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A case of in-hospital thoracotomy with subsequent open chest cardiopulmonary resuscitation of a polytraumatized patient is reported. Emergency thoracotomies are rare interventions in challenging situations. Up to now there are only few standards or uniform education and training concepts. The indications are often a borderline decision. The aim of thoracotomy and open resuscitation in combination with a reduction in circulation, for example by cross-clamping the aorta, is to save time to address reversible causes of the hemorrhage, redirect the blood volume into the vital cerebral and coronary circulation and minimize bleeding from subdiaphragmatic bleeding sources. Ultimately, in case of doubt, the thoracotomy can be performed for the patient's benefit with the appropriate indications.Es wird über einen Fall einer innerklinisch durchgeführten Thorakotomie mit nachfolgender direkter Reanimation am offenen Brustkorb eines polytraumatisierten Patienten berichtet. Notfallthorakotomien sind seltene Eingriffe in herausfordernden Situationen. Die Indikationsstellung ist oft eine Grenzentscheidung. In Kombination mit einer Kreislaufverkleinerung, beispielsweise durch Abklemmen der Aorta, verfolgt die Thorakotomie mit direkter Herzmassage das Ziel, die Durchblutung in den lebenswichtigen koronaren und zerebralen Kreisläufen aufrechtzuerhalten, Blutverluste aus distal gelegenen Blutungsquellen zu minimieren und reversible Ursachen zu beheben. Letztlich kann die Thorakotomie im Zweifel zum Wohle des Patienten bei entsprechender Indikation durchgeführt werden.

Based on evaluation and examination results of students, a necessity for improvement of so far purely instructor-based radiological teaching at the local institution was determined. Aim of our study was to use one out of eight seminars to exemplify adaptation of the teaching concept according to learning theory knowledge, to determine the resulting effects and to interpret them.The institutional review board approved the prospective study of the seminar conversion, which was performed after the end of the winter semester 2015/2016. Didactically, this included a course split into online preparation, attendance phase and online follow-up with integration of interactive scaffolding, practice-oriented clinical teaching according to Stanford, Peyton skills transfer and extensive feedback into the attendance phase. At the beginning and at the end of each course, each student filled in identical, standardized questionnaires (n = 256 before and after conversion) using a 5-point Likert scale (1: very good; to 5: deficient) and additionally answered two randomly chosen written examination questions from a content-adapted questionnaire pool of the last five years. For statistical evaluation, the Mann-Whitney U-Test was used for evaluation data and Fisher's Exact test for exam questions.Before/after conversion, the subjective total evaluation score of students was 3.22 (mean value) ± 1.51 (standard deviation) / 1.66 ± 0.78 (p 0.001) and the objective proportion of correctly answered examination questions in the respective cohort at the beginning of the seminar 37.7/53.9 % and at the end of the seminar 55.1/84.6 % (p 0.001).The conversion of the test seminar resulted in both a better evaluation of the teaching unit by the students (evaluation) and a considerably higher rate of correctly answered examination questions from past state examinations (learning success). This supports transferring the concept to comparable teaching units.· Radiological teaching allows integration of current learning theory concepts with reasonable effort.. · In a test seminar this improved the evaluation results of the teaching unit by the students.. · In addition, this also led to a higher rate of correctly answered examination questions from past state examinations.. · This supports further steps towards excellent radiological teaching..· Wirth S, William Y, Paolini M et al. Improvement of Radiological Teaching - Effects of Focusing of Learning Targets and Increased Consideration of Learning Theory Knowledge. Fortschr Röntgenstr 2018; 190: 161 - 174.ZIEL: Basierend auf Evaluationen und Prüfungsleistungen der Studierenden wurde eine Notwendigkeit zur Verbesserung einer institutionell bislang rein frontalen radiologischen Lehre abgeleitet. Ziel unserer Studie war es, zunächst exemplarisch eines von acht Seminaren verstärkt nach lerntheoretischen Erkenntnissen auszurichten, die resultierenden Effekte festzustellen und zu interpretieren.Die Ethikkommission erteilte ein positives Votum zur prospektiven Studie der Seminarumstellung, die nach dem Wintersemester 2015/2016 durchgeführt wurde. Didaktisch wurde in Online-Vorbereitung, Präsenzphase und Online-Nachbereitung aufgeteilt und hierbei interaktives Scaffolding mit praxisbezogenem Clinical Teaching nach Stanford, Skillsvermittlung nach Peyton und ausgedehnter Feedbackeinsatz in die Präsenzphase integriert. Jeweils zu Beginn und am Ende der Präsenzveranstaltungen füllte jede/r Studierende (je n = 256 vor und nach Umstellung) identische, standardisierte Fragebogen unter Verwendung einer 5-Punkte Likert-Skala (1: sehr gut, …, 5: mangelhaft) aus und beantwortete zusätzlich jeweils zwei zufällig geloste schriftliche Prüfungsfragen aus einem inhaltlich abgestimmten Staatsexamen-Fragenpool der letzten fünf Jahre. Zur statistischen Auswertung wurde der Mann-Whitney-U-Test für Evaluationsdaten und Fisher’s-Exact-Test für Prüfungsfragen verwendet.Vor/nach Umstellung betrug die subjektive studentische Gesamtbewertung 3,22 (Mittelwert) ± 1,51 (Standardabweichung) / 1,66 ± 0,78 (p 0,001) und der objektive Anteil korrekt beantworteter Prüfungsfragen in der jeweiligen Kohorte zu Beginn des Seminars 37,7/53,9 % sowie am Ende des Seminars 55,1/84,6 % (p jeweils 0,001).Die Umstellung des Testseminars führte sowohl zur besseren Bewertung der Lehrveranstaltung durch die Studierenden (Evaluation) als auch zu einer erheblich höheren Quote korrekt beantworteter Prüfungsfragen aus vergangenen Staatsexamina (Lernerfolg). Dies motiviert zur Konzeptübertragung auf vergleichbare Lehrveranstaltungen.· In der radiologischen Lehre können bewährte lerntheoretische Konzepte mit vertretbarem Aufwand berücksichtigt werden.. · In einem Testseminar verbesserte dies die Bewertung der Veranstaltung durch die Studierenden.. · Zudem führte dies auch zu einer höheren Quote korrekt beantworteter Prüfungsfragen aus vergangenen Staatsexamina.. · Dies motiviert für weitere Schritte in Richtung exzellenter radiologischer Lehre..· Wirth S, William Y, Paolini M et al. Improvement of Radiological Teaching – Effects of Focusing of Learning Targets and Increased Consideration of Learning Theory Knowledge. Fortschr Röntgenstr 2018; 190: 161 – 174.

Objectives This study was performed to analyse anaesthesia-related complications and side effects in patients undergoing transcatheter aortic valve implantation (TAVI) under general anaesthesia. Design Retrospective study. Setting The study was performed as a single-centre study in a hospital of tertiary care in Germany. Participants All 853 patients, who underwent TAVI at the Universitätsklinikum Regensburg between January 2009 and July 2015, were included. 52.5% were female patients. Primary and secondary outcome measures We gathered information, such as recent illness, vital parameters and medication administered during the intervention and postoperatively for 12 hours. We analysed all anaesthesia-related complications and anaesthesia-related side effects that occurred during the intervention and entire hospital stay. Results We analysed all 853 TAVI procedures. The mean patient age was 79 ± 6 years. In 99.5% of cases, we used volatile-based anaesthesia. 2.8% (n=24; transfemoral (TF): n=19 [3.8%]; transapical (TA): n=5 [1.4%]) of all cases suffered from anaesthesia-related complications. 819 (TF: n=447; TA: n=372) anaesthesia-related side effects occurred in 586 (68.7%, TF: n=325 [64.2%], TA: n=261 [75.2%]) patients. Neither the complications nor the side effects had any serious consequences. Intraoperative hypothermia in 44% of cases (TF: n=202 [39.9%]; TA: n=173 [49.9%]) and postoperative nausea and vomiting in 27% (n=232; TF: n=131 [25.9%], TA: n=101 [29.1%]) of cases were the most common anaesthesia-related side effects. Conclusion In this study, serious anaesthesia-related complications were rarely seen, and non-critical anaesthesia-related side effects could have been avoided through consistent prophylaxis and management. Therefore, despite their high anaesthetic risk, general anaesthesia is justifiable in patients who underwent TAVI.

Objectives This study was performed to analyse anaesthesia-related complications and side effects in patients undergoing transcatheter aortic valve implantation (TAVI) under general anaesthesia. Design Retrospective study. Setting The study was performed as a single-centre study in a hospital of tertiary care in Germany. Participants All 853 patients, who underwent TAVI at the Universitatsklinikum Regensburg between January 2009 and July 2015, were included. 52.5% were female patients. Primary and secondary outcome measures We gathered information, such as recent illness, vital parameters and medication administered during the intervention and postoperatively for 12 hours. We analysed all anaesthesia-related complications and anaesthesia-related side effects that occurred during the intervention and entire hospital stay. Results We analysed all 853 TAVI procedures. The mean patient age was 79 +/- 6 years. In 99.5% of cases, we used volatile-based anaesthesia. 2.8% (n=24; transfemoral (TF): n=19 [3.8%]; transapical (TA): n=5 [1.4%]) of all cases suffered from anaesthesia-related complications. 819 (TF: n=447; TA: n=372) anaesthesia-related side effects occurred in 586 (68.7%, TF: n=325 [64.2%], TA: n=261 [75.2%]) patients. Neither the complications nor the side effects had any serious consequences. Intraoperative hypothermia in 44% of cases (TF: n=202 [39.9%]; TA: n=173 [49.9%]) and postoperative nausea and vomiting in 27% (n=232; TF: n=131 [25.9%], TA: n=101 [29.1%]) of cases were the most common anaesthesia-related side effects. Conclusion In this study, serious anaesthesia-related complications were rarely seen, and non-critical anaesthesia-related side effects could have been avoided through consistent prophylaxis and management. Therefore, despite their high anaesthetic risk, general anaesthesia is justifiable in patients who underwent TAVI.

The use of ionic liquids (ILs) in chemistry and electrochemistry has been studied for some decades. Only recently, researchers have focused on the suitability of ILs as selective solvents in the field of separation technology. ILs represent suitable entrainers and extraction solvents for the separation of azeotropic mixtures by means of extractive distillation and solvent extraction. In this work, ternary vapor−liquid and liquid−liquid equilibria of the azeotropic mixtures ethanol + water and THF + water containing different kinds of commercially available ILs are presented. The four ionic liquids used are derived from butyl-methylimidazolium tetrafluoroborate [BMIM]+ [BF4]- by systematic variation of the cation or the anion. The influence of the IL structure on the relative volatility of the low boiling component in extractive distillation and on the selectivity in solvent extraction processes is discussed in this work.