Ultrasound-guided pudendal nerve block in cats undergoing perineal urethrostomy: a prospective, randomised, investigator-blind, placebo-controlled clinical trial

The objective of this study was to evaluate the clinical usefulness, in terms of analgesic efficacy and safety, of ultrasound-guided pudendal nerve block performed with bupivacaine in cats undergoing perineal urethrostomy. Eighteen client-owned male cats scheduled for perineal urethrostomy were enrolled in the study and assigned to one of two treatment groups. The pudendal nerve block was performed under general anaesthesia as described elsewhere, with 0.3 ml/kg of either saline (group C) or 0.5% bupivacaine (group B) - the total injection volume being split equally on the two sites of injection (left and right). Intra-operatively, assessment of nociception was based on the rescue analgesics requirement, as well as on the evaluation of changes in physiological parameters in comparison with the baseline values. Post-operative pain assessment was performed using three different pain scales at recovery and then 1, 2 and 3 h after recovery. Cats in group B showed lower heart rates and required fewer analgesics during surgery than group C. Post-operatively, group B had lower pain scores and needed less rescue buprenorphine than group C. Iatrogenic block-related complications were not observed. In conclusion, the ultrasound-guided pudendal nerve block can be considered clinically useful in feline medicine as it provides reliable analgesia in cats undergoing perineal urethrostomy.

An urn-based Bayesian block bootstrap

Block bootstrap has been introduced in the literature for resampling dependent data, i.e. stationary processes. One of the main assumptions in block bootstrapping is that the blocks of observations are exchangeable, i.e. their joint distribution is immune to permutations. In this paper we propose a new Bayesian approach to block bootstrapping, starting from the construction of exchangeable blocks. Our sampling mechanism is based on a particular class of reinforced urn processes

Das radikale Milieu im vorrevolutionären Russland

This article traces the networks in the Russian revolutionary underground from the 1860s untill 1917 and subsumes them under the term radical milieu. Though there existed ideological differences all Russian radicals shared a common identity as „anti-society“ against the tsarist regime. In the radical milieu with its own values the participants tried to create their own reality, where all members regardless of their social origin or sex were seen as equal. The radical milieu was backed by a sphere of sympathisers that constituted the main source of material support and the main recruiting field. But the radicals were very careful when selecting new members for their underground world. Applicants had to fulfil defined criteria. The radical milieu in Russia was in a permanent danger to be infiltrated by the secret police. This situation between fear and hope was the background where ideas of solidarity but also visions of violence and revenge against the “traitors” were ripening and then became realised.

Leben für die Sache. Vera Figner, Vera Zasulič und das radikale Milieu im späten Zarenreich

In der zweiten Hälfte des 19. Jahrhunderts treten in Russland vermehrt Frauen und Männer in die Öffentlichkeit, die durch radikale Veränderungen einen „neuen Menschen“ und mit ihm eine neue Gesellschaft schaffen wollen. Vera Figner und Vera Zasulič, die beiden Protagonistinnen der vorliegenden Untersuchung, sind herausragende Vertreterinnen der radikalen Bewegung im ausgehenden Zarenreich. Während Vera Zasulič mit ihrem Attentat auf den St. Petersburger Stadtkommandanten Fëdor Trepov 1878 am Beginn der ersten terroristischen Welle in Russland steht, ist Vera Figner bei ihrer Verhaftung 1883 das letzte führende Mitglied der Terrororganisation Narodnaja Volja (Volkswille), die am 1./13. März 1881 einen tödlichen Anschlag auf Zar Aleksandr II. verübt. Die beiden Frauen verbindet zwar kein engerer persönlicher Kontakt, dafür aber die Zugehörigkeit zum selben Milieu. Beeinflusst von der progressiven Debatte in der Intelligencija der 1860er Jahre entschlossen sie sich bereits in ihrer Jugend, sich von traditionellen Standes- und Geschlechterrollen zu lösen, ihr Schicksal „in die eigenen Hände zu nehmen“ und sich einer „Sache“ zu verschreiben. Zusammen mit anderen Radikalen gerieten sie dadurch in einen immer heftigeren Konflikt mit der autokratischen Staatsmacht, der sich schließlich zu einem Kampf mit terroristischen Mitteln steigerte. Stephan Rindlisbacher nutzt die Biographien dieser beiden radikalen Frauen als „Scheinwerfer“, um das radikale Milieu mit seinen Merkmalen, Funktionsmechanismen und Handlungsspielräumen auszuleuchten. Aus zwei voneinander unabhängigen aber vergleichbaren Blickwinkeln zeichnet er ein eindrucksvolles Bild nicht nur der radikalen Netzwerkstrukturen, Symbole, Praktiken und Identitätsnarrativen, sondern auch der beteiligten Menschen mit ihren Wünschen, Hoffnungen und Ängsten.

Association of congenital, diffuse electrical disease in children with normal heart: sick sinus syndrome, intraventricular conduction block, and monomorphic ventricular tachycardia.

INTRODUCTION Rhythm disturbances in children with structurally normal hearts are usually associated with abnormalities in cardiac ion channels. The phenotypic expression of these abnormalities ("channelopathies") includes: long and short QT syndromes, Brugada syndrome, congenital sick sinus syndrome, catecholaminergic polymorphic ventricular tachycardia, Lènegre-Lev disease, and/or different degrees of cardiac conduction disease. METHODS The study group consisted of three male patients with sick sinus syndrome, intraventricular conduction disease, and monomorphic sustained ventricular tachycardia. Clinical data and results of electrocardiography, Holter monitoring, electrophysiology, and echocardiography are described. RESULTS In all patients, the ECG during sinus rhythm showed right bundle branch block and long QT intervals. First-degree AV block was documented in two subjects, and J point elevation in one. A pacemaker was implanted in all cases due to symptomatic bradycardia (sick sinus syndrome). Atrial tachyarryhthmias were observed in two patients. The common characteristic ventricular arrhythmia was a monomorphic sustained ventricular tachycardia, inducible with ventricular stimulation and sensitive to lidocaine. In one patient, radiofrequency catheter ablation was successfully performed. No structural abnormalities were found in echocardiography in the study group. CONCLUSION Common clinical and ECG features suggest a common pathophysiology in this group of patients with congenital severe electrical disease.

Transition from nerve stimulator to sonographically guided axillary brachial plexus anesthesia in hand surgery: block quality and patient satisfaction during the transition period

OBJECTIVES Sonographic guidance for peripheral nerve anesthesia has proven increasingly successful in clinical practice; however, fears that a change to sonographically guided regional anesthesia may impair the block quality and operating room work flow persist in certain units. In this retrospective cohort study, block quality and patient satisfaction during the transition period from nerve stimulator to sonographic guidance for axillary brachial plexus anesthesia in a tertiary referral center were investigated. METHODS Anesthesia records of all patients who had elective surgery of the wrist or hand during the transition time (September 1, 2006-August 25, 2007) were reviewed for block success, placement time, anesthesiologist training level, local anesthetic volume, and requirement of additional analgesics. Postoperative records were reviewed, and patient satisfaction was assessed by telephone interviews in matched subgroups. RESULTS Of 415 blocks, 341 were sonographically guided, and 74 were nerve stimulator guided. Sonographically guided blocks were mostly performed by novices, whereas nerve stimulator-guided blocks were performed by advanced users (72.3% versus 14%; P < .001). Block performance times and success rates were similar in both groups. In sonographically guided blocks, significantly less local anesthetics were applied compared to nerve stimulator-guided blocks (mean ± SD, 36.1 ± 7.1 versus 43.9 ± 6.1 mL; P< .001), and less opioids were required (fentanyl, 66.1 ± 30 versus 90 ± 62 μg; P< .001). Interviewed patients reported significantly less procedure-related discomfort, pain, and prolonged procedure time when block placement was sonographically guided (2% versus 20%; P = .002). CONCLUSIONS Transition from nerve stimulator to sonographic guidance for axillary brachial plexus blocks did not change block performance times or success rates. Patient satisfaction was improved even during the early institutional transition period.

Development of an ultrasound-guided technique for pudendal nerve block in cat cadavers.

The objective of this prospective experimental cadaveric study was to develop an ultrasound-guided technique to perform an anaesthetic pudendal nerve block in male cats. Fifteen fresh cadavers were used for this trial. A detailed anatomical dissection was performed on one cat in order to scrutinise the pudendal nerve and its ramifications. In a second step, the cadavers of six cats were used to test three different ultrasonographic approaches to the pudendal nerve: the deep dorso-lateral, the superficial dorso-lateral and the median transperineal. Although none of the approaches allowed direct ultrasonographical identification of the pudendal nerve branches, the deep dorso-lateral was found to be the most advantageous one in terms of practicability and ability to identify useful and reliable landmarks. Based on these findings, the deep dorso-lateral approach was selected as technique of choice for tracer injections (0.1 ml 1% methylene blue injected bilaterally) in six cat cadavers distinct from those used for the ultrasonographical study. Anatomical dissection revealed a homogeneous spread of the tracer around the pudendal nerve sensory branches in all six cadavers. Finally, computed tomography was performed in two additional cadavers after injection of 0.3 ml/kg (0.15 ml/kg per each injection sites, left and right) contrast medium through the deep dorso-lateral approach in order to obtain a model of volume distribution applicable to local anaesthetics. Our findings in cat cadavers indicate that ultrasound-guided pudendal nerve block is feasible and could be proposed to provide peri-operative analgesia in clinical patients undergoing perineal urethrostomy.

Electron density building block approach for metal organic frameworks

A general introduction to the state of the art in modeling metal organic materials using transferable atomic multipoles is provided. The method is based on the building block partitioning of the electron density, which is illustrated with some examples of potential applications and with detailed discussions of the advantages and pitfalls. The interactions taking place between building blocks are summarized and are used to discuss the properties that can be calculated.

Ultrasound-guided block of sciatic and femoral nerves: an anatomical study

The sheep is a popular animal model for human biomechanical research involving invasive surgery on the hind limb. These painful procedures can only be ethically justified with the application of adequate analgesia protocols. Regional anaesthesia as an adjunct to general anaesthesia may markedly improve well-being of these experimental animals during the postoperative period due to a higher analgesic efficacy when compared with systemic drugs, and may therefore reduce stress and consequently the severity of such studies. As a first step 14 sheep cadavers were used to establish a new technique for the peripheral blockade of the sciatic and the femoral nerves under sonographic guidance and to evaluate the success rate by determination of the colorization of both nerves after an injection of 0.5 mL of a 0.1% methylene blue solution. First, both nerves were visualized sonographically. Then, methylene blue solution was injected and subsequently the length of colorization was measured by gross anatomical dissection of the target nerves. Twenty-four sciatic nerves were identified sonographically in 12 out of 13 cadavers. In one animal, the nerve could not be ascertained unequivocally and, consequently, nerve colorization failed. Twenty femoral nerves were located by ultrasound in 10 out of 13 cadavers. In three cadavers, signs of autolysis impeded the scan. This study provides a detailed anatomical description of the localization of the sciatic and the femoral nerves and presents an effective and safe yet simple and rapid technique for performing peripheral nerve blocks with a high success rate.

Liberale Romandie, radikale Deutschschweiz? Kantonale Demokratien zwischen Repräsentation und Partizipation

Der vorliegende Beitrag untersucht die weit verbreitete These, dass Deutschschweizer Kantone vor allem radikaldemokratische Merkmale aufweisen, während die lateinischen Kantone stärker liberal-repräsentative Demokratieformen besitzen. Die empirische und mehrdimensionale Messung der Demokratiequalität in den Kantonen zeigt, dass die pauschale These der direktdemokratisch-partizipatorischen Deutschschweizer Kantone auf der einen Seite und der repräsentativdemokratischen Stände der lateinischen Schweiz auf der anderen Seite der Komplexität der kantonalen Demokratien nicht gerecht wird. Als erklärungskräftige Alternative für die Positionen der Kantone auf den Achsen liberaler und radikaler Demokratien an der Schwelle des 21. Jahrhunderts erweist sich vielmehr die Stärke der liberalen und demokratischen Verfassungsbewegungen in den Kantonen Mitte des 19. Jahrhunderts.

Internetbasierte geleitete Selbsthilfe bei verschiedenen Angststörungen: Eine randomisiert kontrollierte Studie zum Vergleich eines individualisierten vs. standardisierten Ansatzes

Hintergrund und Ziel: Internetbasierte psychotherapeutische Interventionen wurden in den letzten Jahren intensiv erforscht. Als besonders vielversprechend haben sich therapeutengeleitete Selbsthilfeprogramme bei verschiedenen Angststörungen erwiesen. Eine neue Entwicklung sind transdiagnostische und individualisierte Ansätze, in welchen auch komorbide Probleme und Störungen, und breitere Patientengruppen angesprochen werden. Beim individualisierten Ansatz werden dem Selbsthilfeprogramm in Abhängigkeit der Probleme der Patienten unterschiedliche Inhalte zugeschaltet. Das Ziel dieser Studie ist die Evaluation einer internetbasierten, individualisierten, geleiteten Selbsthilfeintervention für verschiedene Angststörungen. Methode: In einer kontrolliert-randomisierten Studie wurde der individualisierte Ansatz mit einer standardisierten Intervention, die sich nur auf die primäre Störung der Klienten bezieht, verglichen. 132 StudienteilnehmerInnen, diagnostiziert mit einer Sozialen Angststörung, Panikstörung mit oder ohne Agoraphobie, und/ oder einer Generalisierten Angststörung wurden randomisiert einer der beiden Behandlungsbedingungen oder einer Warteliste zugeteilt. Die Selbsthilfebehandlung dauerte 8 Wochen und wurde von Therapeuten via Email unterstützt. Erhebungszeitpunkte waren Prä, Post und 6 Monate nach Ende der Behandlung. Primäre Ergebnismasse sind störungsübergreifende Masse wie das Beck Angstinventar (BAI) und Daten aus einem diagnostischen Interview. Sekundäre Ergebnismasse sind störungsspezifische Fragebogen. Ergebnisse: Beide Behandlungsgruppen zeigten gegenüber der Warteliste-Kontrollgruppe signifikante Veränderungen auf allen Ergebnismassen. Auf der Basis der Intent-to-treat-Stichprobe betrugen die über die verschiedenen Ergebnismasse gemittelten Effektstärken im Vergleich zur Warteliste-Kontrollgruppe d=.80 für die individualisierte und d=.82 für die standardisierte Behandlungsbedingung. Die Symptomreduktion wurde bis zum 6-Monats-Follow-Up aufrechterhalten. Zwischen den beiden aktiven Behandlungsbedingungen wurden keine Unterschiede gefunden. Diskussion: Die Ergebnisse zeigen, dass sowohl individualisierte wie auch standardisierte internetbasierte Ansätze zur Behandlung verschiedener Angststörungen vielversprechend sind