[S3 guidelines on "full-term vaginal birth" from an anesthesiological perspective : Worthwhile knowledge for anesthesiologists]. / S3-Leitlinie "Vaginale Geburt am Termin" aus anästhesiologischer Sicht : Wissenswertes für den Anästhesisten.

The publication of the new S3 guidelines on "full-term vaginal birth" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.

A haptic guidance tool for CT-directed percutaneous interventions.

We have developed a new navigation approach for computer-assisted interventional radiology. Our system combines a virtual reality display with high-fidelity haptic rendering to provide assistance and guidance of the medical gesture. Specifically, the system is designed to improve the accuracy of blind needle placement within tissues. The proposed technique actively helps the surgeon while keeping him in control of the procedure. We have recently developed an experimental setup for CT-guided biopsy. The setup features a high-precision haptic device connected to the biopsy needle, combined with a graphical interface. The haptic system guides the surgeon's hand to the target tissue based on CT data, whereas a real-time, graphical visualization of the tool trajectory provides navigation information. The setup requires rigid registration of the patient with respect to the haptic interface. Tests have been performed in the presence of radiologists to validate the proposed concept, and early results show that the system is easy to use and requires little training. We are planning to conduct clinical testing in the near future to quantitatively assess system performance.

Abnormal hematologic findings in an African hedgehog (Atelerix albiventris) with gastrointestinal lymphosarcoma.

A 4-year-old African hedgehog (Atelerix albiventris) was examined for weight loss and hematochezia, and was subsequently diagnosed with gastrointestinal lymphosarcoma. Abnormal hematological findings included marked leukocytosis with lymphocytosis and atypical circulating lymphocytes. This report represents the first documentation of hemogram abnormalities associated with gastrointestinal lymphosarcoma in this species.

Therapeutic efficacy of hyperimmune bovine colostrum treatment against clinical and subclinical Cryptosporidium serpentis infections in captive snakes.

Therapy based on the protective passive immunity of Hyperimmune Bovine Colostrum (HBC) (raised against Cryptosporidium parvum in dairy cows immunized during gestation) was tested for heterologous efficacy in subclinical and clinical infections of 12 captive snakes with C. serpentis. Six gastric HBC treatments of 1% snake weight at 1-week intervals each, have histologically cleared C. serpentis in three subclinically infected snakes, and regressed gastric histopathological changes in one of these snakes. In all snakes, each subsequent HBC treatment significantly decreased the number of oocysts recovered in gastric lavage eluants (P < 0.03). The treatments induced oocyst-negative gastric eluants and stools in all snakes, and improved clinical signs of infection. Clinically infected snakes displayed severe histopathological changes in the gastric region; however, the numbers of developmental stages of C. serpentis were moderate. Considering the severity of pathology, much lower than expected pathogen numbers were observed, and it is believed that clinically infected snakes did not have enough time to repair tissue damage that had occurred over the years of infection. As the HBC treatment was safe and highly efficacious, it is recommended to gastrically administer the HBC therapeutically to snakes that are clinically or subclinically infected with C. serpentis. Hyperimmune bovine colostrum can also be used in snake supportive therapy or prophylaxis.

Doxacurium and mivacurium do not trigger malignant hyperthermia in susceptible swine.

The role of succinylcholine in the precipitation of malignant hyperthermia (MH) necessitates the testing of new neuromuscular relaxants for their ability to trigger MH in MH-susceptible swine before general human use. We tested doxacurium and mivacurium, two new nondepolarizing bis-benzylisoquinolinium neuromuscular relaxants, at ED95 and at four times ED95 doses in swine previously documented to be MH-susceptible. In none of the 16 animals was MH triggered after administration of these relaxants, whereas all animals developed fatal MH after administration of halothane or halothane plus succinylcholine. Muscle biopsy specimens taken before administration of the relaxant confirmed that all animals had increased sensitivity to halothane, caffeine, or both. Thus, we conclude that doxacurium and mivacurium are not triggering agents of malignant hyperthermia in MH-susceptible swine.

A new method using simple solid phase extraction for the rapid gas-chromatographic mass-spectrometric determination of 11-dehydro-thromboxane B2 in urine.

A new gas-chromatographic mass-spectrometric method for the rapid determination of 11-dehydro-thromboxane B2 in urine, the major metabolite of systemic thromboxane formation, has been developed. Excellent sample clean-up was obtained in a single step by adsorption of 11-dehydro-TXB2 on phenylboronate cartridges, vigorous polar and organic washing and elution with an acidic methanol mixture. Then the pentafluorobenzylester trimethylsilylether derivative of 11-dehydro-TXB2 was formed and quantified in isotope dilution technique by negative chemical ionisation gas-chromatography tandem mass-spectrometry. The daughter fragments m/z 243/247 of the parent ion m/z 511/515 were monitored. Recovery was linear and quantitative over a wide range, accuracy was 95 + 7% and precision was 11% down to the very low pg range in biologic samples. Independent validation of this very fast extraction method with a reference method applying extensive sample purification with consecutive reversed and straight phase extraction, precolumn derivatisation, reversed phase high pressure liquid chromatography and tandem gas-chromatography mass-spectrometry gave excellent agreement of values. Values for 11-dehydro-TXB2 excretion in 8 healthy controls were 501 + 298 (range 231 to 1141) ng/g creatinin. Excretion was suppressed by aspirin, moderately elevated in heavy smokers (range 680 to 1540) and increased in patients with venous thrombosis or pulmonary embolism (2370 to 13350 ng/g creatinin). This rapid extraction method is useful for the highly specific and sensitive determination of 11-dehydro-TXB2 in large sample numbers.