[Therapeutic hypothermia after non-traumatic cardiac arrest for 12 hours: Hospital Karlovy vary from 2006 to 2009]. / Terapeutická hypotermie po srdecní zástave na 12 hodin: Karlovy Vary 2006-2009.

INTRODUCTION AND AIMS: Therapeutic hypothermia is a standard part of post-resuscitation care. Here we present cohort patients after non-traumatic cardiac arrest and their neurological outcomes who underwent 12 hours of therapeutic hypothermia. Moreover, we focused on examining the results of particular subgroup of patients with initial ventricular fibrillation (VF) with acute myocardial infarction with ST-elevation (STEMI) who underwent coronary intervention (PCI). METHODS: We evaluated retrospectively the patients with non-traumatic out-of- and in-hospital cardiac arrest (IHCA, OHCA), admitted to our intensive care unit (ICU) in 2006-2009. Therapeutic hypothermia was induced in all patients with persistent coma after restoration of spontaneous circulation (ROSC). We maintained the target temperature (32-34 degrees C) for 12 hours. Then, passive rewarming followed. Intravascular cooling device was not used. A good neurological outcome was considered to be cerebral performance category (CPC) 1 or 2 at hospital discharge. RESULTS: Total number of patients was 88 (OHCA n = 63; IHCA n = 25), average age 58 (+/- 16) years, average APACHE II was 29 (+/- 6). Men were in 65%. Target temperature was achieved and maintained in 76% of patients. ICU mortality was 32%, hospital mortality 53%. Initial ECG rhythm was VF in 59%, asystoly in 32% and pulsless electrical activity in 9%. Coronary angiography was performed in 57% and PCI in 42% patients. We did not observe severe arrhythmias, minor gastrointestinal bleeding occurred in 2%. The infectious complications were recorded: early pneumonia in 7%, tracheobronchitis in 10% and bacteraemia in 1% patients. In the group of 23 patients with VF/STEMI/PCI target temperature was achieved and maintained in 91%, ICU and hospital survival rates were 87% and 78%. CPC 1 and 2 was observed in 83% among survivors (n = 15). CONCLUSIONS: We achieved similar results in patients after non-traumatic cardiac arrest who underwent a protocol with 12 hours of therapeutic hypothermia as in studies reporting 24 hours of hypothermia, particularly in patients with VF/STEMI/PCI. Twelve hours of therapeutic hypothermia was associated with a low incidence of infectious complications.

Novel nano-particles as fillers for an experimental resin-based restorative material.

The purpose of this study is to compare the properties of two experimental materials, nano-material (Nano) and Microhybrid, and two trade products, Clearfil AP-X and Filtek Supreme XT. The flexural strength and modulus after 24h water storage and 5000 thermocycles, water sorption, solubility and X-ray opacity were determined according to ISO 4049. The volumetric behavior (DeltaV) after curing and after water storage was investigated with the Archimedes principle. ANOVA was calculated with p<0.05. Clearfil AP-X showed the highest flexural strength (154+/-14 MPa) and flexural modulus (11,600+/-550 MPa) prior to and after thermocycling (117+/-14 MPa and 13,000+/-300 MPa). The flexural strength of all materials decreased after thermocycling, but the flexural modulus decreased only for Filtek Supreme XT. After thermocycling, there were no significant differences in flexural strength and modulus between Filtek Supreme XT, Microhybrid and Nano. Clearfil AP-X had the lowest water sorption (22+/-1.1 microg mm(-3)) and Nano had the highest water sorption (82+/-2.6 microg mm(-3)) and solubility (27+/-2.9 microg mm(-3)) of all the materials. No significant differences occurred between the solubility of Clearfil AP-X, Filtek Supreme XT and Microhybrid. Microhybrid and Nano provided the highest X-ray opacity. Owing to the lower filler content, Nano showed higher shrinkage than the commercial materials. Nano had the highest expansion after water storage. After thermocycling, Nano performed as well as Filtek Supreme XT for flexural strength, even better for X-ray opacity but significantly worse for flexural modulus, water sorption and solubility. The performances of microhybrids were superior to those of the nano-materials.

Laser-induced fluorescence to discriminate between a dental composite resin and tooth.

PURPOSE: Investigation of laser-induced fluorescence of an experimental pigment (Flu) to discriminate between a filling and the tooth and its influence on the material properties of experimental dental composites. MATERIALS AND METHODS: Three experimental composites (EC) were manufactured. The standard contained no Flu, Flu-0.5 contained 0.5%, Flu-1.0 contained 1%. To judge the extent of fluorescence, specimens and fillings placed in natural teeth were irradiated with an infrared laser (980 nm, 120 mW). Flexural strength, modulus of elasticity, depth of cure, water sorption, solubility, and color (CIE-L(*)a(*)b(*)-values) were measured to investigate the influence of Flu on EC. ANOVA was calculated and the statistical significance was p < 0.05. RESULTS: Strong laser-induced green fluorescence was observed so that fillings and tooth structures were clearly discriminated. No influence of Flu on flexural strength and modulus of elasticity occurred. Water sorption and solubility were far below the limits of EN ISO 4049. Increasing Flu concentrations revealed minor but significant reduction of depth of cure, shifts to more white and red and less yellow. SIGNIFICANCE: Flu provides laser-induced fluorescence allowing an easy discrimination between fillings and teeth. Flu did not severely influence the material properties.

Effect of exponential polymerization on color stability of resin-based filling materials.

PURPOSE: To investigate the influence of a halogen light curing device used with constant or exponential polymerization mode on the color stability of contemporary resin-based filling materials. MATERIALS AND METHODS: Eight samples of Charisma (CH), Durafill (DU), Definite (DE), and Dyract AP (DY) each were light-cured with constant power or with soft-start mode (Translux Energy) for 20, 40 or 60s. The CIE-Lab-values (L(*), a(*), b(*)) were measured prior to and after performing dry aging, water aging or a Suntest (EN ISO 7491) and Delta L-, Delta a-, Delta b-, and Delta E-values were calculated. RESULTS: Statistical analysis (GLM and repetition of measures) showed significant changes (p<0.05) of the color values for each material's curing mode and time after each of the aging processes. Four-way ANOVA revealed significant differences (p<0.05) between Delta L-, Delta a-, Delta b-, and Delta E of the materials in dependence on the curing time and mode and aging condition. Exponentially-cured DU was the most color-unstable material after aging in water followed by the 20s exponentially cured DE and CH samples. After the Suntest, DY showed significant bleaching (negative Delta b) and the largest Delta E for all curing times and modes followed by the DE samples. DU and CH were the most color-stable materials in this test. SIGNIFICANCE: The extent of discoloration depends on the (a) curing time, (b) curing mode, (c) aging condition, and (d) material. For the constant curing mode, 40s curing time for the exponential 60s seems to be appropriate.

Spark erosion as a metal-resin bonding system.

PURPOSE: Resin to metal bond strength of two commercial and one experimental metal-resin bonding system for crown and bridge veneer composites was evaluated. MATERIALS AND METHODS: All specimens were prepared and tested according to ISO 10477 Amendment 1. A high precious alloy (HPA), a Co/Cr-alloy (Co/Cr) and pure titanium (Ti) were wet-ground to a final surface finish of 800 grit and air-dried. Twenty specimens of each metal were treated with Rocatec (RO), 20 with a Silano-Pen (SP), and 20 with the experimental spark-erosion (SE) bonding system. A light-curing opaque and a crown and bridge veneer composite were applied to each metal specimen. Ten specimens of each metal and bonding system were stored in water for 24h at 37 degrees C, 10 were thermocycled (TC) 5000 times in a water-bath between +5 and +55 degrees C prior to measuring shear bond strength (SBS). Scanning electron microscopy (SEM) was used to examine the treated metal surfaces. RESULTS: After 24h SE generated significantly higher SBS values on Ti than RO (p<0.05). SP revealed the highest SBS for Co/Cr. After TC significant decreases occurred for RO on HPA, for SP on Co/Cr and Ti, and for SP on Ti. SE revealed the highest mean bond values for all metals. These results and SEM proved that no sandblasting is required for SE to obtain good bond strength. SIGNIFICANCE: The experimental spark-erosion bonding system is an easy and very effective method for surface-treating alloys to obtain high SBS values for crown and bridge veneer composites.

The effects of thermocycling on the flexural strength and flexural modulus of modern resin-based filling materials.

OBJECTIVE: Evaluation of flexural strengths and flexural moduli of hybrids, packables, ormocers, compomers and flowables prior to, and after, thermocycling. MATERIALS AND METHODS: Twenty specimens, size (25 +/- 2) mm x (2 +/- 0.1) mm x (2+/-0.1) mm, of Herculite (HE), Point 4 (P4), TetricCeram (TC), Miris (MI), TetricCeram HB, (HB), Solitaire 2 (SO), Surefil A (SU), Definte (DE), Admira (AD), Dyract AP (DY), Compoglass (CO) and TetricFlow (TF) were made according to ISO 4049. A three-point-bending test was carried out for the first 10 specimens after 24 h water storage at 37 degrees C and for the second 10 specimens after 30-day water storage at 37 degrees C, followed by 5000 thermocycles between +5 and +55 degrees C. For each test series flexural strengths and flexural moduli were calculated. Statistical significance was p < 0.05. RESULTS: Flexural strengths of DY and CO missed the 80 MPa limit of ISO 4049 for occlusal fillings prior to and after thermocycling. AD missed it after thermocycling. HE, P4, TC, MI, HB, SO, SU, DE and TF did not significantly differ prior to and after thermocycling. Flexural strength of SO and AD significantly decreased after thermocycling. No change of the flexural moduli could be observed for any of the test materials. Only SU exceeded 10,000 MPa prior to and after thermocycling. SIGNIFICANCE: Only DY and CO missed the flexural strength limit of ISO 4049 for occlusal fillings. Only SU exceeded a flexural modulus of 10,000 MPa prior to and after thermocycling.

[Blood loss and absorption in TURP vs. TUVRP under low pressure and high pressure conditions]. / Blutverlust und Einschwemmung bei TURP vs. TUVRP unter Niederdruck- bzw. Hochdruckbedingungen.

This study analyzes the causes of different fluid absorption and loss of blood in TURP (transurethral resection of the prostate) and also compares TURP with TUVRP (transurethral vaporesection of the prostate). Continuous intraoperative, intravesical pressure measurement and registration of the extent of fluid absorption (measurement of C(2)H(5)OH in the patient's expiratory air) and precise intra- and postoperative analysis of serum and ASTRUP analysis made it possible to differentiate between high- and low-pressure TUR. In addition positive and negative characteristics of TUVRP could be examined. When fluid absorption was registered, a clear correlation between C(2)H(5)OH absorption and decrease in serum concentration of sodium could be seen, making sodium in serum a good marker of fluid absorption. Neither the duration of the operation nor the size of the adenoma had an influence on fluid absorption and loss of blood, but sinus bleeding and capsular lesions, especially in high-pressure TUR, had a significant influence. An advantage of low-pressure TUR, especially in "low compliance bladder," could be clearly seen. No benefit concerning fluid absorption and loss of blood was seen in cases of total resection by TUVRP. In cases of palliative, planned TUR (elderly patients with multiple risk factors) a TUVRP is recommended.

A new adhesive technology for all-ceramics.

OBJECTIVES: Evaluation of a new surface treatment method to obtain a good bond strength between a luting composite and several ceramics. METHODS: Specimen preparation and test procedure were done according to ISO 10477 Amendment 1. The surfaces of Empress II, InCeram-Alumina, InCeram-Zirconia and Frialit (ZrO2) were ground under water-cooling with 400 grit grinding paper, afterwards polished with 800 grit and air-dried. Each ceramic material investigated was divided into three groups of 10 specimens each. Group 1 was flame-treated with the PyrosilPen for 2.5 s, group 2 for 5 s and group 3 for 10 s/cm(2). After the flame treatment, a methacryl silane was applied followed by a luting composite. Prior to measuring shear bond strength, the specimens were thermocycled 5,000 times in a water-bath between +5 and +55 degrees C. Furthermore, SEM- and Fourier-transform infrared spectrophotometer (FT-IR)-investigations were done. As a control, Empress II etched and silaned was used. RESULTS: Shear bond strength measurements indicated that the optimal treatment time was 5 s/cm(2). Regarding this time the following bond strength values between the luting composite and the various ceramics were obtained: Empress II 23 (5)MPa, InCeram-Alumina 23 (5)MPa, InCeram-Zirconia 13 (8)MPa, and Frialit 16 (6)MPa. The control achieved 27 (6)MPa. On all surfaces of the flamed specimens Si could be detected by FT-IR.Significance. The PyrosilPen-Technology is an easy and effective method for surface-treating silicate, aluminum oxide and zirconium oxide ceramics to obtain good bonding to luting composites.

[Blood flow velocity in the anterior part of the circulus arteriosus in ischemic stroke: correlation with Doppler ultrasonography of the internal carotid arteries]. / Predkosc przeplywu krwi w przedniej czesci kola tetniczego w niedokrwiennym udarze mózgu--korelacja z ultrasonografia dopplerowska tetnic szyjnych wewnetrznych.

UNLABELLED: The correlation was studied between blood flow velocity in the anterior part of the circulus arteriosus and the condition of the internal carotid arteriess in their extracranial course studied by Doppler USG. The arteries in the anterior part of the circulus were studied in 100 patients with ischemic stroke, and in 50 controls without cerebrovascular disease. Only strokes in the area of the middle cerebral artery (MSC) were considered. The patients were divided into 4 subgroups depending on the condition of the extracranial portion of the carotid internal arteries (ICA): 1. with normal pattern of arteries in USG-duplex, 2. with narrowing without haemodynamic importance, 3. with high-grade stenosis and haemodynamic disturbances, 4. with occlusion of the ICA. Transcranial Doppler USG was carried out through a "temporal window" assessing blood flow velocity in the MCA and in the anterior cerebral arteries (ACA) on both sides. RESULTS: In subgroups 1 and 2 the mean flow velocity in MCA was reduced on the side of the stroke. In groups 3 and 4, apart from reduced flow velocity in the MCA on the side of the stroke, increased velocity on both sides was found in the ACAs. CONCLUSION: The degree of ICA narrowing in its extracranial part was influencing the condition of intracranial circulation.

[New direct restorative materials]. / Nieuwe directe restauratiematerialen.

People worldwide have become increasingly aware of the potential adverse effects on the environment, of pollution control and of toxic effects of food, drugs and biomaterials. Amalgam and its potential toxic side effects (still scientifically unproven) continue to be discussed with increasing controversy by the media in some countries. Consequently, new direct restorative materials are now being explored by dentists, materials scientists and patients who are searching for the so-called 'amalgam substitute' or 'amalgam alternative'. From a critical point of view some of the new direct restorative materials are good with respect in aesthetics, but all material characteristics must be considered, such as mechanical properties, biological effects, and longterm clinical behaviour.

New direct restorative materials. FDI Commission Project.

People worldwide have become increasingly aware of the potential adverse effects on the environment, of pollution control and of toxic effects of food, drugs and biomaterials. Amalgam and its potential toxic side effects (still scientifically unproven) continue to be discussed with increasing controversy by the media in some countries. Consequently, new direct restorative materials are now being explored by dentists, materials scientists and patients who are searching for the so-called 'amalgam substitute' or 'amalgam alternative'. From a critical point of view some of the new direct restorative materials are good with respect to aesthetics, but all material characteristics must be considered, such as mechanical properties, biological effects, and longterm clinical behaviour.

[Subarachnoid hemorrhage due to conus medullaris ependymoma]. / Krwotok podpajeczynówkowy spowodowany wysciólczakiem stozka rdzeniowego.

A case of conus medullaris tumour (ependymoma) is reported in which the presenting symptom was subarachnoid haemorrhage, which has left bladder dysfunction. 70-year-old patient was admitted to the Department of Neurology due to symptoms of conus medullaris lesion with retention of urine and diminished pain sensitivity in perianal zona. He had been hospitalized 30 years ago due to vomiting, headache and pain in lumbar region. The cerebrospinal fluid examination confirmed the diagnosis of subarachnoid haemorrhage. Cerebral angiography failed to show the source of bleeding. Myelography and spinal arteriography showed nor tumour neither vascular malformation. Only MRI examination performed after 30 years following the first symptoms of tumour made possible the correct diagnosis--tumour in vertebral canal at L1-L2 level compressing conus medullaris. Surgical procedure confirmed the diagnosis. Histopathological examination--ependymoma myxopapillare.

[Neurological disorders of vitamin B12 deficiency]. / Zaburzenia neurologiczne w niedoborze witaminy B12.

It is almost two hundred years since the description of the first neurological disorders in vitamin B12 deficiency. In spite of that, not all the aspects of the biological effect of the vitamin have been explained. It is well known, that the vitamin performs an important function in organic metabolism and two types of biochemical reactions depend on it. The haematological, gastrological and neurological disorders are the result of deficiency of that vitamin. This article deals with the neurological disorders--subacute degeneration changes of the spinal cord, polyneuropathy and psychical disorders--which accompany vitamin B12 deficiency. It also presents aetiology, epidemiology, clinical symptoms, pathomorphology and it describes the deviations which occur in accessory investigations. The authors pay special attention to the abnormalities which can occur in neurophysiological and imaging examinations made by neurologists. They concentrate on the problems of the differences, especially between multiple sclerosis and subacute degeneration. The article presents the treatment of neurological disorders with regard to different authors' opinions. The importance of the early diagnosis and treatment till regression of pathological symptoms has been particularly stressed.

[Neurologic signs in Addison-Biermer disease (report of 3 cases)]. / Objawy neurologiczne w chorobie Addisona-Biermera, (opis 3 przypadków).

The authors report three patients in whom a neurological syndrome was the first manifestation of Addison-Biermer disease. In the first case a paraneoplastic neurological syndrome was suspected, in two other cases the initial tentative diagnosis was multiple sclerosis. The correct diagnosis was reached after a prolonged diagnostic procedure and after ruling out of other diseases. The course of the disease was very serious in all cases leading to death of one patient despite intensive treatment (postmortem examination confirmed the diagnosis). In the second case the neurological syndrome failed to regress completely. The authors stress the necessity of considering this aetiology in neurological syndromes of atypical pattern and course.

Preparation of extracted natural human teeth for SEM investigations.

Direct and indirect (replica) methods for investigating natural hard tooth tissues by scanning electron microscopy have been compared. The direct method requires an effective dehydration and drying procedure to avoid artefacts. A simple, fast and very effective procedure is described in this investigation. This recommends dehydration with differently concentrated mixtures of water/ethanol followed by mixtures of ethanol/acetone so that critical point drying can be avoided with regard to hard tooth tissues. The indirect method is carried out by taking impressions of the tooth surfaces with an addition-type polysiloxane. A positive model is manufactured from this impression using an epoxy resin. When investigated by scanning electron microscopy, the epoxy model reflects only very obscure pictures of the original tooth surface. The indirect method can only be recommended in cases where direct investigation is impossible. For instance, when non-extracted teeth are investigated or when extracted teeth are expected to be influenced by the dehydration and drying process.

Pharmacokinetics of dirithromycin in patients with impaired hepatic function.

Dirithromycin is a new macrolide antibiotic. A non-blinded, non-comparative study was performed in patients with mild, (Pugh and Childs Grade A) chronic, stable, impaired hepatic function (CSIHF) to determine the single- and multiple-dose pharmacokinetics and safety in such patients. Eight volunteers had disease affecting primarily the hepatic parenchyma, eight had primarily biliary system diseases and five healthy volunteers served as the control population. CSIHF patients and healthy volunteers all received a single dose of dirithromycin 500 mg po and 2 weeks later a 10-day course of dirithromycin 500 mg po once a day. Blood and urine samples were obtained with single dose administration and on days 1 and 10 of multiple-dose administration. The area under the serum concentration versus time curve (AUC) was higher with multiple-dose administration than with single-dose administration in all three treatment groups; however, the difference was not statistically significant between the treatment groups. With multiple-dose administration, peak serum concentrations (Cmax) were 0.69 +/- 0.74, 0.34 +/- 0.15, and 0.78 +/- 0.25 mg/L and the AUC0-24 were 6.45 +/- 6.27, 4.05 +/- 1.59, and 6.60 +/- 2.89 mg.h/L in normal, parenchymal, and biliary volunteers, respectively. Cmax and AUC were consistently lower in subjects with parenchymal disease than those with biliary disease or normal volunteers but the reason for this is unclear. Statistically significant differences in clearance, due to lower non-renal and renal clearances in the biliary volunteers with single- or multiple-dose administration were found between the groups but these differences were not thought to be clinically or pharmacokinetically relevant for short-term antibiotic administration. With dirithromycin administered for 14 days or less, no dosage adjustment should be necessary in patients with mild hepatic insufficiency.

Imaging of the biliary sump syndrome.

Side-to-side choledochoduodenostomy is a safe and effective surgical technique to improve biliary drainage in selected patients. The segment of common bile duct between the anastomosis and the ampulla of Vater may act as a stagnant reservoir or sump. When debris, stones, or infected bile accumulates in the sump, usually because of malfunction of the ampulla of Vater, recurrent abdominal pain or symptoms of cholangitis, pancreatitis, or biliary obstruction may develop. This uncommon (0.14-1.30%) complication is known as the sump syndrome. On imaging studies, diagnostic findings are debris or stone(s) in the common bile duct. Suggestive findings are dilated bile or pancreatic ducts, and changes due to pancreatitis, cholangitis, or liver abscess. Patients with this syndrome frequently have multiple imaging studies before the condition is recognized. The purpose of this essay is to illustrate the imaging findings of this syndrome.