Cerebral Gaseous Microemboli are Detectable During Continuous Venovenous Hemodialysis in Critically Ill Patients: An Observational Pilot Study

BACKGROUND Continuous venovenous hemodialysis (CVVHD) may generate microemboli that cross the pulmonary circulation and reach the brain. The aim of the present study was to quantify (load per time interval) and qualify (gaseous vs. solid) cerebral microemboli (CME), detected as high-intensity transient signals, using transcranial Doppler ultrasound. MATERIALS AND METHODS Twenty intensive care unit (ICU group) patients requiring CVVHD were examined. CME were recorded in both middle cerebral arteries for 30 minutes during CVVHD and a CVVHD-free interval. Twenty additional patients, hospitalized for orthopedic surgery, served as a non-ICU control group. Statistical analyses were performed using the Mann-Whitney U test or the Wilcoxon matched-pairs signed-rank test, followed by Bonferroni corrections for multiple comparisons. RESULTS In the non-ICU group, 48 (14.5-169.5) (median [range]) gaseous CME were detected. In the ICU group, the 67.5 (14.5-588.5) gaseous CME detected during the CVVHD-free interval increased 5-fold to 344.5 (59-1019) during CVVHD (P<0.001). The number of solid CME was low in all groups (non-ICU group: 2 [0-5.5]; ICU group CVVHD-free interval: 1.5 [0-14.25]; ICU group during CVVHD: 7 [3-27.75]). CONCLUSIONS This observational pilot study shows that CVVHD was associated with a higher gaseous but not solid CME burden in critically ill patients. Although the differentiation between gaseous and solid CME remains challenging, our finding may support the hypothesis of microbubble generation in the CVVHD circuit and its transpulmonary translocation toward the intracranial circulation. Importantly, the impact of gaseous and solid CME generated during CVVHD on brain integrity of critically ill patients currently remains unknown and is highly debated.

"Der Papst aus dem Ghetto" [Rezension] : zu dem Roman von Gertrud von Le Fort

L. F.

Fort Richardson Ordnance Detonations and the Harbor Porpoise: A Case Study in Marine Mammal Bioacoustics

Hearing is extremely important for cetaceans because it is their “principal sense” (Weilgart, 2007) thus the harbor porpoise and other marine animals are highly dependent on sound for survival. This is why we should care about the impact of noise on animals like the harbor porpoise. Since sound travels so well in water, an explosion, sonar, boat noise, etc. can affect a very large area and thus many different species of marine mammals. Although military actions such as low frequency sonar have made recent news, noise has been affecting cetaceans, especially beaked whales, since at least 1991 (Weilgart, 2007). This study is an investigation of the possible impacts of artillery detonated on land on harbor porpoise hearing and covers some of the history of Fort Richardson, the legal and historical aspects and history of this type of concern, the science and physics of sound, marine mammal hearing and general biology of the harbor porpoise. Data were collected at the Fort Richardson Army base during June of 2007 by researchers from the University of Connecticut and the University of Rhode Island and will be used to determine the possible impacts that these detonations could have on the harbor porpoise.

"Die kümmerlichen Zeiten dauern fort" [Rezension] : eine Erinnerung an Johann Peter Hebels Biblische Erzählungen

ch.

Lieder im Volkston : Mein goldner Pfau flog fort, ja fort

Isaac Schreyer

Gertrud von Le Fort: Der Papst aus dem Ghetto ... [Rezension]

H.

Frankfurter Latern : ill.-satyrisches, humorist.-lyrisches, kritisch-raisonnirendes, ästhetisch-annoncirendes Wochenblatt, wo d. Woch' zehn Tage hat

hrsg. von Friedrich Stoltze u. Ernst Schalck

Fort mit dem Goldfischglas!

Von Johs. Peter

Ms. Ff. Mus. 1452 - Weichet fort aus meiner Seele : Dom. XV. post Trinitatis ; pp. C. A. T. B., 2 corni da caccia, 2 violini, 2 viole, 2 oboe, violoncello e organo

di Telemann

Der Kaiser und seine Familie fort! : So eben verkündet uns ein Plakat von den sechs interimistischen Ministern Pillersdorf ...

C. M., Akademiker

Ansicht vom Gouvernements-Haus und vom Fort Zelandia mit seinem Tamarindenwald

Louise von Panhuys