[Relevance of CT-scans for pediatric head injuries].

Aim Of The Study: Clinical evaluation of pediatric head injury is quite difficult and often cranial CT scans are performed. We investigated the relevance of CT scans in relation to the therapeutic outcome.

Methods: During a 5-year-period we retrospectively evaluated the results of x-ray and cranial CT scan in respect to primary clinical assessment and degree of head injury.

[Results of femoral shaft fractures in childhood in relation to different treatment modalities].

The clinical and radiological results of femoral shaft fractures in childhood were evaluated and compared in relation to different treatment modalities. One hundred and one children (mean age 5+/-0,4 years) were treated between 1990 to 1999. 38% of the patients were treated conservatively (mean age 2,2+/-0,5 years), 32% of the patients (mean age 6+/-0,5 years) were treated by external fixation, 17% were treated with elastic stable intramedullary nailing (ESIN, mean age 5,6+/-0,8 years) and 12% underwent other internal fixation procedures.

[Optimized management of polytraumatized patients by prehospital ultrasound].

Aim: The purpose of the study was to evaluate the practicability and the benefit of focused abdominal sonography for trauma (FAST) on scene.

Methods: Prehospital ultrasound was performed on 61 patients being suspicious for abdominal trauma. Free fluid in the Koller's and Morison's pouch, pelvis and pleural space was investigated.

[Supracondylar humerus fracture in childhood--an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery--I: Epidemiology, effectiveness evaluation and classification].

In this retrospective study of the pediatric trauma group of German trauma society, issued to investigate the state of the art treatment of the supracondylar fracture of the humerus, 13 clinics took part. In this first part of our study we tested the epidemiology and effectivity of therapeutic interventions based on the classification of v. Laer.

Cerebral blood flow velocity and inflammatory response after severe traumatic brain injury.

Objectives: The cerebral blood flow velocity (CBVF) was measured by transcranial Doppler sonography in patients with severe traumatic brain injury (TBI) in order to determine, whether it depends on the posttraumatic inflammatory response.

Material And Methods: CBVF in both middle cerebral arteries (MCA) was recorded in 25 comatous TBI patients (male 20; female five; mean age +/- standard deviation (S.D.

[Pathological fracture in osteofibrous dysplasia].

Osteofibrous dysplasia Campanacci is a rare tumor-like lesion mostly presented in the meta-epiphyseal region of the tibia. Different options exist about the treatment modalities. The rare case of a 4 1/2-year-old girl suffering from a pathologic fracture of the tibia shaft due to a osteofibrous dysplasia is presented.

Prophylactic hemofiltration in severely traumatized patients: effects on post-traumatic organ dysfunction syndrome.

Objective: To evaluate the effects of prophylactic veno-venous hemofiltration (CVVH) in the absence of renal failure on multiple organ dysfunction syndrome after severe multiple trauma.

Design: Prospective, randomized study.

Setting: Intensive care unit (ICU) in a university hospital.

Differential release of interleukines 6, 8, and 10 in cerebrospinal fluid and plasma after traumatic brain injury.

Traumatic brain injury (TBI) is characterized by a high mortality which is largely determined by the initial cerebral trauma, secondary brain injury or indirectly during a Multiple Organ Dysfunction Syndrome (MODS). Therefore, we analyzed IL-6, IL-8, and IL-10 in cerebrospinal fluid (CSF) and in plasma with respect to blood-brain barrier (BBB) integrity in 29 patients suffering from isolated TBI. IL-6 and IL-8 were significantly increased compared to baseline levels early after trauma in CSF and plasma.

Alterations of norepinephrine levels in plasma and CSF of patients after traumatic brain injury in relation to disruption of the blood-brain barrier.

Background: In injured brain tissue with a disrupted blood-brain barrier (BBB) catecholamines such as norepinephrine (NE) are known to enhance glucose consumption and cerebral blood flow but may lead to an energy depletion increasing the risk of ischemia. Therefore it is of great interest whether the exogenous administration of NE used mainly to maintain an adequate cerebral perfusion pressure influences CSF NE levels or not, and whether elevated plasma or CSF levels of NE can influence the actual clinical condition. We addressed this issue by measuring the levels of NE in CSF and plasma and correlating them with the actual clinical condition of the patients.

Comparison of procalcitonin, sCD14 and interleukin-6 values in septic patients.

The aim of the study was to investigate whether procalcitonin, soluble CD14 and interleukin-6 show advantages in predicting the outcome and specificity for bacterial infection in patients with sepsis in comparison to common C-reactive protein measurement. Laboratory parameters were measured in plasma of patients during 14 days following the diagnosis of sepsis. Patients fulfilling the ACCP/SCCM criteria for sepsis were admitted to an intensive care unit (n=35).

[Severe craniocerebral trauma in multiple trauma. An assessment of the interaction of local and systemic mediator responses].

Isolated severe head trauma (SHT) or SHT in combination with multiple injuries are important factors for the prognosis of morbidity and mortality in patients suffering from the consequences of accidents. The prognosis mainly depends on the presence of primary mechanic brain injury and the development of secondary brain damage. Causes for the development of secondary brain damage are the intracranial space demand after traumatic injury and edema formation which may result in iscemia, as well as inflammatory processes.

Double traumatic abdominal wall hernia and colon laceration due to a pelvic fracture.

A traumatic abdominal wall hernia was observed in association with a colonic laceration due to a pelvic fracture. The presence of this specific combination of injuries is a rare clinical entity. CT evaluation with intravenous and bowel contrast media identified the traumatic abdominal wall hernia and the bowel entrapment.

Altered calcium regulation and function of human neutrophils during multiple trauma.

Altered intracellular Ca2+ concentration is a pivotal regulatory mechanism of leukocyte function. Since polymorphonuclear neutrophils (PMN) are involved in traumatic organ dysfunction, we prospectively investigated Ca2+ regulation and function of circulating PMN multiple trauma patients (Group A: ISS < 27; Group B: ISS > or = 27). Circulating PMN were isolated during 12 days, followed by determination of formyl-methionyl-leucyl-phenylalanine (fMLP)-induced PMN-superoxide production (PMN-SOP) by SOD-inhibitable ferricytochrome C reduction, and PMN cytosolic Ca2+ concentration ([Ca2+]i) by fluorescent fura2/AM (340/380 ratio).

[Diagnostic and therapeutic significance of arthroscopy in distal radius fracture].

Non-operative and minimal-invasive treatment of distal radius fractures have still a poor outcome. Although bony structures often heal acceptable, additional lesions of intraarticular ligamentous structures cause persistent pain and disability. Aim of the study was to present the diagnostic and therapeutic possibilities of arthroscopically assisted treatment of distal radius fractures.

[Value of MRI in diagnosis of post-traumatic wrist complaints].

The diagnostic value of MRI in acute and chronic posttraumatic wrist pain will be demonstrated in several clinical cases. The integration of MRI in a diagnostic algorithm is discussed. The indication of MRI is given for suspected complex ligamentous lesions, occult fractures and soft tissue pathologies, in particular with disconcordant clinical and radiological signs.

Antioxidative resuscitation solution prevents leukocyte adhesion in the liver after hemorrhagic shock.

Background: The generation of iron-dependent toxic oxygen radicals during the initial resuscitation from hemorrhagic shock was shown to be a relevant factor for the initiation of the inflammatory cascade. Therefore, this experimental study was designed to evaluate the effects of a deferoxamine-conjugated hydroxyethyl-starch solution (HES-DFO) on oxygen radical induced injury and microcirculatory alterations in the rat liver compared with resuscitation with regular hydroxyethyl-starch, lactated Ringer's solution (RL), or a gelatin-based solution.

Methods: After hemorrhage and random assignment to 1 hour of blood-free resuscitation with the aforementioned solutions, hepatic microcirculation and leukocyte adhesion characteristics were assessed by intravital fluorescence microscopy in anesthetized rats.

Modern therapy of chronic wounds with respect to radiation.

Background: Descriptions of wound care techniques have been found in some of the oldest archeological findings and chronic wounds have been threaded man thousands of years. However, only in the last few decades substantial progress has been made in understanding the cellular and biochemical processes relevant in normal healing.

Pathophysiology: Wound healing is a complex process involving a variety of different cells, proteins, chemoattractants, proteinases and growth factors.

Mediators in polytrauma--pathophysiological significance and clinical relevance.

Multiple trauma induces an inflammatory response syndrome of the whole body that is triggered by (a) hemorrhage inducing an ischemia/reperfusion (I/R) syndrome and (b) fractures or organ contusions inducing tissue-repair processes. I/R injury generates oxyradical/proteolytic metabolites and adhesion molecules, while tissue and endothelial injury directly stimulate complement, coagulation and kinin pathways. Membrane-derived phospholipase A2 and lipid mediators potentiate cellular interactions and increase microvascular permeability.

Role of nitric oxide in the regulation of the hepatic microcirculation in vivo.

Background/aims: Nitric oxide (NO) is an important mediator in the regulation of vascular tone. However, no data exist on the physiological role of NO in the regulation of the hepatic microcirculation. This study was designed to evaluate the role of NO in the hepatic microcirculation in vivo under physiological conditions.

Adenosine kinase inhibitor GP515 attenuates hepatic leukocyte adhesion after hemorrhagic hypotension.

Adhesion of leukocytes to the vascular endothelium hallmarks a key event in neutrophil-mediated organ injury after ischemia-reperfusion. The autacoid adenosine has been shown to inhibit activated neutrophil function and to interfere with leukocyte-endothelial adherence. Its therapeutic use in ischemia-reperfusion, however, has been limited by severe cardiovascular side effects.

Recombinant N-terminal fragment of bactericidal/permeability increasing protein (rBPI21) prevents shock-induced microcirculatory alterations in the liver.

Objective: To investigate the effects of the recombinant 21-kilodalton N-terminal fragment of recombinant bactericidal and permeability increasing protein (rBPI21) on leukocyte adhesion and the hepatic microcirculation after hemorrhagic shock.

Design: Prospective, randomized, blinded, and placebo-controlled experimental study.

Setting: University research laboratory.

Significance of TNF in hemorrhage-related hemodynamic alterations, organ injury, and mortality in rats.

To evaluate the role of tumor necrosis factor-alpha (TNF-alpha) in hemodynamic alterations, multiple organ damage, and mortality caused by hemorrhagic shock, we employed a monoclonal antibody to TNF-alpha (TNF-alpha MAb) in anesthetized rats subjected to prolonged hemorrhagic shock (mean arterial pressure of 30-35 mmHg for 180 min) followed by resuscitation over 50 min. Treatment of rats with 20.0 mg/kg TNF-alpha MAb 15 min after the end of resuscitation significantly decreased the total peripheral resistance index (P = 0.