Miodrag Vukcevic

Acute patellar dislocation in adolescents: operative versus nonoperative treatment

PurposeThe purpose of this prospective non-randomised study was to compare the efficacy of two opposed methods, operative and conservative. Our hypothesis was that if the method was selected correctly, on an individual basis, the results should be approximately equal.MethodsThe study included 37 adolescents aged between 12 and 16 years, with a mean follow up of 6.1 years. The presence of a significant loose body, confirmed by precise imaging, was the key for selecting operative or arthroscopic treatment. In both groups of patients, we evaluated functional knee scores and the incidence of residual patellofemoral disorders.ResultsWe confirmed our hypothesis using the t-test to compare functional results and a test for comparison of proportions for incidence of residual disorders. There was no statistically significant difference (p=0.091) between operatively and conservatively treated groups with regard to functional results. The same statistical outcome emerged when comparing incidences of re-dislocation (p=0.854), or other major patellar instabilities (p=0.856), between the groups.ConclusionsThe results obtained should not promote a non-operative method on the basis of lower risk, but do support an individual approach based on precise diagnosis and defined criteria.

Non-invasive respiratory monitoring using long-period fiber grating sensors

In non-invasive ventilation, continuous monitoring of respiratory volumes is essential. Here, we present a method for the measurement of respiratory volumes by a single fiber-grating sensor of bending and provide the proof-of-principle by applying a calibration-test measurement procedure on a set of 18 healthy volunteers. Results establish a linear correlation between a change in lung volume and the corresponding change in a local thorax curvature. They also show good sensor accuracy in measurements of tidal and minute respiratory volumes for different types of breathing. The proposed technique does not rely on the air flow through an oronasal mask or the observation of chest movement by a clinician, which distinguishes it from the current clinical practice.

Home mechanical ventilation in children is feasible in developing countries

Background:  The results of many national surveys on pediatric home mechanical ventilation (HMV) in developed countries have been presented elsewhere, but data from developing countries with low national incomes are scarce.

Successful treatment of laryngomalacia and bilateral vocal cord paralysis with continuous positive airway pressure

INTRODUCTION Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction. CASE REPORT In a 14 month old boy severe laryngomalacia and bilateral vocal cord paralysis were diagnosed by flexible bronchoscopy. A sleep study showed a severe obstructive sleep apnoea (OSA). The patient was ventilated at home via the face mask with non invasive mechanical ventilation (CPAP) for a year. The level of pressure had to be set at 7 cm H2O to correct desaturation with an improvement in mean SpO2. On the follow up bronchoscopic examination laryngomalatia was improved, vocal cord paralysis persisted and sleep study revealed significant improvement. DISCUSSION In the patient with severe laryngomalatia and bilateral vocal cord paralysis with OSA conservative treatment with CPAP was used instead of a surgical intervention. Non invasive ventilation was used every night, for at least 6 hours, without adverse events. Invasive measurement of transdiaphragmatic pressure is the best way of titrating of CPAP level. This case report suggests the efficacy of noninvasive titrating of CPAP level by the hemoglobin oxygen saturation trend measurement. CONCLUSION In case of severe laryngomalatia and associated vocal cord paralysis, followed by OSA non invasive ventilation by nasal CPAP represents an effective and safe alternative to surgery.

Rib-cage-movement measurements as a potential new trigger signal in non-invasive mechanical ventilation.

Non-invasive ventilation performed through an oronasal mask is a standard in clinical and homecare mechanical ventilation. Besides all its advantages, inevitable leaks through the mask cause errors in the feedback information provided by the airflow sensor and, hence, patient-ventilator asynchrony with multiple negative consequences. Here we investigate a new way to provide a trigger to the ventilator. The method is based on the measurement of rib cage movement at the onset of inspiration and during breathing by fibre-optic sensors. In a series of simultaneous measurements by a long-period fibre grating sensor and pneumotachograph we provide the statistical evidence of the 200 ms lag of the pneumo with respect the fibre-optic signal. The lag is registered consistently across three independent delay metrics. Further, we discuss exceptions from this trend and identify the needed improvements to the proposed fibre-sensing scheme.

A new method for respiratory-volume monitoring based on long-period fibre gratings

Respiratory-volume monitoring is an indispensable part of mechanical ventilation. Here we present a new method of the respiratory-volume measurement based on a single fibre-optical long-period sensor of bending and the correlation between torso curvature and lung volume. Unlike the commonly used air-flow based measurement methods the proposed sensor is drift-free and immune to air-leaks. In the paper, we explain the working principle of sensors, a two-step calibration-test measurement procedure and present results that establish a linear correlation between the change in the local thorax curvature and the change of the lung volume. We also discuss the advantages and limitations of these sensors with respect to the current standards.

Real-time chest-wall-motion tracking by a single optical fibre grating: a prospective method for ventilator triggering

OBJECTIVE The ventilators involved in non-invasive mechanical ventilation commonly provide ventilator support via a facemask. The interface of the mask with a patient promotes air leaks that cause errors in the feedback information provided by a pneumatic sensor and hence patient-ventilator asynchrony with multiple negative consequences. Our objective is to test the possibility of using chest-wall motion measured by an optical fibre-grating sensor as a more accurate non-invasive ventilator triggering mechanism. APPROACH The basic premise of our approach is that the measurement accuracy can be improved by using a triggering signal that precedes pneumatic triggering in the neuro-ventilatory coupling sequence. We propose a technique that uses the measurement of chest-wall curvature by a long-period fibre-grating sensor. The sensor was applied externally to the rib-cage and interrogated in the lateral (edge) filtering scheme. The study was performed on 34 healthy volunteers. Statistical data analysis of the time lag between the fibre-grating sensor and the reference pneumotachograph was preceded by the removal of the unwanted heartbeat signal by wavelet transform processing. MAIN RESULTS The results show a consistent fibre-grating signal advance with respect to the standard pneumatic signal by (230  ±  100) ms in both the inspiratory and expiratory phases. We further show that heart activity removal yields a tremendous improvement in sensor accuracy by reducing it from 60 ml to 0.3 ml. SIGNIFICANCE The results indicate that the proposed measurement technique may lead to a more reliable triggering decision. Its imperviousness to air leaks, non-invasiveness, low-cost and ease of implementation offer good prospects for applications in both clinical and homecare ventilation.

Stylistics and the cultural context in literary translation: Njegoš’s The Mountain Wreath in the German translation

Considering the example of the translation of Njegos’s The Mountain Wreath into the German language, the paper analyses the translational solutions that are dictated by the principles of the subject. The translator Alois Schmaus chose to take this step in order to bring home to the modern reader a world which appears to be archaic. He made this decision for two reasons. First, the German reader is unfamiliar with the historical context that is the subject of this poem; secondly the rules of prosody in Serbian and German do not match. By choosing to carry over the Serbian epic decasyllable, Schmaus favours the Serbian poetic tradition. From the historical point of view German verse, constructed as an Alexandrine, is burdened with the context of courtly poetics. The hexameter, meanwhile, which was introduced into German literature by Klopstock and later popularised by Voss and Goethe, appears in the context of the rise of the bourgeoisie. Both verses require changes while being translated, which affect the poem’s characteristics. In order to maintain authenticity, Schmaus pleads for the “Serbian trochee”: iamb and dactyl, metrical feet that are closer to the German language, would have impeded the setting the diaeresis and affected the syntax. Because of this, Schmaus places a spondee at the end of every verse and sets the historical context in the tradition of martyrdom.

Martin Schubert (Hrsg.): Schreiborte des deutschen Mittelalters: Skriptorien – Werke – Mäzene

Angesichts zeitgemäßer theoretischer Überlegungen, die im literaturkritischen Zusammenhang stehen, mag die Frage berechtigt sein, ob denn eine Verwertung von literaturgeschichtlichen Darstellungen in einem Sprachraum überhaupt Neues erwarten lässt. Und tatsächlich ist es von der Vielzahl der Darstellungen deutscher Literaturgeschichte her betrachtet ebenso wie von der Fülle der verschiedenen Ansätze her eine durchaus plausible Frage. Es mögen aber gerade diese Martin Schubert angeregt haben, durch im Vorfeld klar ausdifferenzierte Kriterien nach Ergebnissen zu suchen, die sich dementsprechend aussondern. Eben solchen allgemeinen Vorgaben folgend, verdankt das vorliegende Buchprojekt seine spezifische Stellung unter den bisher erschienenen Titeln zum Thema der deutschen Literaturgeschichte. Die Schreiborte des deutschen Mittelalters, so die Gegenstandsbeschreibung im Titel des Sammelbandes, bestätigen das in der Geschichtsschreibung zur deutschen Literatur mittlerweile erhärtete Vorgehen, dass eine systematische Zusammenführung von Angaben, versammelt an einem Ort, stets etwas Neues vorweisen kann. In 27 Beiträgen zu Orten, in denen schriftliche Tätigkeit seit dem frühen Mittelalter belegt ist, wird ein Überblick geboten, der sich konzeptuell als Geschichte geschachtelter Eingrenzungen (1) beschreibt. Zeitlich beschränkt sich der Band auf das Frühund Hochmittelalter, da im Spätmittelalter die historischen wie die literaturhistorischen Raumgrenzen unschärfer werden (Tervooren/Haustein 2003: 4). Räumlich wiederum erfassen die Beiträge, entsprechend der mit-abgebildeten geographischen Karte zu den behandelten Orten, ein Gebiet von Lübeck im Norden, über Magdeburg und Prag, Wien und Vorau im Osten bis hin zu St. Gallen und Zürich im Süden sowie Maastricht im Westen. Hinzugenommen werden zwei Orte mit nicht eindeutig lokalisierbaren Skriptorien. Die Auswertung der hier entstandenen Handschriften kündigt insofern neue Aufgaben in der deutschen Literaturgeschichtsschreibung an. Freilich sind die Autoren auch stets darum bemüht, den vorgegebenen Rahmen nicht zu überschreiten. Allerdings sind die Abgrenzungskriterien in Abhängigkeit von den historischen Umständen doch variabel. Zum einen gestaltet sich der Blick auf die lateinisch gehaltene Tradition der Schriftlichkeit nicht überall gleich, und zum anderen tragen verschiedene anderssprachige Einflüsse ebenfalls zu Unterschieden in der sprachund literaturgeschichtlichen Entwicklung einer Sprachgemeinschaft bei. Ein zentrales Merkmal dieses die Geschichte der Schriftlichkeit auf deutschsprachigem Gebiet behandelnden Bandes ist jedenfalls die sprachliche Tradition, welche von der deutschen Kulturtradition ausgehend in diese die lateinische Tradition integriert. Ebenso wichtig ist es, in diesem Zusammenhang nachdrücklich hervorzuheben, dass dieser Band sich nicht nur durch die Diskussion des aktuellsten Forschungsstandes auszeichnet, sondern auch im Versuch, den Gegenstand zeitgemäß zu präsentieren. Eingangswird dazu imAnsatz prämissenhaft zwischenOrten derWerkentstehung und Orten der Überlieferung unterschieden (3). Bei den Literaturund sprachwissenschaftlichen Analysen werden als Hilfsmittel diesbezüglich kodikologische und dialektale Merkmale herangezogen. Diese haben zur Spezifizierung des Ansatzes beigetragen, Studia Neophilologica 87: 123–128, 2015