Coagulopathy after traumatic brain injury: incidence, pathogenesis, and treatment options.

Coagulopathy after traumatic brain injury (TBI) is frequent and represents a powerful predictor related to outcome and prognosis. The complex pathophysiological mechanisms of the coagulopathy of TBI are multifactorial and remain still undefined. The nature of the coagulation abnormalities differs between severe TBI and non-TBI with somatic injuries.

Early single-shot intravenous steroids do not affect pulmonary complications and mortality in burned or scalded patients.

Background And Objectives: Inhalation injury, especially in combination with cutaneous burns, is the major cause of morbidity and mortality in patients admitted to burn care centers. Either with or without the presence of a cutaneous burn, inhalation injury contributes to high risk for developing severe pulmonary complications. Steroids may reduce a prolonged and destructive inflammatory response to toxic or allergic substances.

Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES).

Background: Laparoscopic cholecystectomy is one of the most common surgical procedures in Europe (and the world) and has become the standard procedure for the management of symptomatic cholelithiasis or acute cholecystitis in patients without specific contraindications. Bile duct injuries (BDI) are rare but serious complications that can occur during a laparoscopic cholecystectomy. Prevention and management of BDI has given rise to a host of publications but very few recommendations, especially in Europe.

Overviews of reviews often have limited rigor: a systematic review.

Objective: To examine published overviews of systematic reviews in terms of descriptive and methodological characteristics.

Study Design And Setting: MEDLINE, Database of Abstracts of Reviews of Effects, the Cochrane Database of Systematic Reviews, and several Health Technology Assessment databases were searched for overviews of reviews up to February 2012. We extracted data from the methods and results sections of the included overviews.

Knee injuries in severe trauma patients: a trauma registry study in 3.458 patients.

Background: Purpose of the presented study is to answer the following questions: Are knee injuries associated with trauma mechanisms or concomitant injuries? Do injuries of the knee region aggravate treatment costs or prolong hospital stay in polytraumatized patients?

Methods: A retrospective analysis including 29.779 severely injured patients (Injury Severity Score [greater than or equal to] 16) from the Trauma Registry of the German Society for Trauma Surgery database (1993-2008) was conducted. Patients were subdivided into two groups; the "Knee" group (n=3.

Development of a risk index for the prediction of chronic post-surgical pain.

The incidence of chronic post-surgical pain (CPSP) after various common operations is 10% to 50%. Identification of patients at risk of developing chronic pain, and the management and prevention of CPSP remains inadequate. The aim of this study was to develop an easily applicable risk index for the detection of high-risk patients that takes into account the multifactorial aetiology of CPSP.

Pharyngeal selective brain cooling is associated with reduced CNS cortical lesion after experimental traumatic brain injury in rats.

Therapeutic hypothermia (TH) is still being explored as a therapeutic option after traumatic brain injury (TBI) but clinical data has not supported its efficacy. Experimental approaches were promising, but clinical data did not support its efficacy in the treatment of TBI. A novel approach of pharyngeal selective brain cooling (pSBC), recently introduced by our group, has been accompanied by superior neurofunctional, sensorimotor, and cognitive outcomes.

Vascular endothelial growth factor (VEGF165) plus basic fibroblast growth factor (bFGF) producing cells induce a mature and stable vascular network--a future therapy for ischemically challenged tissue.

Background: Vascular endothelial growth factor (VEGF)(165) induces formation of immature blood vessels with increased permeability. In this study, we used a cell-based gene-transfer model of fibroblasts to investigate the effects of a combined in vivo treatment consisting of the VEGF165 and basic fibroblast growth factor (bFGF) proteins on ischemic and non-ischemic tissues.

Materials And Methods: After controlled in vitro adenoviral transfection we transplanted fibroblasts into either healthy tissue, or into an ischemic skin flap model at different tissue locations and at different time points.

Acute traumatic coagulopathy: Incidence, risk stratification and therapeutic options.

Background: Uncontrolled hemorrhage is responsible for over 50% of all trauma-related deaths within the first 48 hours after admission. Clinical observations together with recent research resulted in an appreciation of the central role of coagulopathy in acute trauma care. A synopsis is presented of different retrospective analyses based upon datasets from severe multiply injured patients derived from the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft fur Unfallchirurgie (DGU)/ German Society of Trauma Surgery) with respect to frequency, risk stratification and therapeutic options of acute traumatic coagulopathy (ATC).

Development and validation of the revised injury severity classification score for severely injured patients.

Introduction: Trauma scores are often used for prognostication and the adjustment of mortality data. The appropriate consideration of identified prognostic factors is mandatory for a valid score with good outcome prediction properties. The Trauma Registry of the German Society for Trauma Surgery (TR-DGU) initially used the Trauma and Injury Severity Score (TRISS) but various reasons led to the development of a new scoring system, the Revised Injury Severity Classification (RISC).

Pharyngeal selective brain cooling improves neurofunctional and neurocognitive outcome after fluid percussion brain injury in rats.

Therapeutic hypothermia (TH) after cardiac arrest reduces mortality and improves neurological outcome. Experimental TH after traumatic brain injury (TBI) indicated similar effects, but benefits were not reproducible in large clinical trials. Therefore, a novel approach of pharyngeal selective brain cooling (pSBC) was tested in respect to neurological outcome in a model of experimental TBI.

"The good into the pot, the bad into the crop!"--a new technology to free stem cells from feeder cells.

A variety of embryonic and adult stem cell lines require an initial co-culturing with feeder cells for non-differentiated growth, self renewal and maintenance of pluripotency. However for many downstream ES cell applications the feeder cells have to be considered contaminations that might interfere not just with the analysis of experimental data but also with clinical application and tissue engineering approaches. Here we introduce a novel technique that allows for the selection of pure feeder-freed stem cells, following stem cell proliferation on feeder cell layers.

Head injury and outcome--what influence do concomitant injuries have?

Background: Severe head injury (HI) is known to be a major determinant of mortality in patients with multiple injuries but additional injuries also contribute to the clinical outcome. The Trauma Registry of the German Society for Trauma Surgery offers sufficient data for comparative outcome analysis in relation to the injury pattern.

Methods: A total of 21,356 cases from Trauma Registry of the German Society for Trauma Surgery with complete data for pattern of injury (Abbreviated Injury Scale [AIS], Injury Severity Score), the incidence of hospital mortality, organ failure, sepsis, duration of hospital stay, and intubation-free days.

Red-blood-cell to plasma ratios transfused during massive transfusion are associated with mortality in severe multiple injury: a retrospective analysis from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie.

Background: To test whether an acute transfusion practice of packed red blood cells (pRBC) : fresh-frozen plasma (FFP) 1 : 1 would be associated with reduced mortality in acute bleeding multiply injury.

Methods: Retrospective analysis using the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie 2002-2006) on primary admissions with substantial injury (Injury Severity Score > 16) and massive transfusion (> 10 pRBCs). Seven hundred thirteen patients were divided into three groups according to the pRBC : FFP ratio transfused, that is, (i) pRBC : FFP > 1.

Stem cell-based cellular replacement strategies following traumatic brain injury (TBI).

Given the limited capacity of the central nervous system for self-repair, the use of stem cells holds an enormous potential in cell replacement therapy following traumatic brain injury and has thus received a great deal of scientific and public interest in recent years. During the past decade, several stem/progenitor cell types and lines from various sources such as embryonic rodent and human stem cells, immortalized progenitor cells, bone marrow derived cells or even post-mitotic neurons derived from human teratocarcinoma cells have been assessed for their potential to improve neurofunctional and behavioural outcome after transplantation into the experimentally injured brain. A number of studies indicate that cells engrafted into the injured brain can survive and, at least in part, may reverse behavioural dysfunction and histomorphological damage.

Differential immunoresponses following experimental traumatic brain injury, bone fracture and "two-hit"-combined neurotrauma.

Objective And Design: Cytokine-mediated immunoresponses are consequences of isolated traumatic brain injury (TBI) and muskuloskeletal trauma but little is known when both impacts occur simulanteously in combined neurotrauma (CNT), i. e. TBI + muskuloskeletal trauma (bone fracture).

Quality of life after multiple trauma: the effect of early onset psychotherapy on quality of life in trauma patients.

Background And Aims: The aim of this study was to improve health-related quality of life (HRQOL) related to depression, anxiety, pain, physical functioning and social aspects for severely injured trauma survivors by early onset cognitive behavioural therapy applied on the surgical ward.

Materials And Methods: The study was a randomised, controlled study. Of 298 primary screened patients 171 were eligible and randomised.