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Purpose The purpose of this paper is to explore the reasons behind the occurrence of serious accidents during interior firefighting operations of the German fire services despite numerous and significant safety improvements. Design/methodology/approach The paper is a case study relying on accident investigation reports from four accidents that happened in Germany between 2005 and 2016. Findings The study finds that the system of interior attack firefighting in Germany is a tightly coupled and complex system, as described by the normal accident theory, and that all four cases were caused by unanticipated interactions between components of the system and were therefore system accidents as described by the normal accident theory. This means that these accidents were ultimately caused by the properties of the system that make it susceptible to system accidents. Research limitations/implications To prevent these accidents, there is a need to change the properties of the system that make it susceptible to system accidents. Practical implications The study identifies factors that make the system inherently dangerous. Hence, practical measures can be undertaken to counter these factors and make the system safer. Originality/value This study is the first application of the normal accident theory to the operations of the fire services in general, and it is the first theory-guided inquiry into accidents of the German fire services. The findings of this paper provide new explanations for accidents and new approaches to improve safety during interior attack firefighting operations.

To evaluate the safety and impact of biopsy tract plugging with gelatin sponge slurry in percutaneous liver biopsy. 300 consecutive patients (158 females, 142 males; median age, 63 years) who underwent computed tomography-guided core biopsy of the liver in coaxial technique (16/18 Gauge) with and without biopsy tract plugging were retrospectively reviewed (January 2013 to May 2018). Complications were rated according to the common criteria for adverse events (NCI-CTCAE). The study cohort was dichotomized into a plugged (71%; n = 214) and an unplugged (29%; n = 86) biopsy tract group. Biopsy tract plugging with gelatin sponge slurry was technically successful in all cases. Major bleeding events were only observed in the unplugged group (0.7%; n = 2), whereas minor bleedings (4.3%) were observed in both groups (plugged, 3.6%, n = 11; unplugged, 0.7%, n = 2). Analysis of biopsies and adverse events showed a significant association between number of needle-passes and overall ( P  = 0.038; odds ratio: 1.395) as well as minor bleeding events ( P  = 0.020; odds ratio: 1.501). No complications associated with gelatin sponge slurry were observed. Biopsy tract plugging with gelatin sponge slurry is a technically easy and safe procedure that can prevent major bleeding events following liver biopsy.

The article at hand is envisaged to enumerate significant technological parameters for the successful impregnation of carbon fiber rovings having 50,000 (50 K) filaments, each within a fine-grained, cementitious suspension. Parameters such as the number of rollers as well as the influence of roller deflection and rotation have been investigated and discussed with regard to the quality of the related impregnation and mechanical properties resulting therefrom. Morphological analysis disclosed distinct differences in the fiber matrix distribution, which are particularly reflected in the flexural performance of the mineral-impregnated carbon fibers (MCFs) produced. Moreover, with the best fiber matrix distribution, uniaxial tensile tests on MCFs demonstrated superior tensile strengths, moduli of elasticity, and elongations at rupture.

Objectives To retrospectively determine incidence of early arterial blood flow stasis and its influencing factors during resin-based radioembolization (RE) of liver tumours. Methods Data of patients undergoing resin-based RE from 06/2006–12/2013 were reviewed. Second RE procedures of the same liver lobe were excluded. 90-yttrium dose was calculated according to the body surface area method. Data were categorized according to RE without full dose application because of early stasis and with full dose application. Clinical/procedural characteristics were recorded. Logistic regression was performed to identify associations between clinical/procedural characteristics and early stasis. Results 362 patients [220 male; mean age 62 years (range 26–90)] underwent 416 RE sessions with early stasis occurring in 103 REs (24.8 %). Highest incidence and degree of stasis were observed in breast cancer metastases [42.6 % (20/47); 55.8 % of mean intended dose administered]. Independent risk factors were: metastasized breast cancer (odds ratio [OR] 2.18, p  = 0.02), liver tumour-burden <25 % and 25–50 % (ORs 5.33, 15.64; p  < 0.0001), tumour hypovascularity (OR 2.70, p  = 0.04), previous bevacizumab therapy (OR 2.79, p  = 0.0009) and concurrent chemotherapy (OR 8.69, p  < 0.0001). Conclusion Early stasis was observed in 24.8 % of resin-based REs. In the presence of the identified risk factors, extra care should be taken during microsphere administration. Key Points • Early arterial blood flow stasis is a known problem of resin-based RE . • The study showed that early stasis occurs in 25 % of REs . • Several clinical and procedural factors are associated with early stasis . • In patients at risk extra care should be taken during RE .

Little is known about the specific anaesthesiological and multidisciplinary management of high-intensity focused ultrasound (HIFU) in uterine fibroids. This observational single-center study is the first reporting on an interdisciplinary approach to optimize outcome following ultrasound (US)-guided HIFU in German-speaking countries. A sample of forty patients with symptomatic uterine fibroids was treated by HIFU. Relevant treatment parameters such as total treatment time for intervention, anaesthesia, and sonication time as well as total energy, body temperature, peri-interventional medication and complications were analyzed. Interventional variables did not correlate significantly either with opioid dose or with body temperature. The average fibroid volume reduction rate was 37.8% ± 23.5%, 48.5% ± 22.0% and 70.2% ± 25.5% after 3, 6 and 12 months, respectively. No major anaesthesiological complications occurred apart from an epileptic seizure prior to HIFU treatment in one patient. Peri-procedural hyperthermia (> 37.5 °C) occurred in two patients. Post-procedural two patients experienced a sciatic nerve irritation up to one year; one patient with very large treated fibroid experienced strong short-lasting post-procedural pain. There were two complication-free pregnancies of HIFU-treated patients. Multidisciplinary management is crucial to optimize safety and outcome of US-guided HIFU for uterine fibroids. Peri-procedural pain and temperature management are critical points where an adequate collaboration between anesthesiologist and interventionalist is mandatory.

Purpose This study was designed to evaluate the results of a novel technique for transrenal ureteral occlusion using an Amplatzer vascular plug (AVP) II in patients with urinary fistulas. Methods We retrospectively evaluated the results of transrenal occlusion of 15 ureters in 9 hospitalized patients [8 females, 1 male, mean age 64 (range 52–79) years] suffering from pelvic malignancy (4 cervix-carcinomas, 3 bladder-carcinomas, 1 colorectal carcinoma, and 1 vulva-carcinoma). Seven patients were treated for urinary fistulas (4 ureteroenteral, 3 vesicovaginal); the others showed ileum-conduit-insufficiency and Mainz-pouch incontinence, respectively. From 2008 to 2009, an AVP was used in combination with coils and tissue adhesive ( n  = 5). Since 2009, ureteral occlusions were performed using a latex-covered AVP ( n  = 10). All patients had previous nephrostomy with only incomplete clinical improvement. Results Fourteen of 15 interventions were technically successful. Four of five ureters occluded with a combination of AVP, coils, and tissue adhesive were permanently sealed after a single procedure, whereas one showed slight leakage. After placement of two additional coils 20 days later, permanent occlusion was achieved [mean follow-up 195 (range 30–687) days]. Nine of ten ureters occluded with a latex-covered AVP were completely sealed after a single intervention [mean follow-up 152 (range 10–462) days]. In one case, the latex-cover dislocated during implantation. The AVP alone failed to provide complete dryness. There were no dislocations of the AVP or other major complications. Conclusions Transrenal ureteral occlusion using an AVP is a practical, simple, and quick method and can be advantageous in palliative patients suffering from pelvic malignancy.

Purpose To describe a new approach to protect nontarget healthy liver tissue using degradable starch microspheres (DSM) as a short-term embolizate during radioembolization of liver tumours with 90 Y microspheres. Methods Between December 2011 and July 2012 radioembolization was performed in 54 patients. Five of these patients (three women, two men; mean age 67 years) underwent protective temporary embolization using DSM (EmboCept® S) of normal liver tissue that could not be excluded from the area treated by radioembolization through catheter repositioning. Clinical symptoms, laboratory findings, preinterventional imaging, and 99m Tc-MAA and bremsstrahlung SPECT/CT, as well as baseline and follow-up imaging with 18 F-FDG PET/CT and MRI, were evaluated in relation to the technical and clinical success of the protective embolization. Results Temporary embolization of arteries supplying normal liver tissue using DSM was technically successful in all five patients. 99m Tc-MAA SPECT/CT performed in the first two patients after DSM injection showed no increased pulmonary shunting compared to the MAA test injection without DSM. Bremsstrahlung SPECT/CT after radioembolization demonstrated satisfactory irradiation of the tumour and successful protection of normal liver tissue. There were only mild hepatotoxic effects (grade 1) on laboratory follow-up examinations, and no adverse events associated with DSM embolization or radioembolization were recorded. Conclusion Temporary embolization with DSM before radioembolization is feasible and can effectively protect areas of normal liver tissue from irradiation and avoid permanent embolization if other methods such as catheter repositioning are not possible due to the location of the metastases.

Background This study aimed to evaluate the embolic properties, time to reperfusion, and histologic changes in temporary embolization of liver tissue with degradable starch microspheres (DSM) in a swine model. Methods In four adult minipigs, DSMs were injected into the right or left hepatic artery on the lobar level until complete stasis of the blood flow was detectable angiographically. The time required to complete angiographically determined reperfusion was noted. The animals were killed 3 h after complete reperfusion, and samples were taken from the liver. Histologic examinations of the embolized liver parenchyma and untreated tissue were performed. Results Hepatic arterial embolization using DSMs was technically successful in all cases, with complete blood flow stasis shown by control angiography. A single vial of DSMs (450 mg/7.5 ml) was sufficient to embolize a whole liver lobe in all cases. Angiography showed complete reconstitution of hepatic arterial perfusion after a mean time to reperfusion of 32 ± 6.1 min (range, 26–39 min). Hematoxylin and eosin staining showed no histologically detectable differences between untreated tissue and parenchyma embolized with DSMs except for mild sinusoidal congestion in one case. Indirect in situ DNA nick end labeling staining (TUNEL) showed only single positive hepatocytes, indicating apoptosis. Conclusion Temporary embolization of the hepatic artery using DSMs is feasible with complete reperfusion after 30 min in pigs. Even after complete arterial blood flow stasis, no extensive tissue damage to the embolized liver parenchyma was observed at histologic examinations in this short-term study.

[...]an Amplatzer vascular plug IV (St. Jude Medical, St. Paul, Minnesota, USA, made of nitinol wires and used for transcatheter embolisation in the peripheral vasculature and occlusion of abnormal vessel communications) was delivered into the fistula ( figure 1D ).

Purpose To evaluate safety of coblation of simulated lytic metastases in human cadaveric vertebral bodies by measuring heat distribution during thermal tissue ablation and comparing it to radiofrequency ablation (RFA). Materials and methods Three devices were compared: a 10 mm single-needle RFA electrode, a 20 mm array RFA electrode and the coblation device. To simulate bone metastases, a spinal tumor model was used stuffing a created lytic cavity with muscle tissue. Measuring of heat distribution was performed during thermal therapy within the vertebral body, in the epidural space and at the ipsilateral neural foramen. Eight vertebral bodies were used for each device. Results Temperatures at heat-sensitive neural structures during coblation were significantly lower than using RFA. Maximum temperatures measured at the end of the procedure at the neural foramen: 46.4 °C (±2.51; RFA 10 mm), 52.2 °C (±5.62; RFA 20 mm) and 42.5 °C (±2.88; coblation). Maximum temperatures in the epidural space: 46.8 °C (±4.7; RFA 10 mm), 49.5 °C (±6.48; RFA 20 mm) and 42.1 °C (±2.5; coblation). Maximum temperatures measured within the vertebral body: 50.6 °C (±10.48; RFA 10 mm), 61.9 °C (±15.39; RFA 20 mm) and 54.4 °C (±15.77; coblation). Conclusion In addition to RFA, the application of coblation is a safe method to ablate vertebral lesions with regards to heat distribution at heat-sensitive neural spots. The measured temperatures did not harbor danger of thermal damage to the spinal cord or the spinal nerves.