Focus on focus: Lack of coherence between systemic and microvascular indices of oedema formation

Background: Fluid therapy remains a cornerstone of therapy in shock states. However, fluid overloading ultimately results in oedema formation which is related to excess morbidity and mortality. Handheld microscopes are now frequently used to study the sublingual microcirculation. As a corollary, these devices measure focal distance, or surface to capillary distance. Physiologically, this could represent a microvascular index of oedema formation and could have the potential to guide fluid therapy. This potential tool should be investigated, especially given the frequently reported lack of coherence between systemic and microvascular parameters in the critically ill. Therefore, we set out to assess the correlation between microvascular focal distance and systemic indices of oedema formation, specifically fluid balance and weight gain. Methods: Following ex vivo testing of focal distance measurement reliability, we conducted a prospective observational cohort study in patients admitted to the intensive care unit of our university teaching hospital. We determined surface to capillary distance using sidestream dark field (SDF) and incident dark field (IDF) imaging by assessing the focal distance point or object distance range at which a sharp recording could be made. Measurements were performed in post-cardiac surgery patients and in patients following emergency admission at two time points separated by at least several hours. Data on fluid balance, weight and weight gain were collected simultaneously. Results: Sixty patients were included. The focal setting, focus point for SDF and the object distance range for IDF did not differ significantly between time points. Focus was not correlated with difference in fluid balance or weight gain. Conclusions: There is a lack of coherence between surface to capillary distance as determined by SDF or IDF imaging and fluid balance or weight gain. Thus, focal distance as a microvascular index of oedema formation cannot currently be used as a proxy for systemic indices of oedema formation. However, given the lack of coherence, further research should determine whether focal distance may provide better guidance for fluid therapy than traditional markers of overzealous fluid administration

Beitrag zur Kenntniss des Corpus mammillare und der sogenannten Schenkel des Fornix

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Beitrag zur Lehre von der Scabies

Nachstehende Untersuchung beschäftigt sich vorzugsweise mit der inneren Organisation des Sarcoptes hominis und ergänzt somit die betreffende Abhandlung in meinen Beiträgen zur Kenntniss der durch Parasiten bedingten Hautkrankheiten (Stuttgart 1855, Ebner und Seubert). ..

Psychiatrische Jugendfürsorge (mit besonderer Berücksichtigung der Verhältnisse in Bayern).: Referat erstattet auf dem bayerischen Psychiatertag am 29. Juni 1912.

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The connections of the basal optic root (posterior accessory optic tract) and its nucleus in various mammals

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49926/1/900740303_ftp.pd

Historical controversies about the thalamus: from etymology to function

The authors report on and discuss the historical evolution of the 3 intellectual and scientific domains essential for the current understanding of the function of the human thalamus: 1) the identification of the thalamus as a distinct anatomical and functional entity, 2) the subdivision of thalamic gray matter into functionally homogeneous units (the thalamic nuclei) and relative disputes about nuclei nomenclature, and 3) experimental physiology and its limitations.Galen was allegedly the first to identify the thalamus. The etymology of the term remains unknown although it is hypothesized that Galen may have wanted to recall the thalamus of Odysseus. Burdach was the first to clearly and systematically define the thalamus and its macroscopic anatomy, which paved the way to understanding its internal microarchitecture. This structure in turn was studied in both nonhuman primates (Friedemann) and humans (Vogt and Vogt), leading to several discrepancies in the findings because of interspecies differences. As a consequence, two main nomenclatures developed, generating sometimes inconsistent (or nonreproducible) anatomo-functional correlations. Recently, considerable effort has been aimed at producing a unified nomenclature, based mainly on functional data, which is indispensable for future developments. The development of knowledge about macro- and microscopic anatomy has allowed a shift from the first galenic speculations about thalamic function (the "thalamus opticorum nervorum") to more detailed insights into the sensory and motor function of the thalamus in the 19th and 20th centuries. This progress is mostly the result of lesion and tracing studies. Direct evidence of the in vivo function of the human thalamus, however, originates from awake stereotactic procedures only.Our current knowledge about the function of the human thalamus is the result of a long process that occurred over several centuries and has been inextricably intermingled with the increasing accumulation of data about thalamic macro- and microscopic anatomy. Although the thalamic anatomy can currently be considered well understood, further studies are still needed to gain a deeper insight into the function of the human thalamus in vivo

Post-Variscan thermal and tectonic evolution of the KTB site and its surroundings

The post-Carboniferous crustal evolution of the German Continental Deep Drilling Program (KTB) area, as summarized in this paper, could not be predicted from surface observations: deep drilling was essential for its revelation, The most conspicuous and unexpected feature discovered in the drill hole is the absence of marked gradients with respect to the pre-Carboniferous record, There are no depth-related differences in K-Ar cooling ages of hornblende and white mica, in petrology or in lithology, All metamorphic rocks encountered, both at the surface as well as in the drill hole down to 9100 m depth, were below 300 degrees C from the Carboniferous onward. The late to post-Carboniferous deformation is essentially confined to several fault zones, A major fault zone encountered in the drill hole at 7000 m depth is linked by a prominent seismic reflector to the Franconian Lineament, the surface boundary between Variscan basement and Mesozoic cover, This fault zone probably formed in the late Paleozoic and reactivated as a reverse fault in the Mesozoic. Two important episodes of NE-SW directed shortening by movements along reverse faults took place in the early Triassic and in the late Cretaceous, as indicated by the distribution of apatite and titanite fission-track ages, the sericite K-Ar ages of fault rocks, and the sedimentary record in the adjacent basins, Upper crustal slices were detached at a specific level, corresponding to the approximate position of the brittle-ductile transition in post-Variscan times, and form an antiformal stack that was penetrated by the KTB throughout its entire depth range.</p

The mesencephalic root of the fifth nerve. A comparative anatomical study

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49899/1/900460202_ftp.pd