Nationales Reanimationsregister

Within the scope of the symposium “Rescue Medicine in Germany” (held at the Reisensburg near Ulm in 2002), the need for a standardized data acquisition set for prehospital cardiac arrest patients was identified. Therefore, the working group “Emergency Medicine” of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) created a nationwide data acquisition system for primary medical care in prehospital cardiac arrest patients treated with cardiopulmonary resuscitation procedures. The system is in full accordance with the “Utstein style.” Integration of this data acquisition system, for example into the “Dortmund protocol,” is providing a standardized data web base of all acquired prehospital data analyze and to compare processing and structural quality. As additional modules for this nationwide data web base system, an inhospital module “further clinical treatment” and a “long-term follow-up” module are currently in the developmental process.     

Zwei Kammern für die Mikroskopie und Mikrophotometrie vitaler Zellen

Zusammenfassung Es werden zwei Kammern zur mikroskopischen Beobachtung und mikrophotometrischen Untersuchung von lebenden Zellen beschrieben. Mit ihrer Hilfe ist es möglich. Zellen ohne Schädigung mechanisch so zu stabilisiren, dasß sie bis zu Stunden an derselben Stelle liegen bleiben.In der Einstromkammer liegen die Zellen in einlagiger Schicht zwischen einem Deckglas und einer licht- und gasdurchlässigen Folie, die durch Adhäsion festgehalten wird. Der an die Folie angrenzende Raum kann mit gewünschten Gasgemischen durchströmt werden.In der Zweistromkammer liegen die Zellen zwischen zwei lichtdurchlässigen Folien, von denen die eine Gase, die andere auch Flüssigkeiten und gelöste Substanzen durchtreten läßt. Der an die flüssigkeitsdurchlässige Folie angrenzende Raum kann mit gewünschten Lösungen, der andere gleichzeitig mit Gasgemischen beströmt werden. Die Funktionsweise der Zweistromkammer wird am Beispiel der Formänderung von Erythrocyten bei Beströmen mit Lösungen verschiedenen osmotischen Druckes demonstriert. Beide Kammern eignen sich zur Vital-Mikroskopie und Photometrie von einzelnen Zellen, insbesondere Blutzellen und Gewebeschnitten.     

The DGAI CPR registry - the datasets "hospital care" and "long-term process"

After several years of preparation the German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für An?sthesiologie und Intensivmedizin--DGAI) has, during its annual conference 2007, officially launched the DGAI CPR registry. After implementation of the dataset "primary care" in 2004, the datasets "definite care" and "long-term process" have now been released. The completed, internet based database is open for any interested person or institution as a tool for quality management. Data may be recorded online, and basic analyses be performed immediately. Beyond that benchmarks with other institutions are possible, by including the well accepted Utstein style on international level too.     

Flexible non-fusion scoliosis correction systems reduce intervertebral rotation less than rigid implants and allow growth of the spine: a finite element analysis of different features of orthobiom™

The orthobiom™ non-fusion scoliosis correction system consists of two longitudinal rods, polyaxial pedicle screws, mobile and fixed connectors and a cross-connector. The mobile connectors can move along and around the rod, thus allowing length adaptation during growth. The aim of this study was to determine the effects of different features of this novel implant on intervertebral rotations, to calculate the movement of the mobile connectors along the rods for different loading cases and to compare the results with those of a rigid implant construct. A finite element analysis was performed using six versions (M1–M6) of a three-dimensional, nonlinear model of a spine ranging from T3 to L2. The models were loaded with pure moments of 7.5 N m in the three main anatomical planes. First, the validated intact model (M1) was studied. Then, the orthobiom™ implant system was inserted, bridging the segments between T4 and L1 (M2). The effect of pedicle screws only in every second vertebrae was investigated (M3). For comparison, three connection variations of screws and rods were investigated: (1) an implant with rigid screws and mobile connectors (M4), (2) an implant with non-locking polyaxial screws and fixed connectors (M5) and (3) a completely rigid implant construct (M6). For flexion, extension and lateral bending, intervertebral rotation was reduced at all implant levels due to the implants. A rigid implant construct (M6) and an implant with non-locking polyaxial screws and fixed connectors (M5) led to the strongest reduction of intervertebral rotation. The orthobiom™ non-fusion implant system (M2, M3) allowed much more intervertebral rotation than a rigid implant (M6). Differences in intervertebral rotations were small when polyaxial screws were placed at every second level only (M3) instead of at every level (M2). For axial rotation, intervertebral rotation was strongly reduced by a rigid implant construct (M6) and by an implant with rigid screws and mobile connectors (M4). For rotation, an implant with non-locking polyaxial screws (M2, M3, M5) led to nearly the same intervertebral rotations as in an intact spine without an implant (M1). The predicted maximum translation of the mobile connectors along the rod was 4.2 mm for extension, 3.1 mm for lateral bending, 1.6 mm for flexion and 0.8 mm for axial rotation. The movement of the connectors was highest for those closest to the ends of the rods. With rigid screws, the maximum translation was significantly reduced. This study, conducted under a load-controlled loading protocol, showed that intervertebral rotation was reduced much less by the non-fusion orthobiom™ system than by a rigid implant. The mobile connectors moved considerably along the rod when the spine was bent. It can be expected that the connectors also move along the rod as the adolescent grows, possibly leaving the discs intact until the patient is fully grown.     

Optimierung des Säure-Basen-Status unter Hypothermie

Under laboratory conditions, it can be demonstrated within sufficient clinical accuracy that the base excess (BE, [mmol/l]) is independent of temperature. In any blood gas analyzer with temperature correction, the results are consistent with tonometry when measuring a sample of hypothermic equilibrated blood at 37 degrees C. Under clinical conditions, it is shown that there is practically no difference in the CO(2) partial pressure, irrespective of whether measured directly by capnometry (p(et)CO(2)) or obtained from arterial blood (p(a)CO(2)) in the blood gas analyzer after correction for the patient's temperature. Hence, the clinical recommendations for hypothermia are: correct artificial ventilation, preferably pCO(2) 40+/-5 mmHg, should be established by capnometry and controlled by temperature-corrected p(a)CO(2): metabolic changes should be diagnosed by temperature-independent BE: the temperature-corrected pH, if at all, should be used only for the diagnosis of acidosis or alkalosis.     

Selective endothelin B receptor blockade does not influence BNP-induced natriuresis in man

Brain natriuretic peptide (BNP) and endothelin-1 (ET-1) both exhibit natriuretic activity within the human kidney. Furthermore, they both act partly through activation of the endothelial nitric oxide pathway. Since ET-1 may cause vasodilation and natriuresis via stimulation of the ET-B receptor, the aim of the present study was to investigate whether renal ET-B receptors participate in the renal actions of BNP. In this placebo-controlled, crossover study, we infused BNP (4 pmol/kg/min) or placebo (i.v.) for 1 h, with or without co-infusion of the ET-B receptor antagonist BQ-788 (50 nmol/min) for 15 min on 4 separate days, in 10 healthy subjects (mean age 54+/-6 years.). During infusion, we measured effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) using PAH/inulin clearance. Cardiac output was measured before and after infusion, using echocardiography. Blood pressure and heart rate (HR) were monitored as well. Urine and plasma samples were taken every hour to measure diuresis, natriuresis, cyclic 3',5' guanosine monophosphate, and ET-1 levels. BNP with or without ET-B receptor blockade increased natriuresis and diuresis. In addition, BNP alone increased GFR and filtered load, without changing ERPF. BQ-788 infusion did not affect renal hemodynamics or natriuresis. Neither BNP nor BQ-788 altered cardiac output, blood pressure, and heart rate. In conclusion, the present study shows that selective ET-B receptor blockade has no effect on the BNP-induced natriuresis and glomerular filtration rate.     

A Comparison between Xenogenic Deproteinized Bone Substitute Pyrost? and Autologous Bone Graft in the Surgical Management of Simple Bone Cysts

Background: The basic principle of surgical treatment of simple bone cysts has remained unchanged over the years, with curettage followed by packing of the defect with autogenic bone graft. With the introduction of ceramic biomaterials, an alternative packing material is available, avoiding the complications associated with cancellous bone harvesting or the use of a bioceramic implant. The aim of this study was to compare bony union and recurrence rate after packing of surgically treated simple bone cysts with either Pyrost^® or autogenic spongiosa. Patients and Methods: 58 patients with simple bone cysts were treated by curettage followed by packing of the cavity with either high-porosity hydroxyapatite (Pyrost^®) inoculated with locally aspirated autogenic bone marrow (n = 26) or autogenic spongiosa (n = 32). Minimum X-ray follow-up was 36 months. Results: No recurrence of the bone cyst was seen in 44 (75.9%) patients. According to Neer's criteria, complete obliteration was observed in 43.1% and residuals were found in 53.4%. The remaining 3.4% required subsequent operation due to recurrence. Entire packing of the cavity with xenogenic deproteinized bone substitution was radiologically confirmed in 80.8%. There were no significant differences (p = 0,76) between the use of autogenic spongiosa and the xenogenic deproteinized bone substitute concerning the rate of recurrency and radiographically verified complete bone consolidation. Conclusions: Pyrost^® can be considered an alternative to conventional bone grafting in the treatment of simple bone cysts. The primary advantages of bone substitute materials ar their abundance and the avoidance of morbidity associated with bone harvesting. Questions concerning long-term biocompatibility and biomechanical aspects of the composite of unabsorbed bone substitute and bone warrant further investigation.