Changes in ductus venosus flow profile in twin-twin transfusion syndrome: role in risk stratification.

OBJECTIVES: To evaluate changes in ductus venosus (DV) waveforms and the timing of these changes in twin-twin transfusion syndrome (TTTS), to relate these to disease severity and to assess the clinical applicability of the suggested measurements in the prediction of TTTS. METHODS: DV time intervals and velocity-time integrals (VTI) normalized to cardiac cycle and total VTI, respectively, as well as velocity ratios were analyzed in 149 monochorionic diamniotic (MCDA) twin pairs. Pregnancies were assigned to the following groups: uncomplicated MCDA (n = 29); TTTS Stages I+II (n = 50); TTTS Stages III+IV (n = 49); and pre-TTTS (n = 21), of which 14 remained stable and seven progressed to TTTS. Intertwin differences were calculated as larger/recipient minus smaller/donor and related to disease severity. Receiver-operating characteristics curve analysis was used to distinguish TTTS vs uncomplicated MCDA and pre-TTTS progressing to TTTS vs non-progressing pre-TTTS. Intra- and interobserver reliability of measurement of DV parameters were evaluated using intraclass correlation coefficients (ICCs). RESULTS: No intertwin differences in DV parameters were found in uncomplicated MCDA pregnancies. Diastolic VTIs and filling times were significantly shorter in recipient twins in TTTS cases and in larger pre-TTTS twins in comparison with their cotwins. Time intervals, VTIs and velocity ratios correlated significantly with Quintero stages. An intertwin difference in early filling time (eT) normalized to cardiac cycle, eT (%) ≤ -3.6%, could differentiate TTTS from uncomplicated MCDA pregnancies (82.8% sensitivity; 79.8% specificity) and eT (%) ≤ -2.8% predicted progression to TTTS (73.1% sensitivity; 67.4% specificity). CONCLUSIONS: DV flow profiles and timing of waveform events are already altered in pre-TTTS and early-stage disease, reflecting abnormal ventricular filling and circulatory imbalance. Intertwin comparison of filling times and VTI may allow prediction of evolving TTTS in MCDA pregnancies. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Tissue Doppler imaging in fetuses with aortic stenosis and evolving hypoplastic left heart syndrome before and after fetal aortic valvuloplasty.

OBJECTIVES: Fetal aortic valvuloplasty can improve filling and reduce afterload of the left ventricle in critical aortic stenosis. Success of an intrauterine intervention is currently measured by technical success, clinical survival and eventual postnatal biventricular physiology. In the present study we investigated the use of tissue Doppler imaging (TDI) to evaluate changes in ventricular function assessed before and after prenatal aortic valvuloplasty. METHODS: Between October 2008 and December 2012, cardiac function was assessed by TDI before and after intervention in 23 fetuses that underwent technically successful valvuloplasty for critical aortic stenosis and in which postnatal outcome was known. The measurements were transformed into gestational age-independent Z-scores where appropriate. RESULTS: Mean ± SD gestational age at intervention was 27.5 ± 3.1 weeks. Of the 23 fetuses, 14 had biventricular outcome. Before intervention all left ventricular (LV) TDI-derived parameters and mitral annular plane systolic excursion (MAPSE) were severely abnormal. It was possible to demonstrate considerably improved cardiac function after technically successful valvuloplasty. Among fetuses with postnatal biventricular outcome, TDI-derived LV myocardial peak velocity during early diastole (E') and myocardial peak velocity during systole in the ejection phase (S') significantly increased, E'/myocardial peak velocity during late diastole with atrial contraction (A') increased towards normal values, and LV transmitral-to-mitral-annular diastolic velocity ratio (E/E') and myocardial performance index (MPI') decreased but remained abnormally elevated. In addition, right ventricular A', S' and MPI' significantly improved after intervention. CONCLUSION: Technically successful fetal aortic valvuloplasty led to significantly improved myocardial performance. It was possible to use TDI to detect distinct changes in ventricular function and TDI-derived parameters correlated with a biventricular outcome after birth. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Urinary tract infection prophylaxis using Escherichia coli 83972 in spinal cord injured patients.

PURPOSE: Escherichia coli 83972 was previously shown to establish bladder colonization in select patient groups. We evaluate the safety and feasibility of using bacterial interference with E. coli 83972 to prevent urinary tract infection in spinal cord injured patients. MATERIALS AND METHODS: A total of 21 men and women with neurogenic bladder secondary to spinal cord injury underwent intravesical inoculation with E. coli 83972. Frequency of symptomatic urinary tract infection before and after colonization was compared. RESULTS: Successful long-term bladder colonization was achieved in 13 study participants. Mean duration of colonization was 12.3 months (range 2 to 40). Subjects had no symptoms of urinary tract infection while colonized with E. coli 83972 (0 infection per 18.4 patient-years). Successfully colonized subjects had experienced a mean of 3.1 symptomatic urinary tract infections per year (range 2 to 7) before colonization. Symptomatic infection also occurred in 4 subjects who were not successfully colonized with E. coli 83972 and in 7 others after spontaneous loss of colonization. Colonized subjects reported subjective improvement in quality of life with respect to urinary tract infection while colonized. CONCLUSIONS: E. coli 83972 may be safely used to establish long-term asymptomatic bladder colonization in spinal cord injured subjects. Preliminary findings suggest that colonization with E. coli 83972 may reduce the frequency of urinary tract infection in patients with neurogenic bladder secondary to spinal cord injury.

Virulence properties of Escherichia coli 83972, a prototype strain associated with asymptomatic bacteriuria.

Little is known about bacteria associated with asymptomatic bacteriuria (ABU) with regard to urinary tract colonization mechanisms. In this study, virulence properties of Escherichia coli 83972, a strain that was isolated from a clinical ABU episode, were examined. The genetic potential for expression of P and type 1 pili was demonstrated, and DNA sequences related to type 1C and G (UCA) pilus genes were also detected. However, E. coli 83972 did not express D-mannose-resistant or D-mannose-sensitive hemagglutination after growth under standard conditions in vitro or upon isolation from the urine of colonized test subjects. Limited uroepithelial cell adherence was observed in vivo, and weak D-mannose-sensitive hemagglutination was detected after extended growth in urine in vitro.

Virulence factors of Escherichia coli isolates from patients with symptomatic and asymptomatic bacteriuria and neuropathic bladders due to spinal cord and brain injuries.

Chronic bacteriuria is a common occurrence among spinal-cord injury patients and others with neuropathic bladders. If bacteria are present in the urinary tract, the patient may develop symptoms of infection or remain asymptomatic. We have compared virulence properties of 28 Escherichia coli isolates from patients with symptomatic urinary tract infections (UTI) and 29 E. coli isolates from patients with asymptomatic bacteriuria (ABU). Bacteria from patients with symptomatic UTI were more likely to be hemolytic than isolates from patients with ABU (P = 0.05) or fecal isolates obtained from healthy volunteers (P < 0.001). Bacteria from patients with symptomatic UTI were also more likely than strains isolated from patients with ABU (P = 0.08) or fecal strains (P < 0.001) to exhibit D-mannose-resistant hemagglutination of human erythrocytes. The results suggest that E. coli isolates from nonimmunocompromised patients who require intermittent catheterization and who develop symptomatic UTI may be distinguished from bacteria recovered from patients who remain asymptomatic and possibly from normal fecal E. coli.

Injuries due to letter bombs.

In Austria in late 1993 ten letter bombs were sent to outstanding persons who have been engaged in the care of foreigners. Four of these bombs detonated, when they were opened by the addressee. The remaining six bombs were discovered in time and could be deactivated by specialists. The construction of these bombs and the lesions sustained by the four victims will be discussed. The injuries mainly concerned the left hand, i.e., the hand used by right-handed persons to hold a letter when opening it. The way holding the letter was of crucial influence on the degree of injury, as with the same explosive charge (which can be assumed deducing from the investigation of the deactivated bombs) injuries varied considerably. They ranged from minor tissue-lesions to mutilated fingers and the risk of exsanguination.

[Electroshock devices as weapon]. / Elektroschockgeräte als Waffe.

13 electric shock weapons were investigated. The authors measured the electrical output and observed the effects on corpses and test persons. The electric shock weapons produced only moderate pain and did not stop the disposing capacity. The electrocardiogram and the circulation parameters were not influenced. The electric shock weapons tested might have only a limited deterrent effect and might be able to cause fatal complications under circumstances. Drug use and heart disease might enhance the risk.

Shots fired with silencers--a report on four cases and experimental testing.

Four cases of homicide, in which silenced firearms were used, are reported and supplemented by data from experimental investigations regarding wound features, marks, traces, and ballistic behavior. Wound features are largely determined by the construction of the silencer. In one case, even a muzzle imprint was produced by a silenced weapon fired at contact range. In general, silencers are likely to result in a decrease in bullet energy and accelerated energy release in the target (tissue). In terms of wound morphology, silencers produced a reduction in or even a lack of the contact ring (ring of dirt). In close-range and contact wounds, any features indicative of shots fired at close range were missing (such as soot deposit and powder tattooing). It is also worth mentioning that biological matter may get into the silencer in shots fired at contact range.

[Simulation of terrorist attacks and incidents as an aid in investigating and reconstructing homicides of political significance]. / Die Simulation von Terroranschlägen und Attentaten als Hilfsmittel zur Aufklärung und Rekonstruktion von Tötungsdelikten mit politischer Tragweite.

The investigation of political motivated crimes and terrorist attacks requires also methods which include aspects of public relations. We present a simulation method which is useful for investigation of crimes and furthermore for giving evidence in court and also information to the public.

[Medical and technical aspects of weapon effects. IV. Plastic bullets reduce the risk of the military assault rifle (StG 77)]. / Medizinische und technische Aspekte der Waffenwirkung. IV. Kunststoffgeschosse verminderter Gefährlichkeit für das Sturmgewehr (StG 77).

56 x 45 mm Rota-ammunition was introduced to meet the requirements of security personnel at prisons. The Austrian military assault rifle (StG 77) can be used for this ammunition. The bullet consists of an X-ray dense plastic material with a weight of 1.6 g. Therefore the kinetic energy of this projectile is lower than that of the standard ammunition, also on its flight it loses velocity at a higher rate. Thus, this bullet has the advantage of being less dangerous over long distances (500 m versus 2500 m or more) but still offers at short distances (fe 10 m) a reasonable capacity of incapacitation. Tests concerning ballistics, penetration and shooting at gelatine and soap targets were performed. By means of these tests we compared the wounding capacity of the standard ammunition (5.56 x 45 mm S-cartridge) and the investigated Rota-ammunition.

[Medical and technical aspects of the effect of weapons III. Black powder muzzle loading guns]. / Medizinische und technische Aspekte der Waffenwirkung III. Schwarzpulvervorderladerwaffen.

The report deals generally with ballistics and morphology of wounds caused by black powder muzzle loading guns. Two cases are reported.

[Gunshot wounds of the head in soldiers wearing military helmets-- general aspects and experiments and observations on the biomechanics and wound morphology]. / Schädelschüsse bei Trägern militärischer Schutzhelme--Allgemeines sowie Experimente und Beobachtungen zur Biomechanik und Wundmorphologie.

With respect to wound ballistics, the situation is different if the person wearing a military helmet suffers head injuries from a bullet. The mechanisms of injury were investigated in four experimental series and supplemented by a case history. The study showed surprising results: in the majority of cases, the helmet does not protect the wearer, but instead intensifies the damage caused by the bullet. The reasons for this phenomena are changes in the stability of the projectile and deformation of or damage to the bullet. All of these mechanisms result in the bullet striking the tissue with higher energy. In this investigation, Kevlar helmets were also tested, which are not penetrated by 9 X 19 mm parabellum bullets. Even so, however, severe injuries of the skull and brain can occur because the projectile causes intensified impressions on the skull under the helmet and, in addition, an acceleration of the head.

[Teeth as an intermediate target--a cause for rapid disintegration of the full metal-jacketed bullets used by the military]. / Zähne als Zwischenziel--eine Ursache für die rasche Zerlegung von militärisch verwendeten Vollmantelgeschossen.

Sharp-pointed full metal-jacketed bullets fired from assault rifles are expected to have a low tendency of deformation or destruction within biological tissues. In principle this also should apply to small calibre projectiles .223. If a bullet penetrates the oral region, contact with teeth can cause early break up and even total disintegration of the projectile. Under such circumstances the fragments are possibly retained within the body. A case of accidental gunshot injury to the head inflicted with an assault rifle AUG Steyr. 223 of the Austrian army serves to demonstrate and discuss the wound ballistic effects in relation to the altered behaviour of the projectile. Analogous findings were reproduced in experimental models.