Increasing Fatigue Endurance of Hydroxyapatite and Rutile Plasma Sprayed Biocomponents by Controlling Deposition In-Flight Properties.

Three sets of hydroxyapatite and rutile-TiO2 coatings were plasma sprayed onto metallic substrates. The spray parameters of the sets were modified so as to obtain different in-flight temperatures and velocities of the powder particles within the plasma jet (ranging from 1778 to 2385 K and 128 to 199 m s-1, respectively). Fatigue endurance of the coated specimens was then tested. The samples were subjected to a symmetric cyclical bend loading, and the crack propagation was monitored until it reached a predefined cross-section damage. The influence of the coating deposition was evaluated with respect to a noncoated reference set and the in-flight characteristics. Attributed to favorable residual stress development in the sprayed samples, it was found that the deposition of the coatings generally led to a prolongation of the fatigue lives. The highest lifetime increase (up to 46% as compared to the noncoated set) was recorded for the coatings deposited under high in-flight temperature and velocity. Importantly, this was achieved without significantly compromising the microstructure or phase composition of the deposited HA and TiO2 layers.

Is carotid endarterectomy under the cervical plexus block safe for all patients with various degree of cardiovascular risk?

BACKGROUND: The result of the GALA study did not answer the question whether it is safe to perform carotid endarterectomy (CEA) under the cervical plexus block (CPB) in patients at high cardiovascular (CV) risk. The aim of the study was to compare CV stability and the frequency of cardiovascular and neurological complications in 3 groups of patients with various degree of CV risk who underwent CEA under CPB. METHODS: 60 patients operated on in CPB were divided into the 3 groups according to the degree of their CV risk (I: very high, II: medium, III: low). STATISTICAL ANALYSIS: Chi-square, Kruskal Wallis test. RESULTS: No statistically significant difference was confirmed in the changes of blood pressure (MAP, BP syst, BP diast), heart rate, cardiovascular complications, the rate of the shunt insertion and neurological complications and the level of haemodynamic instability, except for hypotension (p = 0.041) in the three groups. Life threatening CV complications did not occur in any of the groups. The frequency of haemodynamic changes and postoperative complications: hypertension (I--40%, II--60%, III--60%), hypotension (I--35%, II--25%, III--5%), arrhythmias (I--30%, II--15%, III--10%), neurological complications: 2x (TIA), the frequency of shunt insertion: 15 %. CONCLUSION: CPB can be performed in all three groups of patients, even in high-risk cardiac patients. The results will have to be confirmed in a larger group of patients in future (Tab. 3, Fig. 4, Ref. 16).

Quality of prehospital management of patients with burn injuries--a retrospective study.

The authors evaluate the quality of burn patient management prior to admission to a specialized department. The most frequent mistake was found to be inadequate airway management (no intubation) and a lack of an i.v. line and volume resuscitation. These problems could be seen especially in the patients admitted to the specialized department as secondary transfers, following initial treatment in another healthcare facility. Prehospital care of the patients admitted as primary transfers was found to be satisfactory in the majority of cases. The authors conclude that some mistakes in diagnosis may be caused by the development of the burn over time as well as by the fact that certain clinical experience is necessary for determining the correct diagnosis. The predominant cause of inadequate management in patients with severe thermal injuries is underestimating the severity of the injury and ignorance of the possible consequences of inadequate management of the patients for transfer.

The most frequent problems in the initial stage of burn management.

On the basis of three case reports discussed in the article, the authors demonstrate the most frequent serious drawbacks occurring in the initial stage of care of severely burned patients. The first case report highlights the importance of correct determination of the extent of the burn trauma, which should be correctly assessed by every first contact physician. The second case report demonstrates the need for adequate management of patients with severe burn trauma (especially airway management and i.v. establishment). In the third case (a little baby) again the need for correct patient assessment, timely airway management and beginning of resuscitation and especially of appropriate and immediate transfer of the burned patient to the specialized burn facility are highlighted.