Ungeplante Zweiteingriffe nach Frakturen des oberen Sprunggelenks

The purpose of the present study was to analyze the risk factors associated with unexpected second procedures and strategies of revision surgery. Within a 5 year period 647 patients with closed ankle fractures AO type 44 were identified of which 77 (11.9%) needed revision surgery. Complications were addressed to 4 main groups: deep infections (IG) were seen in 29 patients (4.5%), problems with primary wound closure (WG) in 22 patients (3.4%), insufficient reduction (KG) in 22 patients (3.4%) and other causes (RG) included 4 patients (0.6%). Significant predictive factors for soft tissue complications were higher age, comorbidities with peripheral arteriosclerosis, high American Society of Anesthesiologists (ASA) score and diabetes mellitus. AO 44 type B2 and B3 fractures were often associated with soft tissue problems. The more complex fracture types AO 44 C1-C3 and A2-A3 were significantly associated with problems of insufficient congruency post-surgery. The distribution of the mean revision rate was significantly different (p<0.01) for all groups: IG 4.59, WG 3.5, KG 1.55, RG 1.25. In summary, we strongly recommend immediate reduction of displaced fractures and to consider a more detailed fracture classification. To reduce the amount of unexpected ankle procedures individual risk factors should be weighed against the advantages of optimal open reduction and internal fixation.     

Prinzipien des perioperativen Gerinnungsmanagements

The coagulation system is a complex network of interacting proteins and cells with extensive sensitivity, amplification and control pathways. The system represents a delicate balance between procoagulant and anticoagulant as well as profibrinolytic and antifibrinolytic activities. Clinically relevant phenotypes, e.g. bleeding and thrombosis, occur immediately when this balance is no longer in equilibrium. A correct understanding of the complex coagulation pathophysiology in the perioperative setting is essential for an effective treatment. In a bleeding patient, patient’s history, clinical findings, routine and advanced laboratory coagulation testing as well as point-of-care coagulation monitoring help to reliably and readily identify the underlying coagulation disorder. Modern coagulation management is proactive, individualized, balanced and follows clearly defined algorithms. Coagulopathic bleeding can be successfully controlled with specific interventions in the coagulation system.     

Raumlufttechnische Anlagen im Operationssaal

The prophylactic benefit of air conditioning systems against infections is currently being very controversially discussed. According to DIN?1946-6 operating theatres are graded into various room classes depending on the requirements. This article describes the special conditions required by oral and maxillofacial surgical interventions and the costs and benefits of such systems will be discussed.     

Update Granulomatose mit Polyangiitis (GPA, Wegener-Granulomatose)

Granulomatosis with polyangitis (GPA, Wegener’s granulomatosis) is characterized by a granulomatous inflammation of the respiratory tract and a necrotizing ANCA-associated small to medium-size vessel vasculitis with a predilection for the lungs (pulmonary capillaritis) and kidneys (necrotizing glomerulonephritis). The disease evolves stage-wise and typically starts as inflammation of the respiratory tract followed by development of systemic vasculitis manifestations. Today, treatment is evidence-based and adapted according to activity and disease stage which has resulted in a significant improvement in long-term outcome. Early mortality during the first year of treatment poses one of the main problems and is a result of infections under immunosuppressive treatment. Furthermore, treatment of refractory disease activity which is often represented by granulomatous manifestations is still a challenge and may result in significant organ damage if not treated successfully.     

Maximale Blutalkoholkonzentration nach forciertem Konsum von alkoholfreiem Bier

In recent years sales of non-alcoholic beer have constantly increased. In Germany, so-called non-alcoholic beer may still have an ethanol content of up to 0.5% (by volume). This marginal amount of ethanol might have negative implications for certain groups of persons such as novice drivers. So far no reliable data regarding the blood ethanol concentration after consumption of non-alcoholic beer have been published. Therefore, a drinking experiment was performed as follows: after 5 days of abstinence from ethanol 78 test persons were asked to drink 1.5?l of non-alcoholic beer (ethanol content 0.41–0.42%) within 1?h. Blood samples were taken on a regular basis and analyzed for ethanol by headspace gas chromatography-flame ionization detection (HS-GC-FID). A total of 67 data sets could be interpreted and in 20 test persons ethanol was detected in blood with a limit of detection (LOD) of 0.0005?g/l. The maximum blood ethanol concentration was 0.0056‰. The results of the study suggest that even after consumption of unrealistically high amounts of non-alcoholic beer negative forensic implications are not to be expected.     

Ruptur einer zerebralen arterioven?sen Malformation

Arteriovenous malformations are vascular anomalies characterised by the presence of an arteriovenous shunt in the absence of a normally structured capillary bed. The prevalence of manifestations in the brain is given in specialist literature with a high level of variability. Brain hemorrhages resulting from a lesion of a cerebral arteriovenous malformation and leading to sudden unexpected death are relatively seldom in forensic autopsy material. The forensic significance of this syndrome may be illustrated by the example of a 16-year-old female who was found dead in the bathroom of her parents?? home for reasons which were initially unexplained.     

Synthetische Cannabinoide

In recent years a flood of new psychoactive substances offered as “legal highs” appeared on the drugs market worldwide. In some parts of the world amphetamine-type stimulants are predominant but in Germany synthetic cannabinoids represent the bigger problem. The high dynamics which are maintained by the “cat and mouse game” of scheduling substances and the producers circumventing the regulations by adding new, chemically modified substances, poses a great challenge for both forensic science and toxicology.