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Resection margin status is a known prognosticator in patients who undergo resection for hilar cholangiocarcinoma. However, the influence of an isolated positive circumferential margin on clinical outcome is unclear. Patients with resected de novo hilar cholangiocarcinoma from two European hepatobiliary centres (Medical University of Vienna and Aintree University Hospital, 2006–2016) were classified according to resection margin status (negative, surgically positive, isolated circumferentially positive) and investigated with respect to overall survival (OS), recurrence-free survival (RFS) and recurrence pattern. Eighty-three (48 male/35 female) patients were enrolled. The median age was 64 years (range 33–80). The median follow-up was 21.7 months (range 0.3–92.4). Forty (48%) patients had negative resection margins, 25 (30%) had an isolated positive circumferential margin and 18 (22%) had a positive surgical margin. The 5-year OS rates in patients with negative, isolated positive circumferential and positive surgical resection margins were 47%, 33% and 0%, respectively. Median OS was 45.6, 32.7 and 14.5 months, respectively (log rank, P = 0.011). Upon multivariable Cox regression analysis, resection margin status and lymph node status remained statistically significant (P 0.05). Our data show that these three resection margin types were associated with different clinical outcomes. Circumferential margin status may therefore serve as a novel prognostic biomarker.

Die neurologisch-psychiatrische Schlafmedizin umfasst die Diagnostik der Insomnien, Hypersomnien und Parasomnien. Ziel der Arbeit war die Uberprufung, welche Aufnahmediagnosen zu welchen Entlassdiagnosen fuhren und wie haufig ein Diagnosewechsel erfolgt. Hierzu wurden die polysomnografischen Befunde aller neurologisch-schlafmedizinischen Patienten im SRH Krankenhaus Pfullendorf der Jahre 2010 bis 2017 analysiert. In einem standardisierten diagnostischen Verfahren wurden Patienten mit neurologisch/psychiatrisch-schlafmedizinischen Fragestellungen untersucht. Im stationaren Setting wurden zwei Tagestests (Multipler Wachbleibetest und Multipler Schlaflatenztest) in drei Polysomnografien eingebettet. An der Studie nahmen 401 Patienten in 414 stationaren Aufenthalten teil. Die neurologisch-schlafmedizinische Diagnostik fuhrte in 46,9 % der Falle zu einem Diagnosewechsel. Haufigste Entlassdiagnose war bei 229 Patienten die Insomnie. Bei 44 Patienten wurde die Entlassdiagnose Narkolepsie gestellt. Die neurologisch/psychiatrisch-schlafmedizinische Diagnostik erlaubt die klare Diagnosestellung und damit den Beginn adaquater Therapie.

Das Thema Hyponatriamie ist von groser klinischer Relevanz in der taglichen Praxis. Es ist als „Symptom“ vieler unterschiedlicher Organerkrankungen zu sehen. Neben endokrinologischen sind auch nephrologische, pulmologische, kardiologische, neuropsychiatrische und gastrointestinale/hepatale Ursachen von Relevanz. Zusatzlich kann auch eine inadaquate Behandlung des Wasser- und Volumenhaushalts (Infusion oder diuretische Therapie) zu einer Hyponatriamie fuhren. Aktuelle europaische bzw. amerikanische Empfehlungen zur Diagnose und Therapie der Hyponatriamie konnen die Behandlung erleichtern. Diese Richtlinien sind wertvoll fur die tagliche Praxis, konnen aber nicht alle Aspekte abdecken. Deshalb ist es wichtig, auch die physiologischen Zusammenhange in der Entstehung und Aufrechterhaltung einer Hyponatriamie zu verstehen.

Traditionally, abdominal drainage (AD) is routinely inserted in patients after liver transplantation (LT) to drain ascites and to detect postoperative hemorrhage and bile leakage. However, the benefit of this surgical practice remains a matter of debate regarding potential drainage-associated morbidities. In a retrospective pair-matched analysis in a 1:1 ratio, 116 patients after LT were assessed with regards to benefits and risks of abdominal drainage under immunosuppression, respecting model for end-stage liver disease (MELD), age, and gender. The indications for LT were comparable between the drain and the no-drain group. There was an increased rate of early bile leakage in patients with abdominal drainage (13.8 vs. 1.7 %, p = 0.032). In addition, a significantly higher incidence of infections requiring antibiotic therapy was observed in the drain group (63.8 vs. 39.7 %, p = 0.015). The contribution of drains as a diagnostic tool was marginal, as in the drain group, other diagnostic tools than the drain itself confirmed 50 % of all early bile leakages and 60 % of postoperative hemorrhages. Overall, there was no difference regarding the incidence of incisional hernia after LT (8.6 vs. 10.3 %, p = 1.000), length of hospital stay (22.9 ± 18.7 vs. 18.6 ± 18.6 days, p = 0.215), and 1- and 5-year patient (p = 0.981) and graft survival (p = 0.092). Equal results can be achieved with or without an abdominal drain in recipients with whole-liver grafts in spite of an increased risk of postoperative infection and biliary leakage in the former group. A benefit of AD as a diagnostic tool could not be demonstrated.

A layered composite coating material with favorable properties for application as a transparent conductor is presented. It is composed of layers of three nanoscopic materials, namely zinc oxide nanoparticles, single wall nanotubes, and graphene oxide nanosheets. The electrically conducting layer consists of single wall nanotubes (SWNTs). The layer of zinc oxide nanoparticles acts as a primer. It increases the adhesion and the stability of the films against mechanical stresses. The top layer of graphene oxide enhances the conductivity of such coatings. Such three-layer composite coatings show better conductivity (without compromising transparency) and improved mechanical stability compared to pure SWNT films. The processes used in the preparation of such coatings are easily scalable.

PURPOSE Changes in electrolyte homeostasis are important causes of acid-base disorders. While the effects of chloride are well studied, only little is known of the potential contributions of sodium to metabolic acid-base state. Thus, we investigated the effects of intensive care unit (ICU)-acquired hypernatremia on acid-base state. METHODS We included critically ill patients who developed hypernatremia, defined as a serum sodium concentration exceeding 149 mmol/L, after ICU admission in this retrospective study. Data on electrolyte and acid-base state in all included patients were gathered in order to analyze the effects of hypernatremia on metabolic acid-base state by use of the physical-chemical approach. RESULTS A total of 51 patients were included in the study. The time of rising serum sodium and hypernatremia was accompanied by metabolic alkalosis. A transient increase in total base excess (standard base excess from 0.1 to 5.5 mmol/L) paralleled by a transient increase in the base excess due to sodium (base excess sodium from 0.7 to 4.1 mmol/L) could be observed. The other determinants of metabolic acid-base state remained stable. The increase in base excess was accompanied by a slight increase in overall pH (from 7.392 to 7.429, standard base excess from 0.1 to 5.5 mmol/L). CONCLUSIONS Hypernatremia is accompanied by metabolic alkalosis and an increase in pH. Given the high prevalence of hypernatremia, especially in critically ill patients, hypernatremic alkalosis should be part of the differential diagnosis of metabolic acid-base disorders.

Hypernatremia is common in the medical Intensive Care Unit (ICU) and has been described as an independent risk factor for mortality. Hypernatremia has not yet been studied in a collection of ICU patients after cardiothoracic surgery. Therefore, we wanted to determine the incidence of hypernatremia in a surgical ICU and its association with outcomes of critically ill surgical patients.In this retrospective cohort study performed at a surgical ICU of a university hospital in Vienna, patients were admitted to the ICU after major cardiothoracic surgery between May 1999 and October 2007. Data on serum sodium in the ICU, ICU mortality, hospital mortality, and length of ICU stay were collected prospectively.2,699 patients underwent surgery during the study period, and 2,314 patients were included in the study. Two hundred twenty-one (10%) patients acquired hypernatremia during their ICU stay. Median onset of hypernatremia was on day 4 (2-7). Patients with ICU-acquired hypernatremia had a higher ICU mortality (19%) compared to patients without hypernatremia (8%; p0.01). Length of ICU stay was increased in patients with hypernatremia (17 vs. 3 days; p0.01). In a multivariate Cox regression, ICU-acquired hypernatremia was an independent risk factor for ICU mortality within 28 days.Hypernatremia is a common event early in the course of critical illness after major cardiothoracic surgery and is independently associated with ICU mortality within 28 days. Future research should focus on the impact of hypernatremia on physiological functions as well as adequate and safe treatment of the electrolyte disorder.

Anders als von Herfried Munkler konstatiert ist eine fur die Botschaften irregularer Gewaltakteure empfangliche und unterstutzungswillige Offentlichkeit auch fur das Terrornetzwerk Al-Qaida von zentraler Bedeutung. Die in den vergangenen Jahren zu beobachtende Intention der Terroristen, eine Maximierung materieller Schaden und von Todesopfern in der Zivilbevolkerung herbeizufuhren, belegt keineswegs das Fehlen jeglicher politischer Zielsetzungen. Sie ist vielmehr das Ergebnis einer bewussten Entgrenzung des Feindbegriffs. Al-Qaida hat dezidierte und genuin politische Ziele; den Kern seiner Strategie macht jedoch das Bemuhen um eine hinreichende Mobilisierung der islamischen Bevolkerung aus. Die daraus resultierende fundamentale Bedeutung des „zu interessierenden Dritten“ fur Al-Qaida bietet zahlreiche Ansatzpunkte fur eine Strategie der „Gegenmobilisierung“, die sich starker auf den Bereich der public diplomacy konzentriert denn auf militarische Gewaltanwendung.

Zur Aufrechterhaltung des Flussigkeitshaushaltes im menschlichen Korper ist eine enge „Kooperation“ zwischen Herz und Niere notwendig. Aus evolutionarer Sicht ist dabei besonders interessant, dass der Niere etwa 25 Prozent des Herzminutenvolumens zur Verfugung stehen, um 150 Liter Primarharn zu filtrieren, aber davon nur ein Prozent letztendlich ausgeschieden wird. Dieser „hohe Arbeitsaufwand“ fur beide Organe erscheint absurd, lasst sich aber aus unserer Verwandtschaft mit den Suswasserfischen herleiten, die grose Mengen an hypotonem Harn produzieren mussen, um die uber die Haut und Kiemen resorbierte Wassermenge zu eliminieren.

Gitelman syndrome is a rare hereditary disorder of the thiazide-sensitive NaCl transporter in the distal renal tubular cells, but mimicking of such hereditary tubular disorders has been described in different autoimmune diseases (Sjögren syndrome, SLE, ...). A 62-year-old woman with painful red eyes and sicca syndrome presented at the ophthalmological department. The diagnostic evaluation identified a Sjögren syndrome with early endophthalmitis as the reason for the red eyes. Results of laboratory examination indicated severe hypokalemia, metabolic alkalosis and hypomagnesemia, although this had not been seen years earlier. Together with the urine analysis, a rare case of an acquired Gitelman syndrome was diagnosed. Substitution with potassium and magnesium improved the initial symptoms of weakness, but renal electrolyte wasting persisted even after treatment of Sjögren syndrome. In patients with autoimmune disease, laboratory analysis of serum electrolytes should be performed because different acquired tubular disorders can lead to severe hypokalemia.

Chronic breast pain after surgery can have a profoundly negative impact on the physical and psychosocial function of patients. Treatment options are still in development, and no method hitherto described 100% pain relief. A 45-year-old woman suffering from chronic pain following breast surgery, who underwent reduction mammaplasty that lead to 100% pain relief, is presented. We suggest that mammaplasty could be a valuable treatment option in treating carefully selected patients with chronic breast pain. To our knowledge, this is the first report of mammaplasty for the treatment of chronic breast pain following breast surgery.