This study demonstrates that semisolid foods are the cause of a large number of asphyxiations, especially among the elderly. Knowledge of the fact that semisolid foods are a high-risk factor in elderly individuals should be distributed in public and private healthcare systems, and awareness could be a first step in reducing the incidence of food/foreign body asphyxia.

Summary:The so-called pinch-off syndrome is observed in up to 1% of all central venous catheters (CVCs), and is a valuable warning prior to fragmentation, which occurs in approximately 40% of the respective cases. As long-term indwelling CVCs are used with increasing frequency, this paper describes the necessity of pinch-off monitoring following the experiences of a case study and a review of the current literature on this specific topic in order to point out preventive practice guidelines.Besides easy preventive practices such as a high level of suspicion and adequate X-ray controls, findings give strong evidence that the most important specific factor might be the adequate approach.In our hands, the supraclavicular technique has provided the best results with regards to percutaneous introduction of large bore CVCs. Central venous catheters (CVCs) are useful therapeutic and diagnostic devices for administration of fluids, chemotherapeutic agents, parenteral nutrition and for central venous pressure monitoring, for vascular access, for extracorporal treatment regimens, and bone marrow transplantation. [1][2][3] As with most invasive procedures, central venous catheterization is associated with numerous potential complications, both during placement and later in long-term maintenance. Pneumothorax, infection, bleeding, arrhythmias, malposition, and thrombosis are well-known complications. 3,4 A rare but serious complication is catheter fragmentation with subsequent embolization through the heart into the pulmonary artery occurring in approximately 40% of patients who develop the possible precursor warnings of catheter fragmentation, the so-called pinchoff sign described by Aitken and Minton in 1984. [5][6][7] As long-term indwelling, CVCs have often become the patient's lifeline and are used with increasing frequency worldwide, we report a representative case of our own experience and summarize the current literature on this specific topic in order to emphasize preventive practice guidelines. Case reportA 35-year-old female presented with acute lymphatic leukemia in 1988. After treatment with standard chemotherapy she achieved complete remission. After 4 years, she relapsed and required reinduction. Prior to reinduction a port-a-cath was inserted by surgical cut-down technique. After chemotherapy the patient was scheduled for autologous bone marrow transplantation. Since the treating physicians considered an additional long-term device necessary for autologous bone marrow transplantation a double-lumen Hickman-catheter (Bard 12.0 Fr, Round Dual Lumen; Cranston, RI, USA) was inserted by surgical cut-down to access the contralateral subclavian vein. The procedure was performed by the surgeons without complications. The slight kinking of the line on the postprocedural chest radiograph was accepted because the catheter lines were functioning, the catheter tip was positioned correctly and the lumina of both catheter lines were inconspicious.Conditioning chemotherapy was administered and was followed by bone marrow tra...

The aim of this study was to assess survival and prognostic factors of 98 consecutive patients with unresectable glioblastoma multiforme (GBM) after stereotactic biopsy. Patients were diagnosed between 1993 and 1998, and the treatment modality subsequent to stereotactic biopsy was determined by the year of diagnosis. Before 1995, patients did not receive further specific therapy after stereotactic biopsy (n=36). In 1996, patients were administered radiotherapy starting within 6 weeks after stereotactic biopsy (n=24). From 1997 to 1998, patients received combined radio-/chemotherapy (RCT; CCNU orally) starting within 2 weeks after stereotactic biopsy (n=38). Patients' age ranged from 21 to 84 (median 64) years and their median Karnofsky performance score 2 weeks after stereotactic biopsy was 80 (range 60-100). Survival and prognostic factors were analyzed with respect to administered treatment modalities (without specific therapy versus radiotherapy versus combined RCT), with respect to age (>oror=or<80), tumor location (frontal, parieto-temporal, central, occipital) and tumor size (>or5 cm) by the Kaplan-Meier method, by log-rank test and multivariate Cox regression analysis. Post-biopsy treatment modality was the strongest predictor for survival. Median (range) survival was 9 (3-47) weeks in those without specific therapy, 13 (5-54) weeks in patients receiving radiotherapy and 31 (11-101) weeks in patients receiving combined RCT (p

Centenarians, though perceived to have been healthy just prior to death, succumbed to diseases in 100% of the cases examined. They did not die merely "of old age." The 100% post mortem diagnosis of death as a result of acute organic failure justifies autopsy as a legal requirement for this clinically difficult age group.

The aim of this study was to assess the efficacy and toxicity of a combination of dacarbazine (D) and fotemustine (F) administered to a homogenous group of patients with recurrent or progressive glioblastoma multiforme (GBM). Thirty-one patients with computed tomography or magnetic resonance imaging scan evidence of recurrent or progressive GBM after first-line chemotherapy with nitrosoureas as well as radiation therapy were given a combination of D (200 mg/m2) and F (100 mg/m2). At 30 min after termination of D administration, F was given over 60 min. Treatment was performed in an outpatient setting every 21 days. A total of 140 cycles (range 1-12 cycles; median 4 cycles) was administered. One partial response (3%) lasting for 11 weeks was observed. Sixteen (52%) patients reached stable disease lasting between 7 and 94 weeks. Median survival from start of the D/F combination was 45 (range 10-150) weeks. Median time to progression was 17 (3-101) weeks for all patients. Major toxicity was myelosuppression resulting in exclusion from study in seven (23%) patients [due to thrombocytopenia common toxicity criteria (CTC) grade 2 persisting longer than 3 weeks in three patients, due to thrombocytopenia CTC grade >/=3 in three and due to leukopenia CTC grade 3 in one patient]. No other toxicity than alopecia occurred. We conclude that the D/F combination is a well-tolerated second-line regimen and can be administered in a complete outpatient setting. D/F shows efficacy even in nitrosourea-pretreated patients and justifies further investigation.

After the second recurrence of spinal seeding in hemangioblastoma not associated to von-Hippel-Lindau disease, we treated an adult female patient with thalidomide 200 mg orally/day at night for longer than 1 year. The patient reported subjective relief of symptoms after 1 month. Magnetic resonance imaging (MRI) controls 1,6 and 11 months after begin of thalidomide treatment did not show further tumor progression. She remained wheelchair-bound, but mobility of her arms continuously improved. There was no thalidomide associated side-effect in this patient until her death from pneumonia due to legionnaire's disease. Antiangiogenic treatment with interferon (IFN) alpha-2a and IFN alpha-2b and with SU 5416 has been reported to be effective and well tolerated in several patients with previously progressive angioblastomas and hemangioblastomas. This case adds further evidence of the efficacy of an antiangiogenic treatment concept in a progressive hemangioblastoma.

No abstract

No abstract