Algorithm for extrication and medical care in vehicular trauma

The rescue and treatment of trapped persons in car accidents requires a close cooperation and coordination between firefighters and medical personnel. Priorities of medical care as well as aspects of extrication should be considered equally. Procedures on scene should follow a sequence securing life support and careful rescue of the trapped patient.The developed algorithm allows for prioritized and coordinated management and represents a transparent guide for both teams, during training as well as practical application. The concept incorporates the ABC priorities for polytrauma management and also the structure of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.     

Viagra: a success story for rationing?

The 1998 launch of Viagra prompted widespread fears about the budgetary consequences for insurers and governments, all the more so since Viagra was only the first of a new wave of so-called lifestyle drugs. The fears have turned out to be greatly exaggerated. This paper analyzes the rationing strategies adopted in four countries (United States, Britain, Germany, and Sweden), relates them to the characteristics of different types of health care systems, and identifies the conditions necessary for successful cost containment. The case of Viagra, it concludes, holds out two general lessons: first, allow exceptions to total bans on reimbursement; second, involve the medical profession in the decision-making process.     

Malignant intestinal non-Hodgkin's lymphoma from the surgical point of view

BACKGROUND: Primary intestinal non-Hodgkin's lymphoma (I-NHL) is much less frequent than gastric lymphoma and has hardly been studied in prospective trails. To the surgeon, patients frequently present with abdominal emergencies. PATIENTS AND METHODS: A consecutive series of patients subjected to surgery because of I-NHL between 1998 and 1999 was evaluated retrospectively for characteristic clinical, radiographic and intraoperative findings. Patients with gastric lymphoma were not considered. RESULTS: 10 patients, 8 males and 2 females, with I-NHL were subjected to first-line surgery because of painful abdominal tumor, intestinal hemorrhage, obstruction or perforation. I-NHL was located most often in the small bowel (n = 7). It was rare in the colon (n = 2) and the duodenum (n = 1). Median postoperative follow-up was 28 months. Perioperative mortality was 10% (n = 1). Probability of survival 3 years after surgery was 60%. CONCLUSIONS: Patients with I-NHL frequently present with complications of tumor growth, requiring urgent surgical treatment. Irrespective of surgical complications we advocate surgery in cases of resectable disease as first-line treatment. Adjuvant treatment is indicated with respect to resection status and histopathological staging.     

Deep brain stimulation of the subthalamic nucleus versus levodopa challenge in Parkinson's disease: measuring the on- and off-conditions with FDG-PET

Summary. In order to compare the effects of high-frequency stimulation of the subthalamic nucleus (STN-DBS) and a levodopa-challenge on cerebral metabolic activity, we conducted PET scans with [¹⁸F]2-fluoro-2-deoxyglucose (FDG) in the drug- and stimulation- on- and off-condition in a single patient suffering from advanced PD. Our data revealed evidence for improved thalamocortical processing released from inhibition by overactive basal ganglia output nuclei in both on-conditions. While levodopa also led to a reduction of lentiform hyperactivity, effective STN stimulation seemed to interfere with distinct cerebellar and limbic circuits. Received November 2, 2001; accepted January 15, 2002 Published online June 28, 2002     

Physiological Effects of an Ultra-Cycle Ride in an Amateur Athlete - A Case Report

The physiological effects of ultraendurance exercise are poorly investigated. The present case report describes the exercise intensity of ultraendurance cycling and its physiological impacts on various organ functions in an amateur cyclist performing the Ötztal Radmarathon twice en bloque in a circuit of 2 identical laps (distance 460 km; cumulative altitude difference 11,000 m). In a pre-race laboratory test the athlete''s performance capacity was measured as the maximal aerobic power (VO_2max= 70 ml.kg^-1.min^-1), a maximal power output (5.7 W.kg^-1) and lactate threshold of 89%. The overall intensity during the ride was moderate (HR_mean = 131 b.min^-1; %HR_max = 0.71) and significantly declined during the course of the race. Extensive biochemical laboratory testing performed pre- and post-race excluded major exercise-induced organ disturbances. For further confirmation and better understanding of the physiological effects of ultra-cycle events future studies of larger athlete populations are required.Key Words: Ultraendurance event, exercise intensity, heart rate, organ functions, cycling     

Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD

The authors retrospectively compared 1-year results of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN; n = 16) and internal pallidum (GPi) (n = 11) in advanced PD and found about equal improvements in "off" period motor symptoms, dyskinesias, and fluctuations. STN stimulation reduced medication requirements by 65% and required significantly less electrical power. These advantages contrasted with a need for more intensive postoperative monitoring and a higher incidence of adverse events related to levodopa withdrawal.