Electrical impedance tomography may optimize ventilation in a postpartum woman with respiratory failure.

Amniotic fluid embolism is a rare peripartum complication with the sudden onset of haemodynamic instability, respiratory failure and coagulopathy during labour or soon after delivery. A 31-year-old woman with amniotic fluid embolism was treated with vasopressors, inotropes, intravenous fluid, tranexamic acid and ventilatory support. Assessment of respiratory impairment was made using conventional chest X-ray, computed tomography and electrical impedance tomography. The potential for electrical impedance tomography to improve monitoring and guide respiratory therapy is explored.

[Breaking new ground in teaching medical students emergency medicine. Evaluation of a multi-centre student-guided teaching concept]. / Neue Wege in der Notfallausbildung von Medizinstudierenden. Evaluation eines multizentrischen, studentisch geleiteten Kurskonzepts.

BACKGROUND: Medical students who want to apply for preliminary medical examinations in Germany have to prove that they have attended a first-aid course. However, lay courses are often not up to the standards and needs that medical students require. As a result since 1996 members of the task group "AGEHMED", all of whom are medical students, have been teaching their peers in target groups orientated first aid and emergency techniques at medical school. The task group is (currently) active with 190 students at 6 German medical schools. All students, even those without any previous knowledge, can participate in emergency medicine education of their peers following a supervised 5-step model. OBJECTIVE: The aim of this study was to examine the results of a questionnaire that was used for evaluation of peer-guided first-aid courses at medical schools over the last 7 years and to assess its validity and reliability. MATERIALS AND METHODS: From 2000 to 2007 59 first-aid courses with 4,941 medical students were evaluated. After carrying out descriptive analyses the factorial validity and reliability (Cronbach's alpha) of the questionnaire were assessed. The inter-scale correlation of the significant factors was also analysed. RESULTS: The courses were continuously well rated. The amount of variance explained by the factors"quality of the course","learning success","comparison to other university courses","overall satisfaction" and"scheduling of the course" was 68%. The mean inter-scale correlation was r=0.23 and Cronbach's alpha was between 0.62 and 0.81. CONCLUSIONS: The peer-guided courses have been continually well received by the course participants over the last 7 years. The questionnaire shows sufficient validity and reliability. Based on these results, it can be presumed that this approach can be more widely put into practice in the education of medical students.

Immunosuppressive activity of the immunophilin-binding drug Sanglifehrin A in human whole blood: potent inhibition of interleukin-6 produced by lymphocytes and monocytes.

The novel immunosuppressant Sanglifehrin A (SFA) is an immunophilin-binding metabolite with a yet unidentified mechanism of action. Several reports demonstrated the effects of SFA on proliferation and cytokine production of purified T cells with in part different results. However, less is known about the impact of SFA on the regulation of innate immune responses. We used a whole blood assay to investigate the impact of SFA on monocyte responses and T-lymphocyte activity/proliferation upon lipopolysaccharide (LPS) stimulation and anti-CD3/anti-CD28 costimulation, respectively. SFA was found to inhibit interleukin (IL)-2 protein expression of T lymphocytes. Whereas IL-2 mRNA expression was significantly reduced after 4 h of costimulation, the mRNA expression of IL-4 and IL-6 but not tumour necrosis factor (TNF)-alpha was inhibited by SFA both after 4 and 24 h of costimulation. The production of IL-2 and IL-6 protein in T lymphocytes was even strongly affected by SFA than the mRNA expression of the respective cytokine. Unlike other immunophilin-binding immunosuppressants, SFA also inhibited LPS-induced IL-6 and TNF-alpha mRNA and protein expression. At the single cell level, SFA was demonstrated to block the intracellular production of IL-6 in CD14+ monocytes but not the expression of other proinflammatory cytokines such as IL-8 and TNF-alpha. On the basis of these data, we propose that SFA may have a significant effect on the initiation and direction of immune responses. Considering the pleiotropic role of bioactive IL-6 production at the interface of innate and acquired immunity in a variety of disease conditions, it was found that these novel aspects of the unique immunosuppressive action could strongly impact on future clinical application of SFA.

[Unclear intraoperative cardiorespiratory decompensation. Anaphylactic reaction?]. / Unklare intraoperative kardiorespiratorische Dekompensation. Ist es eine Anaphylaxie?

During anaesthesia a patient is exposed to a variety of substances, all of which could lead to anaphylactic reactions. In addition, other drugs may exert clinical side-effects by non-immunological mechanisms, e.g. by direct stimulation of the release of histamine by mast cells. Initially, the observed symptoms, such as hypotension or tachycardia, may be misunderstood by the anaesthetist, leading to a possible delay in diagnosis and subsequent treatment of the anaphylactic event. Cardiac ischemia and lung embolisms are important differential diagnoses that often cannot be definitely ruled out during the acute situation and that have to be followed up once the patient has been stabilised. We report a case of anaphylactic reaction after the administration of ampicillin which required treatment and ventilation in the intensive care unit. Despite an accurate determination of serum tryptase levels, the diagnosis of an anaphylactic reaction to ampicillin was eventually confirmed by skin testing. During anaesthesia, anaesthetists should consider anaphylaxis when unforeseen symptoms such as bronchospasm, haemodynamical instability and/or flush arise. In cases of unexpected reactions, patients should undergo allergological follow-up to prevent fatal re-exposure.

[Ultrasound-guided interventions using magnetic field navigation. First experiences with Ultra-Guide 2000 under operative conditions]. / Ultraschallgesteuerte Interventionen unter virtueller Führung. Erste Ergebnisse mit dem US-Guide 2000 unter operativen Bedingungen.

AIM: Ultrasound-guided interventions are presently performed as free-hand-type procedures or using biopsy transducers. In this article we report on our experience with a new navigation-system for sonographically guided interventional procedures under OR-conditions. METHODS: The US-Guide 2000 trade mark is an electromagnetic guidance system that assists physicians in ultrasound-guided interventional procedures. This system accommodates both in-plane and out-of-plane needle placement. We evaluated this system for the first time under OR-conditions. Overall, for 39 interventional procedures (23 thermoablations of malignant liver lesions, 16 diagnostic punctures) were performed. RESULTS: All targets were reached successfully without any complications. No interactions with other OR-devices were seen. CONCLUSION: The US-Guide 2000 trade mark as a virtual needle-guiding system allows a safe and accurate sonographically assisted intervention. The major advantage is the possibility of out-of-plane needle placement and the combination of flexibility of free-hand-type procedures with the accuracy of a biopsy transducer. This increases the safety of punctures especially when lesions are difficult to reach and/or are situated next to vulnerable structures. It also reduces the interventional trauma.