Epidemiologie und Behandlungsmanagement bei Schockraumpatienten mit Gesichtsschädelverletzungen

Objective

To minimize overall mortality and optimise reconstructive and cosmetic outcome in severely injured patients with maxillofacial injuries the interdisciplinary coordination of several surgical disciplines is required. It is still discussed controversy whether patients with maxillofacial fractures benefit from early fracture repair or if delayed operative management also yields in good results.

Methods

Herein we analysed the data of 1252 severely injured patients between May 1998 through June 2002 in our trauma department regarding fractures of the maxillofacial region, injury severity, length of ICU stay and postoperative complications in patients with either early (within 72?hours) or delayed (>?3?days) facial fracture repair.

Results

147 patients had severe facial fractures. Average age was 39.8 years (3–87 years), mean ICU was 25 (+/– 16) and the overall mortality 12% (n?=?18). The most common cause for the injuries were traffic accidents in 45%. 78 patients (53%) underwent surgical repair of the maxillofacial fractures; 18 patients had early fracture repair and 60 patients had delayed operative repair. We found 4 complications (22%) in the early repair group and 13 local complications (21%) in the group with delayed surgical repair.

Conclusion

Delayed repair of maxillofacial injuries in severely injured patients is feasible and yields in good results compared to early fracture repair.     

First pass metabolism of ethanol is strikingly influenced by the speed of gastric emptying

Background—Ethanol undergoes a first passmetabolism (FPM) in the stomach and liver. Gastric FPM of ethanolprimarily depends on the activity of gastric alcohol dehydrogenase(ADH). In addition, the speed of gastric emptying (GE) may modulateboth gastric and hepatic FPM of ethanol.
Aims—To study the effect of modulation of GE onFPM of ethanol in the stomach and liver.
Methods—Sixteen volunteers (eight men andeight women) received ethanol (0.225 g/kg body weight) orally andintravenously, and the areas under the ethanol concentration timecurves were determined to calculate FPM of ethanol. In seven of thesesubjects, FPM of ethanol was measured after the intravenousadministration of 10 mg metoclopramide (MCP) and 20 mgN-butylscopolamine (NBS) in separate experiments to eitheraccelerate or delay GE. GE was monitored sonographically by integrationof the antral area of the stomach every five minutes for 90 minutesafter oral ethanol intake. In addition, gastric biopsy specimens weretaken to determine ADH activity and phenotype, as well as to evaluategastric histology. Blood was also drawn for ADH genotyping.
Results—GE time was significantly delayed by theadministration of NBS as compared with controls (p<0.0001) and ascompared with the administration of MCP (p<0.0001). This wasassociated with a significantly enhanced FPM of ethanol with NBScompared with MCP (p = 0.0004). A significant correlation was notedbetween GE time and FPM of ethanol (r = 0.43, p = 0.0407).Gastric ADH activity did not significantly correlate with FPM of ethanol.
Conclusion—FPM of ethanol is strikingly modulatedby the speed of GE. Delayed GE increases the time of exposure ofethanol to gastric ADH and may therefore increase gastric FPM ofethanol. In addition, hepatic FPM of ethanol may also be enhanced asthe result of slower absorption of ethanol from the small intestine. Thus a knowledge of GE time is a major prerequisite for studying FPM ofethanol in humans.

Keywords:first pass metabolism of ethanol; gastric emptying; alcohol dehydrogenase; ethanol metabolism; stomach

     

Heterogeneous in vitro effects of doxorubicin on gene expression in primary human liposarcoma cultures

Background  

Doxorubicin is considered one of the most potent established chemotherapeutics in the treatment of liposarcoma; however, the response rates usually below 30%, are still disappointing. This study was performed to identify gene expression changes in liposarcoma after doxorubicin treatment.     

Increased level of polymerase Ⅲ transcribed Alu RNA in hepatocellular carcinoma tissue

There have been extensive observations that RNA containing repetitive elements accumulates in transformed cells and tumor tissues. In the present study, we first obtained result consistent with previous observations by in situ hybridization.     

Motor performance and functional ability in preschool- and early school-aged children with Juvenile Idiopathic Arthritis: a cross-sectional study

Objective  

To describe the level of motor performance and functional skills in young children with JIA.