Clinical implications of immediate or later periportal edema in MS-CT trauma scans: surrogate parameter of intravenous fluid status and venous congestion

Periportal edema (PPE) of the liver in multislice computed tomography (MS-CT) scans that develops immediately (primary PPE [pPPE]) or later (secondary PPE [sPPE]) is not uncommon in severe trauma patients. Although PPE may serve as a marker for blunt abdominal trauma (22–31 % of cases), distinct causes and clinical implications of PPE are unclear. We analyzed the incidence of pPPE and sPPE in 68 MS-CT scans in severe trauma patients (2007–2009). Exclusion criteria were severely burned patients and patients with preexistent liver diseases predisposing to PPE. We divided PPE+ patients into two subpopulations—either initial/primary PPE (pPPE+) or later/secondary PPE (sPPE+). Further patient data were collected and statistically analyzed. PPE+ was found in 27.9 % (n?=?19). Females predominated (p?=?0.01), and PPE+ patients presented with a significantly better pH at admission (p?=?0.008). The total amount of volume resuscitation (1,983?±?1,155 ml; p?=?0.02) and crystalloids (1,117?±?796 ml; p?=?0.006) administered before MS-CT scans was significantly higher in PPE+, whereas the amount of administered colloids (797?±?640 ml) showed no significant difference in both groups. PPE+ was not associated with further patient data, i.e., trauma mechanism, injury severity, prognosis-relevant factors, adverse clinical events, or mortality. pPPE+ in MS-CT may serve as a surrogate parameter for intravenous volume load and/or venous congestion, and sPPE+ may also indicate venous congestion and right heart failure after severe trauma. In severe trauma patients with pPPE+/sPPE+ in MS-CT scans, causes of PPE relating to intravenous fluid overload and/or venous congestion should be excluded or treated.     

催产素对妊娠末期大鼠蜕膜细胞内游离钙的刺激作用

妊娠末期催产素刺激子宫蜕膜细胞产生与分娩有关的前列腺素,但其作用方式仍未知。本实验分离妊娠19d大鼠蜕膜细胞,测定了催产素作用后蜕膜细胞内游离钙的变化,结果加入0.001～1μmol·L^-1催产素后,蜕膜细胞内[Ca²⁺]i出现瞬息增加,其峰值与催产素浓度呈剂量依赖关系,且此作用有自身钝化现象。说明催产素可能激活妊娠末期大鼠蜕膜细胞内的肌醇磷酯蛋白激酶C系统。给妊娠末期大鼠ip硫酸去氢表雄酮钠盐后分离的蜕膜细胞,催产素作用引起[Ca²⁺]i瞬息增加峰值较对照升高。     

Verteilungsplanung von Verletzten beim MANV oder Katastrophenfall

Relevant changes have occurred in disaster management in Germany due to legal alterations and the introduction of the diagnosis-related groups (DRG) system. This has resulted in a reduction in bed capacities and an increase in bed utilization. In addition to the preclinical deployment strategy the provisional aspects of disaster medicine with the problem of the emergency service/hospital interface will be described. A suggestion for a solution for optimization of patient allocation in mass disasters or catastrophes will be demonstrated with the catastrophe network of the German Society for Trauma Surgery (DGU).     

Degree of exposure and peritraumatic dissociation as determinants of PTSD symptoms in the aftermath of the Ghislenghien gas explosion

Background

This paper investigates risk factors for the development of posttraumatic stress symptoms in the different survivor groups involved in a technological disaster in Ghislenghien (Belgium). A gas explosion instantly killed five firefighters, one police officer and 18 other people. Moreover, 132 people were wounded among which many suffered severe burn injuries.

Methods

In the framework of a large health survey of people potentially involved in the disaster, data were collected from 3,448 households, of which 7,148 persons aged 15 years and older, at 5 months (T1) and at 14 months (T2) after the explosion. Hierarchical regression was used to determine the significant predictors and to assess their proportion in variance accounted for.

Results

The degree of exposure to the disaster was a predictor of the severity of posttraumatic stress symptoms. Peritraumatic dissociation appeared to be the most important predictor of the development of posttraumatic stress symptoms at T1. But at T2, posttraumatic stress symptoms at T1 had become the most important predictor. Dissatisfaction with social support was positively linked to development of posttraumatic stress symptoms at T1 and to the maintenance of these symptoms at T2. Survivors who received psychological help reported significant benefits.

Conclusions

In harmony with the findings from studies on technological disasters, at T1 6,0% of the respondents showed sufficient symptoms to meet all criteria for a full PTSD. At T2, 6,6% still suffered from posttraumatic stress symptoms. The symptoms of the different victim categories clearly indicated the influence of the degree of exposure on the development of posttraumatic stress symptoms. Problems inherent to retrospective scientific research after a disaster are discussed.     

Structure of the Australian system of 'Diagnosis Related Groups' regarding cardiovascular diseases and corresponding cost weights in Germany

BACKGROUND: An adapted system of 'Diagnosis Related Groups' (DRG's) will be introduced for Germany at the beginning of 2003. This article focuses on the structure of the Australian DRG system (AR-DRG 4.1) regarding the diseases of the cardiovascular system and corresponding cost weights in Germany (G-DRG 1.0). METHODS: Cardiac diagnoses, procedures and cost weights (with a different base rate) were compared between the Australian and German DRG's. RESULTS: Categories and procedures for diagnostics and therapies are shown regarding coronary interventions, electrophysiological strategies including implantation of pacemakers and cardioverter/ defibrillators, hybrid treatment modalities, transcatheter closure of interatrial/-ventricular communications as well as interventions during intensive care treatment.     

Uric Acid and Cardiovascular Events: A Mendelian Randomization Study

Obesity and diets rich in uric acid–raising components appear to account for the increased prevalence of hyperuricemia in Westernized populations. Prevalence rates of hypertension, diabetes mellitus, CKD, and cardiovascular disease are also increasing. We used Mendelian randomization to examine whether uric acid is an independent and causal cardiovascular risk factor. Serum uric acid was measured in 3315 patients of the Ludwigshafen Risk and Cardiovascular Health Study. We calculated a weighted genetic risk score (GRS) for uric acid concentration based on eight uric acid–regulating single nucleotide polymorphisms. Causal odds ratios and causal hazard ratios (HRs) were calculated using a two-stage regression estimate with the GRS as the instrumental variable to examine associations with cardiometabolic phenotypes (cross-sectional) and mortality (prospectively) by logistic regression and Cox regression, respectively. Our GRS was not consistently associated with any biochemical marker except for uric acid, arguing against pleiotropy. Uric acid was associated with a range of prevalent diseases, including coronary artery disease. Uric acid and the GRS were both associated with cardiovascular death and sudden cardiac death. In a multivariate model adjusted for factors including medication, causal HRs corresponding to each 1-mg/dl increase in genetically predicted uric acid concentration were significant for cardiovascular death (HR, 1.77; 95% confidence interval, 1.12 to 2.81) and sudden cardiac death (HR, 2.41; 95% confidence interval, 1.16 to 5.00). These results suggest that high uric acid is causally related to adverse cardiovascular outcomes, especially sudden cardiac death.