Unilateral flooding of the lung after intubation with a double-lumen tube makes intraoperative sonography of the lung during video-assisted thoracoscopic surgery possible. After flooding with 15 ml/kg, the arterial partial oxygen pressure (with FiO2=1.0) is higher than that in total atelectasis by about 100 mmHg, while it is only slightly less than that during bilateral lung ventilation. Compared to total atelectasis, lung flooding reduces the pulmonary right-to-left shunt volume. The pulmonary function normalizes within 8 h after the operation.

A sonographic examination of the lung has so far been impossible because of sound reflection. In conjunction with video-assisted thoracoscopic surgery, lung sonography would be helpful to make up for the lack of direct palpation. Animal experiments with pigs were performed to find out whether lung sonography becomes possible following bronchoalveolar flooding with a suitable liquid. The lung was filled with whole electrolyte solution through the left leg of a double-lumen endotracheal tube after resorption atelectasis (method 1) or compressive atelectasis (method 2). As an alternative, liquid perfluorocarbon was used (method 3). Under atelectasis, the lung thus flooded was investigated by ultrasound applied transpleurally and endobronchially. The first results proved that lung flooding is possible if certain prerequisites are fulfilled. Perfluorocarbon flooding led to total sound absorption which prevented sonography, whereas flooding with whole electrolyte solution made complete lung sonography possible, making visible the intrapulmonary vessels, bronchi and peribronchial lymphatic nodes. Measurements proved that the unilateral flooding caused no significant changes in the arterial and central venous pressure nor in transcutaneous oxygen saturation.

The vibrational relaxation of the liquid dihalomethanes CH 2 I 2 , CH 2 Br 2 and CH 2 Cl 2 has been studied by a combination of IR/IR and IR/Raman pump-probe techniques applying a time resolution of ~2 ps.Careful analysis of the results shows a general trend of decreasing relaxation rates from dichloromethane to diiodomethane, with few individual deviations.Possible explanations for these observations are discussed.

Recently, the HESS collaboration has reported the detection of gamma-ray emission above a few hundred GeV from eight new sources located close to the Galactic Plane. The source HESS J1813-178 has sparked particular interest, as subsequent radio observations imply an association with SNR G12.82-0.02. Triggered by the detection in VHE gamma-rays, a positionally coincident source has also been found in INTEGRAL and ASCA data. In this Letter we present MAGIC observations of HESS J1813-178, resulting in the detection of a differential gamma-ray flux consistent with a hard-slope power law, described as dN/(dA dt dE) = (3.3+/-0.5)*10^{-12} (E/TeV)^{-2.1+/-0.2} cm^(-2)s^(-1)TeV^(-1). We briefly discuss the observational technique used, the procedure implemented for the data analysis, and put this detection in the perspective of multifrequency observations.

Einführung: Die akute Darmischämie stellt immer noch eine diagnostische und therapeutische Herausforderung dar. Bei klinischer Verdachtsdiagnose muss die bildgebende Diagnostik ohne Aufschub dringlich erfolgen. Bei hoher perioperativer Letalität diskutieren wir die Lyse des akuten Verschlusses einer Viszeralarterie als alternatives therapeutisches Verfahren am Beispiel eines klinischen Falles.

INTRODUCTION:For surgeons the acute intestinal ischaemia is still a diagnostic and therapeutic challenge. If clinically suspected, the diagnostic procedures such as duplex sonography and arterial angiography should be carried out immediately. Although the diagnosis is often quickly clear, perioperative mortality rate remains high. We report the acute local thrombolytic therapy as an alternative treatment.CASE REPORT:A 80-year-old male patient was referred to our hospital with a complete occlusion of the superior mesenteric artery. Duplex sonography and the arterial angiogram confirmed the clinical diagnosis. Because the patient was assessed to be at high risk we decided to avoid an operation and local thrombolytic therapy using rt-PA and urokinase was carried out.RESULT:The local thrombolytic therapy was successful and led to a complete restoration of the arterial flow within the superior mesenteric artery. The clinical symptoms subsided and no complications were observed.CONCLUSION:Local thrombolytic therapy appears to be a suitable therapeutic option in patients suffering of mesenteric arterial occlusion. Although the duplex sonography often confirms the diagnosis with high accuracy the angiography remains the diagnostic gold standard.

Obwohl die indirekte Embolektomie nach Fogarty et al. [2] zur Therapie der peripheren arteriellen Embolie ein einfach durchzuführendes Verfahren darstellt, ist dieses Krankheitsbild weiterhin mit unverändert hohen Amputationsund Mortalitätsraten verbunden. In der vorliegenden retrospektiven Erhebung (374 Patienten) fanden sich eine Gesamtmortalität von 16,8% und eine Amputationsrate von 9,1%. Die 10-Jahres-Uberlebensrate betrug 38,1%. Zur Klarung der Ursachen der Re-Verschlüsse, welche in 91,2% an gleicher Lokalisation wie der urspriingliche embolische Verschluss gefunden wurden und neben anderen Faktoren entscheidend die Prognose beeinflussen, erfolgte die Einführung der angioskopisch kontrollierten Embolektomie.

There are about 1.5 million sports injuries in Germany every year, but concomitant vascular injuries are rarely encountered. Only single cases have been reported in the literature. The records of 216 patients with vascular injuries who were admitted to the university hospital in Jena between 1987 and 1996 were retrospectively reviewed. Six patients sustained a vascular injury during the accident in different kinds of sport. Vascular repair was successfully performed in three cases. Organ resection was necessary in two cases and one patient was treated conservatively. Most vascular lesions are related to blunt trauma which might create delayed symptoms of ischemia. Therefore measurement of limb pressures, Doppler scan, duplex ultrasonography and angiography are adjuncts in patients evaluation. In case of bleeding or complete ischemia the prompt arterial reconstruction is indicated and subsequently minimizes the risk of reperfusion injury.

Die indirekte Embolektomie nach Fogarty (1963) hat trotz guter Initialergebnisse Nachteile, die im „blinden“ Charakter der Methode bestehen (resultierende inkomplette Ischämie in 30%, Reolddusionsrate 20% und in 90% Reokklusion der gleichen Extremität - eigene Ergebnisse, 27 Jahre Verlaufsbeobachtung), die nach effizienten Kontrollverfahren suchen lassen. Die intraoperative Angioskopie ist eine Methode, die diese Ursachen aufdecken könnte. Insgesamt wurden 56 Embolektomien seit 1994 angioskopisch intraoperativ begleitet. Die begleitende Angioskopie erlaubt die exakte Diagnose „Embolie“ und ermoglicht eine genaue Lokalisation der Thromben. Weiterhin kann durch die Farbbestimmung des Thrombus eine Therapieoption vorgegeben werden (weiß = mechanische Entfernung; rot = Lyse möglich). Die Diagnose der organisierten Embolie (= Wandverhaftung) ist nur durch Angioskopie stellbar. Reflux und gefördertes Thrombenmaterial sind keine Hinweise auf eine vollständige Lumenwiederherstellung. In 90% der historischen Embolektomie-manö wird lumenverschließendes Material zurückbelassen(!). Ebenfallss neu entdeckt werden distale Embolisationen vorangeschalterer arterieller Verschlussbezirke. Eine angioskopie-assistierte Embolektomie ist wegen beobachteter distaler Embolusmigration nicht empfehlenswert. Gegnüber der intraoperativen DSA besteht der Vorteil der unmittelbarren Reaktionsmöglichkeit auf das Endoskopieergebnis ohne Kontrastmittel und Röntgenstrahlung bei noch eröffnetem Gefäß. Es wurden Angioskope der Firmen BAxter, Krauth, Olympus, PolyDiagnost und Storz eingesetzt.

One-lung flooding makes the intraoperative sonography of round pulmonary lesions possible. During the flooded phase, the flooded lung suffers a significant reduction in perfusion. After ischemia and reperfusion, neutrophil granulocytes lead to further tissue injuries. A study was made on four animals to determine whether administration of pentoxifylline — a potent inhibitor of granulocyte adhesion to the endothelium — improves lung function after one-lung flooding. Two animals were subjected to thoracotomy with extended hemodynamic monitoring. Thoracoscopy was performed on two other animals, which were extubated after the flooding liquid was drained and survived for 24°h. A bolus of 1 mg/kg of pentoxifylline was administered at the time of thoracotomy/thoracoscopy, followed by continuous infusion of pentoxifylline at a rate of 1.5 mg/kgper hour until 30°min after reventilation (thoracotomy), or until extubation, respectively. The control group consisted of animals employed in previous experiments. Except for pentoxifylline administration, they were subjected to identical experimental conditions. The control group for the thoracotomy experiment comprised 14 animals, that for the thoracoscopy experiment three animals. The experiments proved that 30°min after the draining of the flooding liquid and reventilation, all four pentoxifylline-treated animals had a higher partial arterial oxygen pressure and a lower pulmonary shunt volume compared with the control animals. In the two animals that survived, a positive effect on lung function was no longer detectable 24°h after extubation. The administration did not lead to a drop in the pulmonary arterial pressure and did not cause any hemodynamic changes other than a moderate tachycardia.

Zur prä- und postoperativen angiologischen Diagnostik für den Gefäßchirurgen zählen in erster Linie die Anamnese, die klinische Untersuchung, Ultraschalluntersuchungen (pw-Doppler-Sonographie und Duplexsonographie), angiographische Methoden (Digitale Subtraktionsangiographie und Magnetresonanztomographie der Gefäße) und die Computertomographie. Wofür wird dann noch die Angioskopie gebraucht?

Bericht über eine Aortenstentimplantation unter ausschließlicher Gefäßdarstellung mit Kohlendioxid am 23.07.1998.

Unilateral flooding of the lung after intubation with a double-lumen tube enables intraoperative sonography of the lung tissue. The flooding restricts the pulmonary blood stream of the flooded lung in a relevant degree and thus reduces the right-to-left shunt volume. The deficient perfusion of the lung tissue during the flooded phase might cause capillary permeability disorders and secondary oedema development. This can be determined by examination of extravascular lung water (EVLW) after draining and reventilation of the flooded lung. Although one-time unilateral lung flooding must be distinguished from bronchopulmonary lavage, it is interesting to study the effects of flooding on the surfactant system. The wet-to-dry ratio of the lung tissues of 13 female pigs was ascertained at different times following one-lung flooding (1 to 11 weeks). A trend towards an increased wet-to-dry ratio in the previously flooded lung was found only in the tissue samples taken 1 h after reventilation. After only 24 h, the two lungs no longer differed in their wet-to-dry ratio. In six pigs, the phospholipid content of the drained flooding liquid was determined. It was shown that the surfactant loss caused by flooding was maximally 47% of the calculated surfactant pool of the respective lung.

Ziel Zentrales Problem bei der Implantation von Aortenstents bei infrarenalen Bauchaortenaneurysmen ist das Auftreten von Endoleckagen mit folgender Größenprogredienz bis zur Aneurysmaruptur. Ziel der Untersuchung war die frühzeitige direkte Erfassung von Endoleckagen mittels Computertomographie (CT), farbkodierter Duplexsonographie (FKDS) und kontrastmittelgestützter farbkodierter Duplexsonographie (KFKDS).

The thermalization processes of well defined excess energy in liquid chloroform were studied on a wide range of time scales. Starting with nearly 10% vibrational population of the CH stretching vibration created by intense picosecond infrared pulses, time resolved spontaneous Raman scattering experiments were performed and analyzed yielding equilibration of the vibrational manifold within less than a nanosecond. The following slower processes were investigated by monitoring the time dependence of thermal lensing and scattering in the excitation volume. The volume expansion (bubble formation included) was found to take several ten μs. As slowest process heat conduction revealing a typical time constant of a few milliseconds is observed.