Verletzungsadaptierte Behandlungsstrategie

Ohne Zusammenfassung Prof.Dr. Hans-Christoph Pape Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl Neubergstr.1,30625 Hannover, E-Mail: Pape.Hans-Christoph@MH-Hannover.de     

An?sthesie in der Augenheilkunde

Ohne Zusammenfassung Prof.Dr. J.-P. Jantzen,DEAA Klinik für Anaesthesiologie und Intensivmedizin, Klinikum Hannover Nordstadt, Haltenhoffstra?e 41,30167 Hannover     

Surgical technique of percutaneous iliosacral screw fixation in S3 level in unstable pelvic fracture with closed degloving injury and morrell lavallee lesion: Two case reports

IntroductionPercutaneous screw fixation is considered the best option in unstable pelvic fracture with severe soft tissue injury. However, fixation technique at the level of S3 has not been well established. This paper showed the feasible surgical technique of S3 screw insertion in unstable pelvic fracture with severe soft tissue injury.MethodsWe reported 2 cases of unstable pelvic injury of an 11 years old boy with Marvin-Tile (MT) C1 pelvic fracture with sacroiliac (SI) joint disruption, skin avulsion and Morel-Lavallée lesion. Second case was 30 years old male with open pelvic fracture MTB2 and vertical sacral fracture Denis zone I with Morel-Lavallée lesion, intraperitoneal bladder rupture, infected laparotomy wound dehiscence. We performed percutaneous screws insertion on both pubic rami and IS screw on S1 and S3 to both cases. Functional outcome was evaluated using Majeed and Hannover pelvic score.ResultsAll patients survived and had good reduction with no residual displacement on SI joint. The former case at 21-month follow up presented with excellent outcome (100/100) by Majeed score and very good outcome (4/4) by Hannover score; while the latter case, at 18-month, present with good outcome (85/100) Majeed score and fair outcome (2/4) Hannover score.ConclusionsPercutaneous screw fixation at the level of S3 is feasible and can be inserted in S3 level by sacroiliac type and sacral type with minimal soft tissue intervention and good functional outcome.     

Knieendoprothetik: es gibt noch viel zu forschen

Ohne Zusammenfassung Prof.Dr. C. J.Wirth Orthop?dische Klinik, Medizinische Hochschule im Annastift e.V., Heimchenstra?e 1–7,30625 Hannover, E-Mail: wirth@annastift.de     

Kostenaspekte der Brachytherapie

Anmerkungen zum Weiterbildungsbeitrag “Die interstitielle Brachytherapie des lokal begrenzten Prostatakarzinoms mittels permanent implantierter Strahlenquellen” von H.-W.Gottfried, E. Schneider und P.M.Messer [Urologe B (2002) 42: 142–150] Dr.C. v. Zastrow Ottostr.3,30519 Hannover     

Pain threshold correlates with functional scores in osteoarthritis patients

Background and purpose — Pain sensitization may be one of the reasons for persistent pain after technically successful joint replacement. We analyzed how pain sensitization, as measured by quantitative sensory testing, relates preoperatively to joint function in patients with osteoarthritis (OA) scheduled for joint replacement.

Patients and methods — We included 50 patients with knee OA and 49 with hip OA who were scheduled for joint replacement, and 15 control participants. Hip/knee scores, thermal and pressure detection, and pain thresholds were examined.

Results — Median pressure pain thresholds were lower in patients than in control subjects: 4.0 (range: 0–10) vs. 7.8 (4–10) (p = 0.003) for the affected knee; 4.5 (2–10) vs. 6.8 (4–10) (p = 0.03) for the affected hip. Lower pressure pain threshold values were found at the affected joint in 26 of the 50 patients with knee OA and in 17 of the 49 patients with hip OA. The American Knee Society score 1 and 2, the Oxford knee score, and functional questionnaire of Hannover for osteoarthritis score correlated with the pressure pain thresholds in patients with knee OA. Also, Harris hip score and the functional questionnaire of Hannover for osteoarthritis score correlated with the cold detection threshold in patients with hip OA.

Interpretation — Quantitative sensory testing appeared to identify patients with sensory changes indicative of mechanisms of central sensitization. These patients may require additional pain treatment in order to profit fully from surgery. There were correlations between the clinical scores and the level of sensitization.     

A Normothermic Perfusion Bioreactor to Preserve Viability of Rat Groin Flaps Extracorporally

Introduction

Various attempts have been made to prolong tissue survival ex vivo. To achieve an adequate ex vivo condition for flap perfusion at normothermic temperatures in a bioreactor model, a suitable perfusion solution is necessary. The main purpose of our setting at 37°C was to produce conditions under which multilineage stem cells from adipose tissue could differentiate. This study was designed to evaluate the effect of permanent perfusion on fat flaps of the rat.

Materials and Methods

We elevated an epigastric adipofascial flap based on the inferior superficial epigastric vessels bilaterally in male Lewis rats and connected it to a bioreactor. The system was run by a cable pump and filled either with Hannover or Eurocollin's solution with or without permanent perfusion for 10 days. The lactate dehydrogenase (LDH) level in each solution was analyzed every 48 hours, assuming that injured cells emit this enzyme to the extracellular space and consequently to the perfusion solution. Histological samples were analyzed at the end of each trial.

Results

There was a continuous significantly greater LDH level (P < .001) in bioreactors perfused with Hannover than with Eurocollin's solution. The nonperfused bioreactors showed a similar finding with lower levels compared with their perfused equivalents. Histological examination revealed significantly better preserved (P < .001) fat tissue structures in Hannover solution–perfused specimens.

Conclusion

Because LDH has a half life of 24 hours, ongoing production of this enzyme for 10 days is a marker for an injured tissue consisting of viable cells. Bioreactors run with Hannover solution showed significantly higher LDH levels. Histological analyses revealed intact cells preserved in Hannover solution. Thus, Hannover solution seemed to be superior to Eurocollin's solution to keep flaps viable under normothermic conditions. The presented model facilitated fat tissue conservation under normothermic conditions and represented a foundation for further studies on the differentiation of vascularized fat tissue.     

Das Wanderjahr von Edward D. Churchill

Ohne ZusammenfassungMit einer Einführung von H. G. Borst, Hannover     

Internationales AO-SICOT Travelling Fellowship

Die Teilnehmer des “International AOI-SICOT Travelling Fellowship 1997” wurden von der Arbeitsgemeinschaft für Osteosynthesefragen (AOI), Davos und Societé International Chirurgienne et Traumatologie (SICOT) ausgew?hlt. Dr. Raul Barrios, New Orleans, USA, Dr. Carlos Rodriguez-Merchan, Madrid, Spanien und Professor Viktor Remizov, Chisinau, Moldova mit Prof. Dr. Christian Krettek, Medizinische Hochschule Hannover als Senior Travelling Fellow, besuchten vom 11. bis 31. Mai 1997 wichtige Trauma- und Forschungszentren in Bangkok, Singapur, Los Angeles, Birmingham/Alabama, Hannover, Zürich und Davos.     

Buchbesprechungen

Tierhaltungslehre . Herausgegeben von Prof. Dr. G. COMBERG, Hannover, und Prof. Dr. J. K. HINRICHSEN, Stuttgart-Hohenheim, unter Mitarbeit von Prof. Dr. H. BEHRENS, Dr. H. M. BLENDL, Grub, Prof. Dr. H. EICHHORN, Gießen, A. GRAUVOGL, Wertingen, Priv.-Doz. Dr. U. PETERS, Rendsburg, Prof. Dr. K. RABOLD, Hohenheim, Prof. Dr. U. RIEMANN, Kiel, Prof. Dr. S. SCHOLTYSSEK, Hohenheim, Prof. Dr. W. SCHULZE, Hannover, Prof. Dr. E. STEPHAN, Hannover, Prof. Dr. D. STRAUCH, Hohenheim, und Dr. H. F. WOLFERMANN, Bad Kreuznach. Schmidt, Vera: Augenkrankheiten der Haustiere . 310 Seiten, 144, teils farbige Abbildungen. Prosser, C. L.: Comparative Animal Physiology . 966 S., 457 Abb., 3. Auflage; W. B. Saunders Co.     

Chopart joint fracture-dislocation: initial open reduction provides better outcome than closed reduction

Injury cause, treatment, and long-term results [American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, Hannover Scoring System, Hannover Outcome Questionnaire] of patients with Chopart joint dislocations or fracture-dislocations were evaluated. Between 1972 and 1997, 100 patients with 110 Chopart joint dislocations were treated in the authors' institution. Pure Chopart joint dislocations were observed in 28 (25%) feet, fracture-dislocations in 60 (55%) feet, and combined Chopart-Lisfranc joint fracture-dislocations in 22 (20%) feet. The primary treatment was operative in 91 (83%) feet and nonoperative in 19 (17%) feet. Sixty-five (65%) patients had follow-up after an average of 9 years (range, 2-25 years). The mean scores of the entire follow-up group were: AOFAS score, 75 points; Hannover Scoring System, 69 points (maximium possible score = 100 points); Hannover Outcome Questionnaire, 68 points (maximium possible score = 100 points). There were no differences between the scores for pure dislocations or fracture-dislocations of the Chopart joint, but significantly lower scores were noted with combined Chopart-Lisfranc joint fracture-dislocations. In all three injury pattern groups, an initial anatomic reduction was essential for good results. The high functional restrictions in Chopart dislocations can most likely be minimized with initial open reduction, especially in fracture-dislocations. A closed reduction yielded good results only with pure dislocations, when anatomic conditions could be restored, or if there were contraindications to surgery.     

A new foot and ankle outcome score: Questionnaire based,subjective, Visual-Analogue-Scale,validated and computerized

Our purpose was to construct and validate a new score taking into consideration the flaws of existing scores.MethodsA new score named Visual-Analogue-Scale Foot and Ankle (VAS FA) with the following features was constructed: questionnaire based on 20 subjective questions, Visual-Analogue-Scale (VAS) based rating, computerized evaluation. The score was validated in 121 subjects. For validation, SF-36^® and Hannover Questionnaire (Q) were obtained and correlated with VAS FA.ResultsThe correlation VAS FA versus SF-36^® and Q (Pearson, all p-values <0.001, r ≥ 0.5) was sufficient for the total score and all score categories (pain, function, other complaints).The time needed for evaluating the scores was significantly lower for VAS FA than for SF-36^® and Q (Oneway-ANOVA, p < 0.001).ConclusionsThe introduced score is the first validated (on SF-36^®), subjective, VAS based outcome score for foot and ankle. The VAS FA is computerized which enables faster evaluation than SF-36^® or Q.     

Association of chromosomal locus 8q24 and risk of prostate cancer: a hospital-based study of German patients treated with brachytherapy

BackgroundGenetic susceptibility contributes to the risk of prostate cancer but the underlying genes are largely unknown. Polymorphic loci on chromosome 8q24 have emerged as possible risk factors for breast and prostate cancer from genome-wide association studies.ObjectiveWe aimed to define the risks associated with two single nucleotide polymorphisms, rs1447295 and rs13281615, in a hospital-based series of prostate cancer patients treated with brachytherapy.Material and methodsWe analyzed genomic DNA samples of 488 prostate cancer cases undergoing brachytherapy at Hannover Medical School, and of 462 male controls from the same location. Genotyping was performed using 5′-exonuclease allelic discrimination assays, and results were evaluated with χ² tests and logistic regression analyses.ResultsWe investigated whether rs1447295 and rs13281615 are associated with disease risk in a hospital-based prostate cancer case-control series from Northern Germany. The rare allele of rs1447295 was observed at higher frequency among cases than among hospital-based controls (13.9% vs. 10.2%, P = 0.01), and there was a dose-dependent trend towards a higher prevalence of heterozygous and homozygous carriers among the prostate cancer patients (per allele OR 1.42, 95% CI 1.07; 1.87, P = 0.02). By contrast, the rare allele of rs13281615 did not predispose to prostate cancer (per allele OR 0.84, 95% CI 0.70; 1.00, P = 0.05). The distribution of combined 8q24 genotypes was significantly different between cases and controls (P = 0.01).ConclusionOur results corroborate previous reports of 8q24 as a prostate cancer susceptibility locus and provide evidence for rs1447295 as a potentially important genetic marker. Further studies are required to confirm whether the adjacent breast cancer-associated variant rs13281615 may be inversely associated with prostate cancer risk.     

Freezing of Stallion Semen with Addition of Glycine Betaine

The effect of addition of glycine betaine to a lactose-EDTA freezing medium on the post-thaw motility of stallion semen was determined. The first three semen-rich fractions of nine stallions were collected with an open-end Krakow artificial vagina on consecutive weekdays. Semen was frozen using the Hannover method with freezing media containing glycine betaine in various concentrations from 0 to 5 %. After thawing, sperm motility was analysed both by a light microscope and by a Hamilton-Thorn Motility Analyser. Total and progressive post-thaw motilities of semen containing 0.25–3 % glycine betaine did not differ significantly from the total and progressive post-thaw motilities of semen frozen without glycine betaine. The total and progressive post-thaw motilities of semen containing 4 or 5 % glycine betaine were significantly lower (P < 0.001) than those of semen without glycine betaine. In conclusion, glycine betaine did not show any beneficial effect on the post-thaw motility of stallion semen when semen was frozen using the Hannover method.     

Evolution of treatment of femoral shaft fracture in polytrauma: Did damage control orthopaedics improve the outcome? A retrospective study

BackgroundTreatment of polytrauma patients with femoral shaft fracture has changed considerably during the past few decades. A transition from early total care (ETC) to “Damage Control” Orthopaedics (DCO) in selected patients was proposed in order to decrease mortality. The aim of the study was to investigate whether this policy change resulted in improved patient outcome.MethodsWe present a retrospective, comparative study, held in a Level I trauma center in Jerusalem, Israel. Polytrauma patients with Injury Severity Score higher than 16 with femoral shaft fracture were included. Data was extracted from our institute's electronic trauma registry. The study examines two time periods: Between the years 1996 and 2006 patients were treated according to the ETC protocol, with immediate intramedullary nailing (IMN) within 12 h. From 2007 until 2019 a DCO policy was adopted, implementing temporary external fixator for high risk patients, according to the “Hannover” criteria. Following resolution of the acute phase, these were converted to IMN. Patients eligible for DCO were matched to controls who received ETC during the earlier period.ResultsA total of ninety-six patients were included (DCO n = 44, ETC n = 52). The groups were comparable in terms of age, gender, mechanism of injury, injury to surgery time and Injury severity score (DCO median 31.5, ETC median 29). No statistical difference was found between the groups in terms of mortality (P = 0.757), acute respiratory distress syndrome (P = 0.534), sepsis (P = 0.519) and hospital stay (DCO median 24 days, ETC median 21.5 days) or ICU stay (Median 7 days in both groups).ConclusionsThis pilot study did not demonstrate better outcome by implementing DCO concepts in the polytrauma patient.Level of evidenceIII prognostic.     

Schädlingsbekämpfung im eigenen Garten – Fallserie schwerer Handverletzungen durch Spreng- und Schussfallen in privatem Gebrauch

Booby traps and gun-like devices for vole control can lead to complex trauma requiring emergency medical care. We present a case series of patients who suffered severe hand and facial trauma through detonation of booby traps and paraphernalia (n = 9, Ø 60 years of age). All patients were admitted to the emergency department of Hannover Medical School for primary care. Between 2011 and 2015 we treated six patients with hand trauma due to gun-like devices, two patients with hand trauma due to booby traps, and one patient with injury to the face including eyes due to a gas cartridge explosion. All hand trauma patients (n = 8) showed injuries of the soft tissue. Six of these patients also presented fractures or lesions of capsular or tendon structures. Therapies included debridement as well as skin grafts or flaps for tissue defect coverage. We informed the Department for Commercial Safety (Gewerbeaufsicht Hannover) in 2014 because we believe that these traps pose a serious safety hazard.     

Hannover Fracture Scale '98 – Neuevaluierung und neue Perspektiven eines etablierten Scoresystems

Die Hannover Fracture Scale (HFS) wurde bereits im Jahr 1983 als Scoresystem für offene Frakturen eingeführt. Mittlerweile wurden die M?glichkeiten zur Versorgung offener Frakturen erheblich optimiert, was nicht zuletzt auch auf neue Osteosyntheseverfahren zurückzuführen ist. Folglich verbesserte sich auch die Prognose offener Frakturen. Aus diesem Grund war es erforderlich, eine Neuevaluation dieses Scores durchzuführen.     

Criteria for amputation, reconstruction and replantation of extremities in multiple trauma patients

The paper defines indications for amputation, reconstruction and replantation of severely injured extremities of multiple traumatised patients using the trauma score PTS (Hannover Polytrauma Score) and the fracture grading for open and closed fractures.     

Anwendung von Everolimus nach Herztransplantation

Zusammenfassung In Kürze wird Everolimus mit dem Handelsnamen (Certican^®) zur Prophylaxe von akuten Abstoßungsreaktionen in Europa zugelassen. Da es sich um ein Immunsuppressivum mit einem neuem Wirkprofil handelt, das in Kombination mit Cyclosporin A und Prednisolon zuerst nach Herz- und Nierentransplantation angewandt wird, hat vor der geplanten klinischen Einführung eine Expertengruppe in einer Konsensuskonferenz die derzeitigen verfügbaren Daten zusammengetragen und bewertet und daraus die nachfolgenden Empfehlungen zum Einsatz von Everolimus nach Herztransplantation zusammengefasst. Diese Anwendungsempfehlungen schließen neben den Hauptindikationen entsprechend den Zulassungsunterlagen, mögliche weitere Indikationen, basierend auf vorhandenen Daten nach Nieren- und Lungentransplantation, sowie Dosierungs- und Überwachungsempfehlungen mit ein. Außerdem wird angeregt, die Ergebnisse der Einzelfallbeobachtungen zum Erhalt valider Informationen beim klinischen Einsatz von Everolimus außerhalb von Studien zusammenzutragen und gemeinsam zu analysieren.Teilnehmer der Konsensus-Konferenz. An der Erarbeitung des Konsensusstatements waren beteiligt (in alphabetischer Reihenfolge): Ass. Prof. Dr. H. Antretter (Innsbruck), Dr. K. Budde (Berlin), PD Dr. Th. Dengler (Heidelberg), Prof. Dr. J. Gummert (Leipzig), PD Dr. S. Hirt (Kiel), PD Dr. M. Hummel (Berlin), Dr. H. Lehmkuhl (Berlin), Prof. Dr. B. Reichart (München), PD Dr. M. Strüber (Hannover), PD Dr. G. Tenderich (Bad Oeynhausen), Prof. Dr. Th. Wahlers (Jena), Prof. Dr. A. Wasler (Graz), Prof. Dr. A. Zuckermann (Wien)     

Buchbesprechungen

Book reviewed in this article: Handbuch der Tierernährung . In zwei Bänden. Herausgegeben von W. Lenkeit, Göttingen; K. Breirem, Vollebekk; E. Crasemann, Zürich. Unter Mitwirkung von D. G. Armstrong, Newcastle; C. C. Balch, Shinfield; W. Bianca, Zürich; A. L. Black, Davis; K. Breirem, Vollebekk; H. Brune, Gießen; R. C. Campling, Shinfield; E. Crasemann, Zürich; A. François, Jouy-en-Josas; K. Günther, Göttingen; H. Hill, Hannover; P. N. Hobson, Aberdeen; H. Hörnicke, Hannover; B. H. Howard, Aberdeen; P. E. Jacobsen, Kopenhagen; H. Karg, München; W. Kaufmann, Kiel; R. Müller, Bonn; L. Paloheimo, Malmi; G. Pulss, Kiel; P. M. Riis, Kopenhagen; K. Rohr, Kiel; H. H. Schlubach, Starnberg; A. Schüren, Zürich; J. Tiews, München; G. Vogel, Köln; H. Zucker, München. Band I: Allgemeine Grundlagen . Leonhardt, H.: Histologie und Zytologie des Menschen.