Matthias Weise

Isolated Rupture of the Right Upper Pulmonary Vein: A Blunt Cardiac Trauma Case

A 37-year-old woman who sustained blunt chest trauma as a result of a car accident was found unconscious at the accident site with signs of circulatory compromise. Computed tomographic trauma screening excluded thoracic, intracranial, and intra-abdominal bleeding, or other pathologic findings, except a small circumferential hemopericardium. Echocardiography revealed a hemopericardium that was partially clotted and the beginning of compression of the right ventricle. Because of progressive hemodynamic compromise, the decision was made for operative exploration. After a median sternotomy, the resultant excessive bleeding necessitated extracorporeal circulation. Careful inspection revealed isolated rupture of the upper right pulmonary vein, which was successfully repaired.

Haemoptysis due to pulmonary venous stenosis

Haemoptysis is a potentially life-threatening condition with the need for prompt diagnosis. In about 10–20% of all cases the bleeding source remains unexplained with the standard diagnostic approach. The aim of this article is to show the necessity of widening the diagnostic approach to haemoptysis with consideration of pulmonary venous stenosis as a possible cause of even severe haemoptysis and haemoptoe. A review of the literature was performed using the Medline/PubMed database with the terms: “pulmonary venous stenosis”, “pulmonary venous infarction” and “haemoptysis”. Further references from the case reports were considered. 58 case reports and case collections about patients with haemoptysis due to pulmonary venous stenosis were detected. This review gives an overview about the case reports and discusses the underlying pathophysiology and the pros and cons of different imaging techniques for the detection of pulmonary venous stenosis. Several conditions predispose to the obstruction of the mediastinal pulmonary veins. Clinical findings are unspecific and may be misleading. Pulmonary venous stenosis can be detected using several imaging techniques, yet three-dimensional magnetic resonance-angiography and three-dimensional contrast-enhanced computed tomography are the most appropriate. Pulmonary venous stenosis should be considered in patients with haemoptysis.

Intimal Pulmonary Artery Sarcoma Presenting as Severe Dyspnea and Right Heart Insufficiency

Background: Pulmonary artery sarcoma is a rare tumor with a poor prognosis. Case Report: We report the case of a 64-year-old man with an intimal pulmonary artery sarcoma presenting with severe high oxygen flow-demanding dyspnea and weight loss of 12 kg in the last 6 months. On echocardiography, right heart insufficiency, markedly elevated right ventricular pressure, a pressure gradient along the right outflow tract, and a tumor mass adherent to the wall of the truncus pulmonalis were detected. The tentative diagnosis by echocardiographic findings was pulmonary artery sarcoma. Computed tomography of the thorax and 18-fluorodeoxyglucose positron emission tomography showed an advanced local tumor manifestation. Surgical resection of the tumor to improve hemodynamics confirmed the diagnosis. Conclusions: Pulmonary artery sarcoma should be considered as a rare differential diagnosis in patients with dyspnea due to right heart failure, particular in the case of additional weight loss, and echocardiographic examination is a useful first diagnostic approach in establishing the diagnosis.

Interoperable validation for IFC building models using open standards

In this paper we are reporting on a prototypical implementation of a model view checker for model instance validation of Industry Foundation Classes (IFC) models. This checker is developed based on the open standards mvdXML as the format for structuring validation rules and the BIM Collaboration Format (BCF) to issue reports as a result of the checking process. The checker is implemented on top of the open source bimserver.org framework. The research presented here has two main aims: (1) to develop an open source IFC validation tool based on flexible and standardized method; (2) to identify issues and capabilities of the current mvdXML rules based on real-world scenarios and to develop stable and easy-to-use IFC validation methods using open standards. Two BIM operational standards required by local building regulations and laws, the Dutch Rgd BIM Norm, and the Norwegian Statsbygg BIM Manual are used to validate both the mvdXML standardsO capabilities and the tools implementation. The rules from these standards are categorized into different rule types and converted to mvdXML templates and rules. These rules are then tested using a prototypical, open source software tool. By combining this tool with a BCF server we demonstrate the deployment of such automated checking procedures in real working processes. Based on these experiences, a detailed discussion about identified issues is provided as the starting point for the future research and a feedback to standardization organizations.

An intrathoracic arteriovenous malformation discovered as an extremely uncommon reason of neonatal congestive cardiac failure.

Congenital arteriovenous malformations are rare causes of congestive cardiac failure in neonates. The most common sites are in the head and liver, but other sites include the thorax, the abdomen and the limbs. The onset of failure is usually not in the immediate neonatal period, but later on in life, albeit that lesions such as the arteriovenous malformation of the vein of Galen, and other arteriovenous malformations in different locations which produce high flow can present early. We describe here the first case, to the best of our knowledge, of prenatal detection of an intrathoracic arteriovenous malformation producing neonatal cardiac failure, which was successfully treated by surgery postnatally.

Prozessgestützte Defintion von Modellinhalten

Das Datenmodell Industry Foundation Classes (IFC) stellt einen umfassenden herstellerneutralen Standard zur Beschreibung von digitalen Gebaudemodellen zur Verfugung. Dabei handelt es sich jedoch zunachst nur um eine Datenstruktur. Fur eine sinnvolle Nutzung im Rahmen von Planungsprozessen ist jedoch daruber hinaus festzulegen, welche Informationen von wem wann welchem Projektbeteiligten wie zur Verfugung gestellt werden sollen. Hierzu wurde von buildingSMART die Methode Information Delivery Manual (IDM) entwickelt, die vorsieht, die Datenaustauschprozesse mithilfe einer grafischen Notation zu beschreiben, um daraus Anforderungen hinsichtlich der auszutauschenden Modellinhalte (Exchange Requirements) abzuleiten. Die technische Umsetzung dieser Anforderungen wird mit einer Model View Definition (MVD) realisiert, die genau festlegt, welche Entitaten und Attribute des IFC-Modells verwendet werden durfen bzw. mussen. Das Kapitel beschreibt im Detail die Herangehensweise der IDM. Daneben wird das Datenaustauschformat COBie vorgestellt, das speziell der Ubergabe von Bauwerksdaten an den Betreiber dient. Das Kapitel schliest mit einer Diskussion der Verfahren zur Festlegung von Ausarbeitungsgraden fur Modellinhalte (Level of Development) und der Vorstellung des BIM-Collaboration-Formats (BCF) zur strukturierten Beschreibung von Konflikten bzw. Mangeln im Modell.

Heparin-induced thrombocytopenia II-induced critical limb ischaemia treated with urokinase and argatroban

Heparin-induced thrombocytopenia II-induced critical limb ischaemia treated with urokinase and argatroban -

A Systematic Review of the Semi-Sitting Position in Neurosurgical Patients with Patent Foramen Ovale: How Frequent Is Paradoxical Embolism?

BACKGROUND The semi-sitting position is preferred in some surgeries of the posterior fossa and the cervical spine. At the same time, it is associated with a risk of air embolism. In the presence of a patent foramen ovale (PFO) with an intracardial right-to-left shunt, an air embolism can result in a paradoxical embolism to the heart or brain. It is unclear whether the risk-benefit ratio favors the semi-sitting position in this scenario. METHODS We conducted a systematic review of the relevant studies published after 2007 by searching the PubMed, Science Direct, and Cochrane Database of Systematic Reviews databases. Studies in which the presence of PFO was stated and the occurrence of paradoxical embolism was evaluated in patients who underwent neurosurgical procedures in the semi-sitting position were included in our analysis. RESULTS We identified 4 observational studies with a total of 977 patients who underwent surgery of the posterior fossa or cervical spine in the semi-sitting position; among these, 82 had a PFO. Air embolism occurred in 33 of these 82 patients (40.2%). No paradoxical embolisms were detected. CONCLUSIONS In experienced medical centers, neurosurgery in the semi-sitting position is feasible with acceptable risk even in patients with PFO. If the PFO is large, or if a permanent right-to-left shunt is present in a patient with a history of paradoxical embolism, it may be reasonable to repair the PFO before surgery if the semi-sitting position is strongly preferred. The risk analysis must be done on a case-by-case basis.

Net reclassification improvement with serial biomarkers and bed-sided spirometry to early predict the need of organ support during the early post-transplantation in-hospital stay in allogeneic HCT recipients

To predict the need of intensive care unit admission with organ support during the transplantation hospital stay in 101 consecutives allogeneic hematopoietic cell transplantation (allo-HCT) recipients the added predictive utility of three times per week Copeptin, MR-proADM, MR-proANP, NT-proBNP, IL-6, Procalcitonin, d-dimer and three times per week bed-sided pulmonary function test was determined in comparison with an index model. The index model was calculated by multivariate regression analysis out of the patients’ routine laboratory parameters. To calculate the added predictive utility of the investigated markers the Δ-AUC and the continuous net reclassification improvement (cNRI + 2 to − 2), splitted for events and non-events were calculated for each marker in comparison with the index model. According to the Δ-AUC, none of the parameters improved risk prediction. In contrast, the cNRI was significantly improved for events and non-events by Copeptin (event 0.75, p value 0.0013; non-event 0.4, p value 0.000079) and for events by NT-proBNP (0.6, p value 0.018). d-dimer and PCT significantly predicted the non-event. Of the spirometry parameters, the FEF50% improved prediction of event and non-event according to the cNRI model. Our data support the additional serial analysis of Copeptin and NT-proBNP in allo-HCT recipients during the transplantation hospital stay.

A rare case for gas in the heart: diagnosis and treatment

A 51-year-old patient with newly diagnosed multiple myeloma was admitted with somnolence, severe abdominal pain, and suspicious of myocardial infarction. Laboratory test results revealed hyperproteinaemia, elevated liver enzymes, impaired renal function, elevated serum lactate, and impaired coagulation tests. Abdominal ultrasound and echocardiography revealed gas inclusions within …