Chancen und Herausforderungen der zunehmenden Digitalisierung der Lehre im Fach Anästhesiologie aus Sicht der Studierenden

Die Anaesthesiologie - Die COVID-19-Pandemie hat die medizinische Lehre weltweit verändert. Seit dem Sommersemester 2020 stehen digitale Lehrformate im Fokus, deren Einsatz zuvor in...     

Safety of same day discharge radial PCI in patients under and over 75 years of age

To check the safety of same day discharge radial PCI in patients under or over 75 years of age. A total of 943 patients who had same day discharge radial PCI between April 1998 and March 2001 were contacted. Patient health status, entry site complications, and repeat interventions during the first month after the procedure were compared in patients under 75 years of age (< 75) with those 75 or over (> or = 75). Responses were received from 811 patients (694 aged < 75 and 117 aged > or = 75 years). Two hundred and thirty-eight patients (34.3%) aged < 75 years and 36 patients (30.7%) aged > or = 75years reported one or more access site complications during the first 24 hours postdischarge, and 105 (15.1%) and 12 patients (10.3%), respectively, during the first month, (P > 0.05). However, all complications in both groups were minor and none of the patients required admission to the hospital. During the first 24 hours postdischarge only one patient (0.1%) aged < 75 years had a repeat angiogram showing a normal patent vessel, while during the first month 4 patients (0.6%) aged < 75 years and none aged > or = 75 years had target vessel closure. Out of the 132 patients who did not respond to our questionnaire, 1 patient aged < 75 and 1 patient aged > or = 75 years had subacute stent thrombosis within a month and died. There were no major entry site complications, and target vessel closure (0.6% versus 0.7%) was similar in patients aged < 75 and > or = 75 years. Thus, same day discharge radial PCI is safe in patients 75 years old or over.     

Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study.

OBJECTIVES: To assess the timeframe of postprocedural complications following transradial percutaneous intervention in selected nonlow-risk risk patients as a feasibility study for same day discharge. BACKGROUND: Percutaneous coronary intervention (PCI) is traditionally performed as an inpatient procedure. Transradial access with its lower complication rate facilitates safe and same day discharge. We hypothesize that with current standards of pharmacotherapy and intervention, complications post transradial percutaneous coronary angioplasty even in a nonlow-risk patient cohort will be evident within 6 hr or occur more than 24 hr post procedure. Under these circumstances, overnight stay results in no improvement in patient safety. METHODS: 2,189 patients underwent transradial PCI at our institution between January 2005 and June 2006. Of these 1,174 were assessed as intermediate or high risk and admitted postprocedure. The remaining 1,015 were assessed as low risk and discharged the day of procedure. All 1,174 inpatients were entered into our study database. Information was collected on patient demographics, angiographic characteristics, post procedural complications, and timing of post procedural events. RESULTS: 1,543 ACC type B2 or C lesions were treated in 1,174 patients. All post-procedural complications were identified within 6 hr of the intervention or occurred more than 24 hr later when patients would have been discharged according to overnight admission protocols. CONCLUSIONS: Day case transradial percutaneous intervention with a 6-hr period of post procedure observation is a safe and feasible practice. The presence of higher-risk features should not be considered an absolute indication for overnight admission in patients considered clinically appropriate for discharge.     

Myocardial tissue recruitment in the dog as determined by double tracer dilution method.

The amount of tissue perfused, as determined from the difference in volume of distribution between a diffusible indicator (125I-antipyrine) and an intravascular indicator (131 I-albumin) was measured at different values of coronary flow, perfusion pressure, and vasomotor tone in the working left ventricle of an open-chest dog. Coronary pressure and flow were regulated independently from the systemic circulation and coronary vasomotor tone was reduced by dipyridamole. At each flow vasomotor tone was assessed by using as a reference the maximal vasodilation induced by arrest of flow. Measured tissue space was considered to be related to the capillary surface area available for tracer diffusion and therefore to the number of perfused capillaries per volume of muscle. A relationship between coronary blood flow and tissue volume was observed. It was found to be independent of vasomotor tone. Vasodilation was found to increase available exchanging capillary surface at a constant perfusion pressure.     

Effects of perhexiline maleate on coronary flow distribution in the ischemic canine myocardium.

Intravenous perhexiline maleate in a canine preparation with fixed coronary flow increases coronary diastolic pressure. It also redistributes coronary flow so as to preserve endocardial flow. Myocardial oxygen consumption was reduced and lactate uptake enhanced by the drug. It had no effect upon the threshold for ischemic-induced left ventricular failure.     

Irreversible Bilddatenkompression in der Radiologie

Due to increasing amounts of data in radiology methods for image compression appear both economically and technically interesting. Irreversible image compression allows markedly higher reduction of data volume in comparison with reversible compression algorithms but is, however, accompanied by a certain amount of mathematical and visual loss of information. Various national and international radiological societies have published recommendations for the use of irreversible image compression. The degree of acceptable compression varies across modalities and regions of interest. The DICOM standard supports JPEG, which achieves compression through tiling, DCT/DWT and quantization. Although mathematical loss due to rounding up errors and reduction of high frequency information occurs this results in relatively low visual degradation. It is still unclear where to implement irreversible compression in the radiological workflow as only few studies analyzed the impact of irreversible compression on specialized image postprocessing. As long as this is within the limits recommended by the German Radiological Society irreversible image compression could be implemented directly at the imaging modality as it would comply with § 28 of the roentgen act (RöV).     

Feminizing genital reconstruction, sigmoid vaginal replacement and anorectoplasty as a one-stage procedure for anorectal atresia associated with ambiguous genitalia.

Anorectal atresia associated with male pseudohermaphroditism presents both diagnostic and surgical challenges. In the past, multiple operations were necessary for feminizing genitoplasty in gender-reassigned children with ambiguous genitalia. We combined the repair of an imperforate anus with a feminizing genitoplasty, including sigmoid vaginal replacement using the posterior sagittal approach in a 3-months-old infant. We conclude that a primary complete reconstruction is advantageous and should be performed in this condition.     

Comparison of medical-grade and calibrated consumer-grade displays for diagnosis of subtle bone fissures

Objective

To compare the diagnostic accuracy of medical-grade and calibrated consumer-grade digital displays for the detection of subtle bone fissures.

Methods

Three experienced radiologists assessed 96 digital radiographs, 40 without and 56 with subtle bone fissures, for the presence or absence of fissures in various bones using one consumer-grade and two medical-grade displays calibrated according to the DICOM-Grayscale Standard Display Function. The reference standard was consensus reading. Subjective image quality was also assessed by the three readers. Statistical analysis was performed using receiver operating characteristic analysis and by calculating the sensitivity, specificity, and Youden’s J for each combination of reader and display. Cohen’s unweighted kappa was calculated to assess inter-rater agreement. Subjective image quality was compared using the Wilcoxon signed-rank test.

Results

No significant differences were found for the assessment of subjective image quality. Diagnostic performance was similar across all readers and displays, with Youden’s J ranging from 0.443 to 0.661. The differences were influenced more by the reader than by the display used for the assessment.

Conclusion

No significant differences were found between medical-grade and calibrated consumer-grade displays with regard to their diagnostic performance in assessing subtle bone fissures. Calibrated consumer-grade displays may be sufficient for most radiological examinations.

Key points

? Diagnostic performance of calibrated consumer-grade displays is comparable to medical-grade displays.? There is no significant difference with regard to subjective image quality.? Use of calibrated consumer-grade displays could cut display costs by 60-80%.

     

Heterogeneity of glioblastoma with gliomatosis cerebri growth pattern on diffusion and perfusion MRI

Journal of Neuro-Oncology - Gliomatosis cerebri (GC) is a rare growth pattern of glioblastoma whose diffuse nature is reflected by unspecific, relatively uniform findings on conventional MRI. In...     

Akuter Vestibularisausfall Eine seltene Differentialdiagnose im Kindesalter

Bei einem 10j?hrigen Jungen bestand nach einer Luftweginfektion wegen Nüchternerbrechens, Schwindels und Spontannystagmus der Verdacht auf erh?hten Hirndruck. Bei kalorischer Unerregbarkeit eines Vestibularorgans und normalem Liquor- und Kernspintomographiebefund des Sch?dels stellten wir jedoch die Diagnose eines akuten Vestibularisausfalls, der sich rasch spontan zurückbildete. Das Pr?dilektionsalter dieser Erkrankung liegt bei 40–50 Jahren, nur 5% der Patienten (Inzidenz 4:100000) sind Kinder. Sie gilt als vestibulares ?quivalent des H?rsturzes. Charakteristisch sind akute Schwindelattacken, kalorische Unter- bzw. Unerregbarkeit eines Vestibularorgans ohne kochle?re Symptome, und die Abwesenheit einer zentralnerv?sen St?rung. Urs?chlich sind infekti?se und ferner vaskul?re, metabolische und toxische Affektionen, die im Kindesalter keine Rolle spielen. Hier geht der Erkrankung in der Regel eine virale Luftweginfektion voraus. Im Gegensatz zum Erwachsenenalter ist im Kindesalter die Prognose exzellent.