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Birth-related fractures are an important differential diagnosis of child abuse in early infancy. While fractures associated to vaginal deliveries are well known, cesarean section is not necessarily known to cause such injuries. Nevertheless neonatal fractures have been described after cesarean sections. To give an overview over the frequency and typical locations of such fractures, the appearance of symptoms and the timespan until diagnosis, a literature research was conducted via Google scholar and Pubmed, using the key words “cesarean section” and “fractures”. Birth-related fractures after cesarean sections are rare but can occur, with the long bones being particularly affected. Therefore, birth injuries should always be considered in the forensic medical assessment of fractures in early infancy, even after cesarean section. To enable a differentiation between birth trauma and physical abuse, birth and operation records should be checked for surgical manoeuvres, possible difficulties during the procedure or other risk factors. Birth-related fractures are usually detected early; in rare cases, the diagnosis is made only weeks after birth.

Peatlands have acted as net CO2 sinks over millennia, exerting a global climate cooling effect. Rapid warming at northern latitudes, where peatlands are abundant, can disturb their CO2 sink function. Here we show that sensitivity of peatland net CO2 exchange to warming changes in sign and magnitude across seasons, resulting in complex net CO2 sink responses. We use multiannual net CO2 exchange observations from 20 northern peatlands to show that warmer early summers are linked to increased net CO2 uptake, while warmer late summers lead to decreased net CO2 uptake. Thus, net CO2 sinks of peatlands in regions experiencing early summer warming, such as central Siberia, are more likely to persist under warmer climate conditions than are those in other regions. Our results will be useful to improve the design of future warming experiments and to better interpret large-scale trends in peatland net CO2 uptake over the coming few decades.Peatlands have historically acted as a carbon sink, but it is unclear how climate warming will affect this. The response of peatland carbon uptake to warming depends on the timing of summer warming; early warming leads to increased CO2 uptake and later warming to decreased uptake.

Object Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires. Methods Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement. Results On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures. Conclusions Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.

Objective Few studies have investigated the implications of intracerebral hematoma (ICH) due to rupture of a middle cerebral artery (MCA) aneurysm and patient outcomes. We hypothesized that patients with Hunt-Hess (HH) grade IV-V may not benefit from aggressive measures. Methods A prospectively acquired aneurysm database was examined. We found 144 patients who harbored a ruptured MCA aneurysm and suffered from ICH or intrasylvian hematoma with or without subarachnoid hemorrhage. The mean age of our patients was 52.5 years (range, 10–82 years) with 87 women and 57 men. Of these, 122 (84.7%) underwent a combination of interventions, including clip ligation, hematoma evacuation, and/or endosaccular coiling; most patients underwent clip ligation at the same time as their hematoma was evacuated. The discharge information was not available for two patients. We examined significant associations among presenting details (e.g., age, sex, admission HH grade) and patients' final outcome. Results The total in-hospital mortality rate was 49% (70 of 142 patients); 42% (51 of 120) for the patients who underwent an intervention and 86.4% (19 of 22) for those who did not undergo any intervention. Among our patients, approximately 52% with an admission HH grade of IV/V died in-hospital after surgery, whereas 21% with admission HH grade of I-III expired during the same time. In the patient cohort with presenting with HH grade IV and V, 4% (3 of 76) demonstrated Glasgow outcome scale 4-5 at discharge, whereas 15% (12 of 78) displayed Glasgow outcome scale 4-5 at 6-month follow-up. Age and sex did not affect outcome. Conclusions Aggressive clip ligation and hematoma evacuation remains a reasonable option for patients suffering from an ICH associated with a ruptured MCA aneurysm. Admission HH grade is the primary prognostic factor for outcome among this patient population as more than half of patients with HH grade IV and V expired during their hospitalization despite aggressive treatment of their hematoma and aneurysm. Long-term functional outcome was poor in up to 85% of surviving patients with HH grade IV-V. It may be beneficial to discuss these prognostic factors with the family before implementing aggressive measures.

Hintergrund: Es werden die Ergebnisse endonasaler Dakryozystorhinostomien (DZR) mithilfe einer transkanalikularen Transillumination und anschliesender Intubation vorgestellt. Material und Methode: 50 endonasale Dakryozystorhinostomien wurden nach einem Mindestintervall von 6 Monaten postoperativ nachuntersucht und zusatzlich die Krankenakten systematisch ausgewertet. Eingeschlossen wurden alle Patienten uber 18 Jahre. Ergebnisse: 50 endonasale Dakryozystorhinostomien wurden an 40 Patienten (78 % Frauen, 22 % Manner) durchgefuhrt. 27 Tranenwege wurden primar operiert, 16 Patienten hatten bereits Voroperationen. In 8 Fallen musste eine Revision durchgefuhrt werden (7 endonasale DZR, 1 externe DZR). Der Median des Alters lag zum Zeitpunkt der Operation bei 48 Jahren, der Median der praoperativen Beschwerdedauer bei 24 Monaten. Bei 42 % der Falle lag eine chronische Dakryozystitis vor. Als Vorerkrankungen bestanden in 3 Fallen eine Sarkoidose und in 1 Fall ein Morbus Wegener. Neben der Obstruktion der Tranenwege wurden zusatzliche Befunde im selben Eingriff saniert (Septumplastiken [n = 12], Nasennebenhohlenoperationen [n = 10], Nasenmuschelkaustiken [n = 7], Konchektomien [n = 1], Entfernung einer Dakryozele [n = 1]). 20 Operationen wurden rechts, 26 links und 2 beidseits durchgefuhrt. Der Median der Operationsdauer lag bei 51 Minuten. Operative Komplikationen traten nicht auf. Die Krankenhausaufenthaltsdauer betrug im Median 4 Tage. Der Median der Dauer bis zur Nachuntersuchung lag bei 23 Monaten. Die Erfolgsrate nach Durchfuhrung von Revisionsoperationen betrug 78 %. Diskussion: Mit einer Rate von 78 % wird in dieser Studie trotz Voroperationen (16 von 40 Patienten) eine gute Erfolgsrate erreicht. Dies wird auf die Technik der Transillumination zuruckgefuhrt. Durch die sichere intraoperative Lokalisierung des Tranensacks mithilfe einer transkanalikular eingefuhrten Lichtsonde wird die Beseitigung der Obstruktion erleichtert.

Object Organ transplantation for renal, liver, cardiac, and pulmonary failure has become more common in recent years, and patients are living longer as a result of improved organ preservation methods, immunosuppressive regimens, and general posttransplant care. Some of these patients undergo spine fusion surgery following organ transplantation, and there is little available information concerning outcomes. The authors report on their experience with and the outcomes of spine fusion in this rare and unique immunosuppressed patient group. Methods Using the Current Procedural Terminology and ICD-9 codes for solid organ transplants, bone marrow transplantations (BMTs), and spine fusion surgeries, the authors searched their patient database between 1997 and 2008. Data points of interest included primary diagnosis, type of organ transplant, immunosuppressant drug therapy, complications from spine surgery, and radiographic analysis of spine fusion. Spine fusion was assessed with CT or radiography at the latest follow-up. Results The database search results revealed 5999 patients who underwent heart, lung, liver, kidney, pancreas, intestine, or bone marrow transplant between 1997 and 2008. Eighteen of the 5999 patients underwent a spine fusion surgery while receiving immunosuppressive therapy. Organ transplants included kidney, liver, heart, pancreas, and allogenic BMT. There were 3 deaths unrelated to spine fusion within 1 year of the surgery and 1 death immediately after spine surgery. Graft-versus-host disease developed in 1 patient when prednisone was stopped prior to the spine surgery. Thirteen patients underwent follow-up radiographic imaging at an average of 25 months after spine surgery; 12 demonstrated radiographic fusion. Conclusions The results suggest that spine fusion rates are adequate despite immunosuppressive therapy in patients undergoing spinal fusion after transplant procedures. The data also illustrate the high morbidity and mortality rates found in the organ transplant patient population.

In this paper, a novel strategy for statistical analysis and multi-objective robust design-parameter optimization of forming processes as well as forming-to-crash process chains is discussed and results presented for a ZStE340 metal blank of a B-pillar. The strategy comprises both physical experiments and numerical simulation and is built upon a novel material and damage model as well as several software tools which allow for an efficient sensitivity, stability and robustness analysis, even for simulation results on highly resolved grids.

Head-to-head poly(vinyl cyclohexane) (H-H PVCH) was prepared from 2,3-diphenylbutadiene, which was polymerized by radical, 1,4 polymerization to poly(2,3-diphenylbutadiene) and then catalytically hydrogenated to H-H PVCH, H-H PVCH was also prepared by catalytic hydrogenation of H-H polystyrene (PS). The catalytic hydrogenations were carried out at an initial hydrogen pressure of 2000 psi and a temperature of 200°C. Some chemical, physical, and thermal properties of H-H PVCH were investigated and compared with the properties of atactic and isotactic head-to-tail (H-T) PVCH. The glass transition temperature of the H-H polymer was found to be 50°C lower than that of the atactic H-T polymer which indicates that the backbone chain has more flexibility. Both H-H and H-T PVCH showed comparable thermal stability. The temperature of the maximum rate of thermal degradation by differential thermogravimetric analysis was approximately 40°C higher than that of the corresponding polystyrenes.

Aufgrund des submukosen Wachstums und der Ausbildung von feinen Tumorauslaufern ist bei Zungenkarzinomen die genaue Einschatzung der Tumorgrose und Bestimmung adaquater Resektionsgrenzen haufig sehr schwierig. Wir entwickelten ein Verfahren zur intraoperativen Darstellung und Markierung von Tumorgrenzen bei Zungenkarzinomen: Bei 9 Patienten wurde die intraoperative Sonographie mit Hilfe eines 8–12-MHz-Schallkopfs nach Fluten der Mundhohle mit physiologischer Kochsalzlosung im Nicht-Kontakt-Verfahren durchgefuhrt. Die Tumorgrenzen wurden unter sonographischer Kontrolle mit Hilfe von Nahtmaterial markiert. In allen Fallen entsprachen die Tumorgrenzen im pathologischen Praparat den sonographisch ermittelten Tumorgrenzen. Die ultraschallgesteuerte Markierung erwies sich somit als sehr hilfreich bei der Tumorresektion. Stets erfolgte die Resektion im Gesunden mit entsprechendem Sicherheitsabstand. Diese nichtinvasive Methode erlaubt eine schnelle und zuverlassige Orientierung wahrend der Resektion von Zungenkarzinomen. Somit ist eine prazise und individuelle Festlegung von Resektionsgrenzen moglich. Diese Methode sollte durch Folgestudien weiterentwickelt werden.

Hintergrund In den letzten Jahren nahm die Zahl der Sporttaucher und in der Folge die Anzahl von Tauchunfallen stetig zu. Die meisten tauchmedizinischen Erkrankungen betreffen das Hals-Nasen-Ohren-arztliche Gebiet. Insbesondere kochleovestibulare Storungen nach dem Tauchen konnen zu persistierenden Schadigungen des Innenohrs fuhren.

Einleitung Mithilfe der dynamischen Magnetresonanztomographie (dMRT) konnen mikrozirkulationsabhangige Gewebeparameter erfasst werden.

Background Exact estimation of a tumor's size and definition of adequate resection margins in carcinomas of the tongue are often difficult because of the tumor's extension and deep infiltration. Methods We developed a method that allows intraoperative visualization and marking of tumor margins: intraoperative endosonography was performed in five patients with carcinomas of the tongue with an 8- to 12-MHz linear array transducer. The oral cavity was flooded with normal saline solution, and the transducer was immersed therein. This allowed scanning in a noncontact mode. The tumor margins were marked with a surgical suture under endosonographic monitoring. Results In the five patients studied, histologic margins corresponded to sonographic margins. The sonographic marking proved to be useful during the resection of the tumor, and histologic safety margins were respected in each case. Conclusions This noninvasive procedure provides a quick and reliable orientation during resection of tongue carcinoma, and a more precise and individual definition of resection margins is possible. Intraoperative noncontact use of endosonography is a promising method, and further studies may confirm this. © 2001 John Wiley & Sons, Inc. Head Neck 23: 233–237, 2001.

The amorphous or wide nasal tip is the most commonly encountered nasal tip deformity, but little has been done to measure the effect of standard rhinoplasty techniques on nasal tip width. In the clinical routine, nasal tip width and soft-tissue cover thickness are estimated by inspection and palpation rather than by measurement. In this study, a B-mode sonograph with a 12-MHz transducer was used in a noncontact mode to measure tip width 0.5 cm occipital to the tip defining point, distance between the alar cartilage domes, and thickness of the soft-tissue cover overlying the lower lateral cartilages. These parameters were measured 3 to 8 weeks before and 56 days to 19 months after a transdomal suture tip plasty in 18 patients. The distance between the alar cartilage domes seemed to be an important factor for tip width because interdomal distance, not soft-tissue cover thickness, correlated with tip width before surgery (correlation: 0.53). Conversely, the degree of tip refinement correlated with preoperative soft-tissue cover thickness (correlation: 0.75), but not with interdomal distance. Ultrasonic imaging of nasal soft tissues may help to assess the effect of different tip refining procedures and other soft-tissue changes after rhinoplasty.

The nonlinear refractive index n2 of excited terthiophene (3T) dissolved in 1,4-dioxane (c=1 mM) has been determined using the z-scan technique at 1047 nm. After excitation with ps-pulses at 349 nm, 3T exhibits a negative n2 of −1.1×10−14 cm2/W. This value, caused by the percentage of excited molecules only, is more than one order of magnitude higher than that of the non-excited 3T. The strong enhancement is due to a resonant S2←S1 transition. By employing a time-resolved $$pump–probe technique, the corresponding excited state absorption (ESA) of 3T was observed at 1047 nm.

In order to identify squamous cell carcinomas of the head and neck (HNSCC) with common biological and clinical features, we investigated the incidence and properties of carcinomas lacking retinoblastoma protein (pR6) cell cycle control. Of 208 HNSCC investigated, 23 (11%) showed a lack of pRb expression. The majority of these tumors (65%) were tonsillar carcinomas. The pRb-negative tonsillar tumors were all stage IV, had metastasized to lymph nodes at the time of diagnosis and were in general poorly differentiated or undifferentiated. Very significantly, the pRb-negative phenotype was strongly associated with the presence of oncogenic human papilloma viruses, implying a viral etiology and functional inactivation of pRb by the viral E7 oncoprotein. Despite the very adverse histopathological factors, patients with pRb-negative tonsillar carcinomas had a better clinical outcome, which was consistent with a uniform favorable responsiveness of these tumors to postoperative radiation therapy.

The diagnosis of cystic echinococcosis (echinococcus granulosus) in an atypical location can be difficult to make and frequently can only be established by histological examination of affected tissues. Surgical excision and fine-needle aspiration biopsy usually lead to the diagnosis. Since puncture of these cysts may cause an anaphylactic reaction due to spillage of hydatid fluid and/or dissemination of infection, the use of fine-needle aspiration biopsy is controversial at present. We report on a patient with a cystic neck mass who developed an allergic reaction after diagnostic fine-needle aspiration biopsy. Cytological examination of the specimen was inconclusive. The allergic reaction led to the diagnosis of echinococcosis, which was confirmed by serological examination. We describe a possible diagnostic procedure for a cystic mass of unknown etiology. If imaging and serological tests are not conclusive, we believe that fine-needle aspiration biopsy is justified. However, this should only be performed in a setting that provides sufficient management for anaphylactic reactions.

In addition to mucositis and myelotoxicity as well known early reactions after radiotherapy or radiochemotherapy in advanced head and neck tumors, late toxicity following treatment is an often underestimated problem. Between 1992 and 1995, 68 patients with advanced oro- and hypopharyngeal tumors were treated primarily with accelerated concomitant boost radiochemotherapy (total dose irradiations of 66 Gy and carboplatin as chemotherapy). Ninety-three per cent of the patients had stage IV disease according to the UICC-TNM classification. Monitoring of follow-up included late toxicity with special attention given to laryngeal edema. In 37 patients (54%) edema of the larynx as a late complication of radiochemotherapy was observed by clinical investigation and CT scan. The median onset of laryngeal edema was found 121 days after completion of therapy, with a median time of observation of 250 days. Observations in these patients demonstrated the chronic character of this edema. An increase in the laryngeal edema in 5 cases resulted in tracheostomy. Laryngeal edema in 10 patients was associated with recurrence of tumor. These results show that after xerostomia laryngeal edema is the main late toxicity in the head and neck after radiochemotherapy and should lead to further investigations to exclude possible recurrent tumor.

Femtosecond time-resolved studies using pump–probe spectroscopy were performed on 2,2′:5′,2″-terthiophene in solution. Optical density changes Δ D were observed in the bleaching region at different excitation wavelengths. The decay curves could be described using a bi-exponential fitting procedure. A fast decay time of 2 ps and a slower one varying with excitation wavelengths (400 nm: 126 ps; 385 nm: 74 ps; 374 nm: 51 ps) were determined. To explain this time behavior we suggest a model with two channels for intersystem crossing starting from different vibronic states in the singlet system into suitable states of the triplet manifold. Experimental data, as well as the applied model, indicate that we observed a fast two-channel intersystem crossing process.

Eine neue Methode wird vorgestellt, mit der die Perfusion und der Schwellungszustand der Nasenschleimhaut sonographisch dargestellt werden. Durch die seitlichen Nasenweichteile hindurch kann das vordere Septum, der Nasenboden und der Kopf der unteren Nasenmuschel der Gegenseite im B-mode-Verfahren sowie die Perfusion der entsprechenden Schleimhaut im farbkodierten Power-Doppler-Mode dargestellt werden. Die Ankopplung des Ultraschalls erfolgt durch ein neutrales Gel bzw. Flussigkeit im Vestibulum nasi. Die Fixierung des Schallkopfes mit Hilfe einer Bisschiene verhindert Bewegungsartefakte und gewahrleistet eine gleichbleibende Bildebene. Fur die Quantifizierung der Perfusion wurde eine automatisierte Farbpixelanalyse entwickelt. Bei 23 von 30 untersuchten Probanden und Patienten war mit dieser Methode die Schleimhautperfusion darstellbar. Eine auswertbare Abbildung der Sonoanatomie gelang in 16 Fallen. Es wurden Perfusionsanderungen unter Einwirkung von physiologischer Kochsalzlosung (bei 10 gesunden Probanden), Naphazolin (bei 10 Patienten mit chronisch behinderter Nasenatmung) und Allergenlosungen (bei 10 Patienten mit allergischer Rhinitis) untersucht. Physiologische Kochsalzlosung fuhrte innerhalb von 10 min zu einer maximalen Perfusionsabnahme um 10% bzw. einer Zunahme um 27% ohne Schwellungsanderung. Wahrend der Provokation mit Naphazolin trat erwartungsgemas eine Abnahme der Perfusion zwischen 10% und 57% und ein Abschwellen der Muschel- bzw. Septumschleimhaut um 17%–43% bzw. 4%–27% auf. Allergenextrakt induzierte eine Zunahme der Perfusion um 24%–181% und ein Anschwellen der Schleimhaut um 4%–31%. Diese Ergebnisse werden als Grundlage fur weitere Untersuchungen von Perfusionsanderungen der Nasenschleimhaut durch Medikamenten- und Allergenprovokationen dienen.

The transient spectral behavior of α-terthiophene (3T) in a TiO 2 SiO 2 and a SiO 2 -inorganic-organic hybrid polymer matrix has been studied after excitation with 12 ps UV pulses at 349 nm. In both materials an excited state absorption from the S 1 state has been observed. Two additional absorption bands observed in the TiO 2 SiO 2 hybrid polymer film at 550 and 865 nm were assigned to 3T radical cation transitions. The absence of the radical cation absorptions in the SiO 2 -inorganic-organic hybrid polymer film indicates, that titanium is involved in the radical cation formation of 3T. The 3T lifetime of the S 1 state has been determined to be 15 ps in the TiO 2 SiO 2 hybrid polymer matrix (TSHP-matrix), 72 ps in the SiO 2 hybrid polymer matrix (SHP-matrix), but 135 ps in dioxane solution. The decay of the radical cations exhibit a fast component (53 ps) and a long living component interpreted as a fast geminate recombination and a trapping process, respectively. The picosecond pump probe experiments show that the radical cation formation starts from higher vibronic levels of the S 1 state and represents an effective competing pathway for the S 1 depletion. The solute-like behavior of 3T molecules incorporated in the hybrid polymer matrices was proved by Raman and steady state absorption measurements.

La region miniere de la Wismut, ou est extrait l'uranium, presente des taux de radioactivite en augmentation dont on ne connait pas encore les dangers potentiels pour l'homme et la faune. L'utilisation de l'abeille mellifere (Apis mellifera) comme indicateur biologique de la pollution de l'environnement par diverses substances est connue, mais aucune recherche n'a ete menee jusqu'a present sur les radionucleides naturels. Une etude comparative du developpement des populations d'abeilles a ete realisee dans la region de la Wismut, qui presente une contamination radioactive, et dans une region temoin situee pres d'lena. La croissance des colonies d'abeilles a ete estimee (Liebig, 1993) sur 2 ans (1993-1995). La comparaison statistique de la diminution relative des populations d'abeilles d'octobre 1993 a avril 1994 et d'octobre 1994 a mars 1995 n'a pas montre de difference significative entre les deux regions (tableau I). L'activite du 226 Ra dans le sol, les plantes et divers types de miels a ete determinee par spectrometrie gamma. Pour le calcul des facteurs de transfert, seuls les miels qui avaient une teneur en pollen de colza > 70 % ont ete pris en compte. Le transfert du 226 Ra du sol dans le colza et du colza dans le miel est tres faible: sol-colza: 0,01-0,05; colza-miel: 0,05-0,17 (tableau II). Les facteurs de transfert etant relativement constants, il semble possible de deduire, de l'activite du 226 Ra dans le miel, des conclusions quant aux valeurs dans le sol et les plantes. Des etudes dans une region fortement contaminee sont necessaires pour pouvoir affirmer definitivement que l'abeille peut etre utilisee comme indicateur biologique pour les radionucleides naturels. L'activite des radionucleides dans les miels de la region de la Wismut est tres faible et la consommation de miel est donc sans danger pour l'homme.

CNDO/S calculations including single and double excited configurations were performed on thiophene oligomers n T with 2–6 monomer units. In contrast to the results on linear polyenes only single excited configurations are necessary to explain the experimental results. The theoretical energies for the lowest 1 1 B states are in good agreement with the low energy absorption origins and the high energy fluorescence maxima and with the 1 1 B state energies observed at low temperature. The results show that the 2 1 A state lies above the 1 1 B state for 2T–6T. Transient absorption bands measured by picosecond spectroscopy could be assigned to transitions between 1 1 B and higher calculated 1 A states of all studied oligomers n T.

The results of endonasal dacryocystorhinostomies (DCR) with transillumination and intubation are presented.In the period from 1999 to 2009 follow-up examinations of 50 endonasal DCRs were carried out. All patients over 18 were included. The files were systematically evaluated. The follow-up examinations were performed after a minimum of 6 months with anamnesis of epiphora.50 endonasal DCRs were performed on 40 patients. Initial surgery was performed on 27 lacrimal ducts, 16 patients had already had operations. Corrective surgery was required in 8 cases (7 endonasal DCRs, 1 external DCRs). 78 % women and 22 % men were included. The median age at the time of operation was 48 years; the median duration of preoperative symptoms was 24 months. In 42 % of the cases a chronic dacryocystitis was found. Pre-existing conditions were sarcoidosis in three cases and one case of Wegener's granulomatosis. As well as lacrimal duct obstruction, additional pathologies were treated in the same session [septoplasty (n = 12), sinus operations (n = 10), and cauterisation of the nasal concha (n = 7), removal of a dacryocele (n = 1), conchectomy (n = 1)]. 20 operations were performed on the right side, 26 on the left side and two bilateral. The median duration of the operation was 51 minutes. No operative complications were encountered. The length of stay in hospital was on average four days. The median of follow-up was 23 months. The success rate was 78 %.The success rate of endonasal DCRs is about 70 to 95 %. Thus, the achieved rate in this study is acceptable, especially as 16 of 40 patients underwent revision surgery. Probably this is attributed to the technique of transillumination. The safe intraoperative localisation of the lacrimal sac with a light probe seems to have a positive effect on the removal of obstructions.

Patients who have undergone myeloablative chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) for conditions such as multiple myeloma, Hodgkin’s disease, and primary amyloidosis may be at higher risk for failure of spinal fusion. As HSCT care and outcomes continue to improve, it is increasingly likely that neurosurgeons will encounter patients post-HSCT who require spinal procedures. To our knowledge there are no published data on fusion outcomes in this unique patient population. We report three patients who underwent spinal fusion following an autologous HSCT. Spinal surgery was performed, on average, 4.5 years after autologous HSCT. No patients were on immunosuppressant chemotherapy at the time of the procedure, although one patient was being treated with rituximab for disease progression peri-operatively. Average radiographic confirmation of fusion was 37 months and all patients ultimately demonstrated fusion, although not without incident. Our results suggest that spinal fusion can occur in patients who have previously undergone myeloablative chemotherapy followed by autologous HSCT.

Several methods are well established for the imaging of salivary glands. Excluding the invasive method sialendoscopy all other methods show the salivary duct system inadequately. The aim of this study is to demonstrate a method to visualize the salivary duct system by B-mode ultrasound.In 10 parotid glands of common pig cadavers the ultrasound contrast agent Levovist (®), which is galactose stabilized by palmitic acid was applied into the main salivary ducts while simultaneously performing a transcutaneous B-mode ultrasound.In all cadavers a visualization of the salivary duct system could be achieved by the application of Levovist (®) because of contrast enhancement. This effect arises as a result of an increased reflection of ultrasound waves on the surface of the microbubbles contained in the contrast agent.A reproducible visualization of the salivary duct system with B-mode ultrasound is possible by an intraductal application of an ultrasound contrast agent. In future this could be established as a reliable and fast method for imaging of the salivary ducts without ionizing radiation for the patient.

Organ transplantation for renal, liver, cardiac, and pulmonary failure has become more common in recent years, and patients are living longer as a result of improved organ preservation methods, immunosuppressive regimens, and general posttransplant care. Some of these patients undergo spine fusion surgery following organ transplantation, and there is little available information concerning outcomes. The authors report on their experience with and the outcomes of spine fusion in this rare and unique immunosuppressed patient group.Using the Current Procedural Terminology and ICD-9 codes for solid organ transplants, bone marrow transplantations (BMTs), and spine fusion surgeries, the authors searched their patient database between 1997 and 2008. Data points of interest included primary diagnosis, type of organ transplant, immunosuppressant drug therapy, complications from spine surgery, and radiographic analysis of spine fusion. Spine fusion was assessed with CT or radiography at the latest follow-up.The database search results revealed 5999 patients who underwent heart, lung, liver, kidney, pancreas, intestine, or bone marrow transplant between 1997 and 2008. Eighteen of the 5999 patients underwent a spine fusion surgery while receiving immunosuppressive therapy. Organ transplants included kidney, liver, heart, pancreas, and allogenic BMT. There were 3 deaths unrelated to spine fusion within 1 year of the surgery and 1 death immediately after spine surgery. Graft-versus-host disease developed in 1 patient when prednisone was stopped prior to the spine surgery. Thirteen patients underwent follow-up radiographic imaging at an average of 25 months after spine surgery; 12 demonstrated radiographic fusion.The results suggest that spine fusion rates are adequate despite immunosuppressive therapy in patients undergoing spinal fusion after transplant procedures. The data also illustrate the high morbidity and mortality rates found in the organ transplant patient population.