[Modern breath analysis]. / Moderne Atemgasanalysen.

BACKGROUND: Analysis of exhaled air is a risk-free option for bedside diagnostics. Modern breath analysis can detect very low concentrations of volatile components. Current research focuses on drug monitoring and diagnosis of various diseases. OBJECTIVES: Presentation and discussion of current breath research relevant to intensive care medicine. MATERIALS AND METHODS: The literature in PubMed was searched using the following terms: "breath analysis", "volatile organic compounds", "critically ill" combined with "drug monitoring", "propofol", "heart failure", "pneumonia", "ARDS", "renal failure", "liver failure", "sepsis" or "hemorrhage". RESULTS: Intravenously administered propofol can now be measured reliably in exhaled air. Functional impairments of the heart, lungs, kidneys and liver show characteristic influences on the exhaled air, which could serve as a new diagnostic tool in the future. Animal experiments already show promising results to detect sepsis, hemorrhage and ventilator-induced lung injury. CONCLUSIONS: In the future, modern breath analysis could enable non-invasive drug monitoring and diagnostics of medical conditions relevant to intensive care medicine.

Influence of the respirator on volatile organic compounds: an animal study in rats over 24 hours.

Long-term animal studies are needed to accomplish measurements of volatile organic compounds (VOCs) for medical diagnostics. In order to analyze the time course of VOCs, it is necessary to ventilate these animals. Therefore, a total of 10 male Sprague-Dawley rats were anaesthetized and ventilated with synthetic air via tracheotomy for 24 h. An ion mobility spectrometry coupled to multi-capillary columns (MCC-IMS) was used to analyze the expired air. To identify background contaminations produced by the respirator itself, six comparative measurements were conducted with ventilators only. Overall, a number of 37 peaks could be detected within the positive mode. According to the ratio peak intensity rat/ peak intensity ventilator blank, 22 peaks with a ratio >1.5 were defined as expired VOCs, 12 peaks with a ratio between 0.5 and 1.5 as unaffected VOCs, and three peaks with a ratio <0.5 as resorbed VOCs. The peak intensity of 12 expired VOCs changed significantly during the 24 h measurement. These results represent the basis for future intervention studies. Notably, online VOC analysis with MCC-IMS is possible over 24 h in ventilated rats and allows different experimental approaches.

[General anesthesia for ambulatory surgery : Clinical pharmacological considerations on the practical approach]. / Allgemeinanästhesie bei ambulanten Operationen : Klinisch-pharmakologische Überlegungen zum praktischen Vorgehen.

Due to modern surgical and anesthesia techniques, many patients undergoing small or even medium surgical procedures will recover within minutes and can then be discharged after a few hours of monitoring. Aside from an optimized surgical technique, a precise and differentiated anesthesia concept is needed to guarantee rapid recovery and home readiness. Nowadays, remifentanil-propofol represents the standard regime in ambulatory anesthesia. The use of alfentanil, desfluran or sevofluran is also possible whereas other intravenous or inhaled anesthetics or other opioids are rarely used. If endotracheal intubation is necessary, a reduced intubating dose of neuromuscular blockers (NMB), such as mivacurium, atracurium and rocuronium, i.e. 1-1.5-times the 95 % effective dose (ED95) is a good possibility to accelerate neuromuscular recovery while still having acceptable intubation conditions. Due to its limitations and contraindications, succinylcholine is not the first choice but may be used in non-fasting patients in need of urgent (ambulatory) surgery, e.g. in bleeding women undergoing dilation and curettage. Even with these reduced dosages monitoring of neuromuscular recovery is crucial and should be applied to all patients when NMBs are used. Furthermore, patients should receive a risk-adapted postoperative nausea and vomiting (PONV) prophylaxis, e.g. with 4 mg dexamethasone and 4 mg ondansetron. Postdischarge nausea and vomiting (PDNV) should be anticipated by a new risk score and prophylaxis or treatment should be initiated. For postoperative pain relief, local or regional anesthesia techniques, such as infiltration, field or nerve blocks should be applied where possible. In addition, non-opioid analgesics are the basic treatment while longer-lasting opioids are only necessary for some patients.

[Segmental variants of the inferior vena cava--manifestations with embryological correlation in differentiation from secondary vena cava occlusion]. / Segmentale Varianten der Vena cava inferior--Erscheinungsbild mit embryologischer Korrelation in Abgrenzung zum sekundären Vena-cava-Verschluss.

The vast variability of the overall rare congenital anomalies of the inferior vena cava (IVC) are mostly detected by accident through different imaging modalities. These cannot be classed as pathological findings, and should not be confused with lymphomas and has to differ from secondary collateral venous pathways. Based on 656 CT examinations 10.5% known forms of IVC anomalies were found. According to the embryological development three main groups of IVC variants could be nosologically classified: agenesis of the suprarenal IVC, anomalies of the pars renalis and anomalies of the infrarenal IVC. Additionally three unusual anomaly complexes were found. For the understanding details of the embryology based on a simplified depiction are presented.

CT and MRI in severe hypophosphataemia with central nervous system involvement.

We report a 38-year-old woman with extreme hypophosphataemia in whom CT and MRI disclosed bilateral lesions within the basal ganglia, thalamus and occipital lobes. After adequate substitution of phosphate the lesions grossly resolved and the patient recovered. This case is the first to demonstrate that profound changes of serum phosphate may be associated with reversible brain lesions.

Pronounced cystic transformation of the Rete testis. MRI appearance.

BACKGROUND: Cystic transformation of the rete testis is a little-known partial or complete obstruction of the spermatozoa-containing secretion of the head of the epididymis. Depending on its severity, either ectasia or a cystic transformation occurs, which spreads to the network of convoluted seminiferous tubules in the mediastinum testis. Findings in contrast-enhanced MRI examinations are characteristic and may help to differentiate this benign entity from malignant neoplasia. The authors present two pronounced cases in different stages, documenting the broad spectrum of possible involvement.

Intra- and infrahepatic agenesis of the inferior vena cava with azygos continuation accompanied by duplication of the postrenal segment.

Agenesis of one or more segments and duplication of the infrarenal segment are, individually, rare abdominal variants of the inferior vena cava (IVC). In this article, the authors report on a case in which these two anomalies occurred concurrently. Details of the embryology are presented insofar as they are necessary for an understanding of this IVC variant. Spiral computed tomography makes it possible to define the vascular morphology and to make a differentiation from lymphadenopathy. Cavography gives an overall picture of the vascular morphology.

[Follow-up of central pontine myelinolysis with clinical remission]. / Verlauf einer zentralen pontinen Myelinolyse mit klinischer Erholung.

We report on a case of central pontine myelinolysis in a young alcoholic woman, which occurred after a period of abstinence. There was a latency between the clinical findings and magnetic resonance imaging. The lowest measured sodium blood level was 121 mmol/l.

[Bladder outflow obstruction due to a small, median prostatic cyst--diagnosis and interventional radiology treatment]. / Blasenentleerungsstörung bei kleiner, medianer Prostatazyste--Diagnostik und interventionell-radiologische Behandlung.

We describe a rare case of a bladder outlet obstruction due to a midline prostatic cyst. In the following clinical appearance, diagnostic imaging and therapy by CT-guided punction are reported. Differential diagnosis and therapy are discussed.

A new murine cell surface differentiation antigen (Leugp90) defined by a rat monoclonal antibody: cellular distribution and biochemical characterization.

Monoclonal antibodies to murine lymphocyte differentiation antigens were generated by fusing the mouse myeloma cell line X63-Ag8.653 with spleen cells derived from Lewis rats hyperimmunized with lymphoid cells from nude (C57BL/6) mice. One of these antibodies--designated 3MB1--recognizes a previously undescribed cell surface antigen. This antigen is expressed on 62% of spleen cells, 9% of thymus cells, and 98% of peritoneal macrophages. Virtually all LPS- and Con A-induced lymphoblasts carry this newly found antigen. The 3MB1 determinant is limited in its expression to leukocytes. It is not found in other tissues such as brain, liver, kidney, or on erythrocytes. Biochemical analysis reveals that the 3MB1 target antigen consists of a single chain glycoprotein with an approximate m.w. of 90,000.