prevalence of mood disorders in early motherhood, the danger of chronic, particularly depressive mood disorders and the negative long-term effects on the socio-emotional development of the child requires specific and individual treatment. Midwives could serve as mediators between women patients and health care professionals. Therefore the project "Early detection and care of peripartum mood disorders, increasing options for reaching affected women" was initiated by the "German chapter of the International Marce Society" in cooperation with midwives. This paper presents results of the preliminary investigation. 111 midwives were interviewed in 12 centres in Germany, Switzerland and Austria regarding their experience and knowledge of psychic disturbances in early motherhood. Psychic disturbances are seen as an essential issue by the participating midwives. In their estimation 39 % of the pregnant women they cared for are exceptionally psychically burdened. In approximately 43 % of the cases they believe that the physical complaints of pregnant women have a psychic background. In addition to "classic" mood complaints, midwives often perceive dysfunctions in the relationship between the mother and her child and that with her partner in the context of psychic disturbances during the peripartum period. In the diagnosis of psychic disturbances in early motherhood, attention should be paid to possible dysfunctional interactions between the mother and her child and that with her partner. Successful treatment of women with psychic disturbances in early motherhood requires cooperation between midwives, obstetricians and other health professionals.

[A patient with visceral leishmaniasis and acute renal failure in necrotizing glomerulonephritis]. / Leishmaniose viscérale autochtone avec insuffisance rénale aiguë par glomérulonéphrite infectieuse.

Renal involvement is an unusual complication of human visceral leishmaniasis (VL). The kidney lesions are characterized more by interstitial damage than glomerular or vascular damage. This case represents a 20 years-old man admitted with pancytopenia, purpura, acute renal failure, and nephrotic syndrome associated with heavy proteinuria. The diagnosis of VL was made on bone marrow smear cytology where Leishmania amastigotes were found. The renal biopsy revealed a segmental necrotising glomerulonephritis with 70% crescents. Treatment with liposomal amphotericine B alone has been ineffective on the course of renal failure, however, partial recovery was obtained after the administration of high dose corticosteroids. We present the various clinical, biological, and histological aspects of this case, from the south of France. It gave us the opportunity to discuss these unusual manifestations of immunomediated necrotising skin and renal lesions.

[Value of arteriography scanning in lower limb artery evaluation: a preliminary study]. / Intérêt de l'artério-scanner dans le bilan des artériopathies des membres inférieurs: étude préliminaire.

PURPOSE: The purpose of this study was to assess the feasability of CT Angiography (CTA) with a single row of detectors and to compare it to digital subtraction angiography (DSA) in the evaluation of lower limb peripheral arterial disease. MATERIAL: and methods. A total of 22 patients underwent 24 lower limb Helical CTA using a Somatom Plus 4A (Siemens) and 24 DSA using an Angiostar unit (Siemens). CT angiography was performed in one acquisition (collimation 3mm/ couch motion 9mm/ interval 2mm) with tube rotation time of 0.75 sec from the aortic bifurcation to the calf. DSA was performed after catheterization of a common femoral artery using the Seldinger technique. Arteries were classified in four categories (normal or stenosis<50%, stenosis>50%, occlusion, aneurysm). VRT images and axial source images were assessed by two independent radiologists whereas digital angiographies were read by a vascular radiologist. RESULTS: Global interobserver agreement was good (Kappa=0.71). The degree of agreement between CTA and DSA ranged from low to excellent (0.25 to 0.97) depending on the artery. CONCLUSION: Lower limb CT angiography is a promising non invasive technique. VRT allows quick evaluation. However, is not accurate enough to replace digital angiography.

Use of supercritical fluid extraction as a method of cleaning anterior cruciate ligament prostheses: in vitro and in vivo validation.

The process of supercritical fluid extraction (SFE) using carbon dioxide as the mobile phase is finding increasing numbers of applications in a wide variety of industries for the extraction, separation, and cleaning of materials. This study assessed the usefulness of this approach in removing surface contaminants from a knitted polyester anterior cruciate ligament (ACL) prosthesis before packaging and sterilizing the product during manufacture. The physical, dimensional, and chemical properties of SFE treated compared with commercially scoured control samples were characterized using a number of textile test methods: electron spectroscopy for chemical analysis, Fourier transform infrared spectroscopy, differential scanning calorimetry, and solvent extraction analysis. The biocompatibility of the samples was measured in terms of their ability to generate CD18 integrin expression on activated human polymorphonuclear cells, and their inflammatory response when implanted for up to 30 days in the knee joint of rats. SFE treatment was successful in removing most of the nonpolar contaminants from the ACL prosthesis and reducing the amount of residuals to a commercially acceptable level. However, some nitrogen containing compounds and polar salts were not removed by the SFE process. The results from the biocompatibility tests demonstrated that the cleaner SFE treated prosthesis induced significantly lower CD18 expression than the scoured control fabric, and was also associated with a milder inflammatory response and a more rapid rate of healing during the 30 day animal trial. Another effect of SFE processing was to cause the polyester device to shrink and lose porosity because of yarn contraction and modification of the polymer's microcrystalline structure.

[Acute ischemia and arterial mesenteric infarction in patients aged over 75. Apropos of a comparative series of 38 cases]. / Ischémie aiguë et infarctus mésentériques artériques chez les patients âgés de plus de 75 ans. A propos d'une série comparative de 38 cas.

We report our experience in a series of 20 patients over 75 years of age with acute mesenteric ischemia and mesenteric infarction. This series was compared with 18 patients under 75 used a control group for scores of specific aspects to acute mesenteric ischemia. Overall mortality (80% versus 55%) (p = 0.1) and desertion rate after exploratory laparotomy (60% versus 35%) were high in the elderly patients with advanced stage disease. There was also a female predominance (80% versus 44%, p < 0.05).

[Current treatment of static deformities of the great toe]. / Traitement actuel des déformations statiques du gros orteil.

The modern techniques of treatment of the hallux valgus are founded on the biomechanic and permit to give again a good function of the big toe. The authors prefer the osseous methods and specially the phalangeal and metatarsal osteotomies. It is necessary also to do a lateral release of the metatarsophalangeal joint and an exostosectomy. The late results are good.

[Post-traumatic false aneurysm of the suprarenal abdominal aorta. Original surgical technique]. / Faux anévrysme post-traumatique de l'aorte abdominale sus-rénale. Technique opératoire originale.

Post-traumatic abdominal aorta false aneurysm is rare, especially in the supra-renal segment. We present the case of a patient which severe respiratory failure who could not be sterno-phreno-laparotomized: we propose an original operative technique of exclusion of the false aneurysm by a limited incision preserving the diaphragm, with circulatory arrest and profound hypothermia, without aortic clamping, under cardiopulmonary bypass. We discuss the other surgical possibilities and propose our technique for special indications.

[Diffuse alveolar pertussis with major hyperleukocytosis with "pseudocentrocytic" contingent]. / Pneumocoqueluche alvéolaire diffuse avec hyperleucocytose majeure à contingent "pseudocentrocytique".

A 21 month-old unvaccinated boy was admitted for an acute respiratory distress episode associated with major leukocytosis (maximum = 146 G/l). Transient heart failure and pneumomediastinum occurred but the outcome was favourable. Coughing attacks then occurred and the diagnosis of pertussis was serologically confirmed. This case report is reminiscent of the possible severity of pertussis pneumoniae, the mechanisms of haematologic abnormalities, and stresses to the benefit of pertussis vaccination.