The influence of aging on the prognostic value of the revised cardiac risk index for postoperative cardiac complications in vascular surgery patients.

OBJECTIVE: The Lee-risk index [Lee-index] was developed to predict major adverse cardiac events [MACE]. However, age is not included as a risk factor. The aim was to assess the value of the Lee-index in vascular surgery patients among different age categories. METHODS: Of 2642 patients cardiovascular risk factors were noted to calculate the Lee-index. Patients were divided into four age categories; < or = 55 (n=396), 56-65 (n=650), 66-75 (n=1058) and > 75 years (n=538). Outcome measures were postoperative MACE (cardiac death, MI, coronary revascularization and heart failure). The performance of the Lee-index was determined using C-statistics within the four age groups. RESULTS: The incidence of MACE was 10.9%, for Lee-index 1, 2 and > or = 3; 6%, 13% and 20%, respectively. However, the prognostic value differed among age groups. The predictive value for MACE was highest among patients under 55 year (0.76 vs 0.62 of patients aged > 75). The prediction of MACE improved in elderly (aged > 75) after adjusting the Lee-index with age, revised risk of operation (low, low-intermediate, high-intermediate and high-risk procedures) and hypertension (0.62 to 0.69). CONCLUSION: The prognostic value of the Lee-index is reduced in elderly vascular surgery patients, adjustment with age, risk of surgical procedure, and hypertension improves the Lee-index significantly.     

Problem Fersenbeinfraktur

This retrospective analysis of data collected by the Workers’ Compensation Board for Precision Mechanics and Electrical Engineering of Braunschweig on 42 patients (39 male, 3 female, average age 44 years) seen between 2004 and 2006 with unilateral, isolated calcaneal fractures sustained during work-related accidents and followed from the initial incident report until the first assessment of whether a pension might be justified. The median height of the falla involved was under 2 m. In 27 patients with displaced fractures operative treatment was performed, and in 17 patients the treatment was conservative. The median duration of treatment was 7.5 months. At the time of the first assessment for a pension movement in the upper ankle joint was restricted by an average of 40% and that in the talo-calcaneal joint by 50% compared with the contralateral side. The decrease in earning capacity averaged 19%. The average total cost of treatment per case up to this point was 25,540.-- euros, 61% of which was accounted for by orthotics, rehabilitation and social insurance contributions, 24% by in-patient treatment and 14% by out-patient treatment. Thus, treatment outcomes following calcaneal fractures are still unsatisfactory, resulting in extended absence from work, high costs and high rates of unfitness for work. Immediately after this diagnosis a case manager should be assigned to the patient in an attempt to improve outcomes.     

Regelungssystematische Vorschläge zur Umsetzung der Richtlinie 2004/23/EG (Geweberichtlinie)

Ohne Zusammenfassung     

Ueber stickstoffhaltige Körper in der Kuhmilch

Ohne Zusammenfassung     

Ueber das Vorkommen von Cholesterin in der Kuhmilch

Ohne Zusammenfassung     

Morphologische Veränderungen des gereizten Nerven

Ohne Zusammenfassung     

异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用

目的探讨钙拮抗剂异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用。方法45例轻型急性胰腺炎患者被随机分为3组常规治疗组、静脉治疗组及动脉灌注组。入院后,常规治疗组采取常规保守治疗;静脉治疗组行合理液体治疗,静脉注射异搏定;动脉灌注组液体补充同时采用持续动脉灌注异搏定1~2周。测定治疗后1、4及7d血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、黏附分子-1(ICAM-1)及P-选择素(P-selectin)水平。结果治疗后4、7d,血清TNF-α和P-selectin水平动脉灌注组较静脉治疗组及常规治疗组明显降低(P<0.05);血清IL-1β水平动脉灌注组和静脉治疗组均较常规治疗组明显降低(P<0.05);血清ICAM-1水平动脉灌注组明显低于常规治疗组(P<0.05)。结论持续区域动脉灌注异搏定可能通过减少细胞因子的产生,抑制黏附分子P-selectin和ICAM-1的上调,阻止急性胰腺炎重症化发展。     

Unwirksame Wahlleistungsvereinbarung und Bereicherungsanspruch des privaten Krankenversicherers

Abstrakt 1. Die Unterrichtung des Patienten, die Wahlleistungsvereinbarung erstrecke sich auf alle an der Behandlung beteiligten ?rzte des Krankenhauses, genügt den Anforderungen des § 22 Abs. 3 S. 1 BPflV nicht. Die Klausel beschr?nkt das Recht des Patienten, ?rztliche Leistungen nur von bestimmten (liquidationsberechtigten) ?rzten seines Vertrauens erbringen zu lassen, in unzul?ssiger Weise und führt zur Unwirksamkeit der Wahlleistungsvereinbarung. 2. Der Bereicherungsanspruch des Versicherungsnehmers geht nicht nach § 67 Abs. 1 S. 1 VVG auf den privaten Krankenversicherer über, denn der Anspruch auf Rückzahlung des Wahlleistungsentgelts ist kein Anspruch auf Ersatz eines Schadens gegen einen Dritten. 3. Die mit dem Versicherungsnehmer vereinbarte Abtretung ist nicht wegen eines Versto?es gegen das RBerG nichtig. Die Abtretung des Bereicherungsanspruchs hat zum Ziel, den Patienten endgültig aus der Auseinandersetzung um die Berechtigung der Honorarforderung herauszuhalten. Der private Krankenversicherer f?rdert deshalb keine fremde Rechtsangelegenheit, sondern wird ausschlie?lich auf eigene Rechnung t?tig. (Leits?tze des Bearbeiters)     

Einfluss von Methadon auf die Entwicklung von Lucilia sericata

The greenbottle fly Lucilia sericata is an insect of great forensic interest for estimating the postmortem interval. The present study investigated the influence of methadone on the development of Lucilia sericata larvae. The results of the study showed a significant acceleration of larval development between day 3 and 5 when methadone is present in the food source. The total development times where shortened by up to 15 h in the group with therapeutic and toxic methadone concentrations. These results should be considered when undertaking forensic entomological examinations.     

Fact or Fiction? MRI of Alar Ligaments and Craniocervical Junction Joints in Whiplash Syndrome

Abstract Whiplash injury of the cervical spine is a frequent issue in medical expertises and causes enormous consequential costs for motor insurance companies. Some authors accuse posttraumatic changes of alar ligaments to be causative of consequential disturbances, although biomechanical experiments achieve contradictory results and neuropsychiatric studies do not support this thesis. MRI provides excellent visualization of alar ligaments. However, signal alterations of alar ligaments must be differentiated from common normal variants. Functional MRI provides no diagnostic yield.