Validierung des NACA-Score anhand objektivierbarer Parameter

Zusammenfassung In einer retrospektiven Studie mit Daten aus 104.962 Primäreinsätzen von 28 Luftrettungszentren der ADAC-Luftrettung und des Bundesinnenministeriums vom 01.01.1999 bis 31.12.2003 wurde die Validität des präklinisch erhobenen NACA-Scores untersucht. Zur Klassifikation der Vitalfunktionen wurde der physiologisch orientierte, für die präklinische Patientenversorgung konzipierte MEES als Score genutzt. Für die Beurteilung der Notfallschwere war der kritischste Messwert für die jeweilige Vitalfunktion aus der präklinischen Versorgungsphase maßgebend. Die Ergebnisse zeigen, dass pathologische Messparameter der Vitalfunktionen für die Einordnung im NACA-Score durch den Notarzt in z. T. mehr als der Hälfte der Fälle keine Berücksichtigung finden. Selbst eindeutige Verläufe wie eine Reanimation oder der Tod des Patienten werden nicht korrekt klassifiziert. Auch unbestritten vitalbedrohende Krankheitsbilder wie der akute Myokardinfarkt (Fehleinschätzung: 51,5%), die Lungenembolie (40,1%) oder das Polytrauma (22,5%) werden im NACA-Score nicht als vitalbedrohend (mindestens NACA-Stufe V) eingeordnet. Zusammenfassend muss festgestellt werden, dass in Übereinstimmung mit der Literatur die Einordnung der Notfallschwere im NACA-Score durch den Notarzt stark subjektiven Einflüssen unterliegt. Daraus ergibt sich, dass der NACA-Score für wissenschaftliche Fragestellungen, zur Qualitätskontrolle und zur retrograden Beurteilung der Einsatzindikation allein ungeeignet ist. Es sollte ein modifizierter NACA-Score erarbeitet werden, der sich auf objektive Messwerte stützt.     

Experimental and clinical possibilities of MR spectroscopy of the heart

MR-spectroscopy of the heart is a relatively new technique for the study of various aspects of cardiac metabolism. The majority of results has so far been obtained with the isolated perfused heart. Here, 31P-MR spectroscopy can be employed to measure high-energy phosphate metabolism and intracellular pH repeatedly and non-invasively. Using a technique called saturation transfer, velocities of enzymatic reactions, such as the creatine kinase reaction, can be measured. Intra- and extracellular Na+ and K+ concentrations can be registered with 23Na- and 39K-MR in conjunction with shift reagent. 13C-MR can be used to tackle carbohydrate metabolism. In-situ-R-spectroscopy allows determination of high-energy phosphates in intact large mammals. Clinical applications of MR-spectroscopy remain to be defined; preliminary results indicate high diagnostic and prognostic potential for patients with coronary artery disease and congestive heart failure.     

Pheophytin a, a low molecular weight compound found in the marine brown alga Sargassum fulvellum, promotes the differentiation of PC12 cells

We identified and characterized a neurodifferentiation compound from the marine brown alga Sargassum fulvellum collected from the Japanese coastline. Several instrumental analyses revealed the compound to be pheophytin a. Pheophytin a did not itself promote neurite outgrowth of PC12 cells. However, when PC12 cells were treated with a low concentration of pheophytin a (3.9 microg/ml) in the presence of a low level of nerve growth factor (10 ng/ml), the compound produced neurite outgrowth similar to that produced by a high level of nerve growth factor (50 ng/ml). Pheophytin a also enhanced signal transduction in the mitogen-activated protein kinase signaling pathway, which is also induced by nerve growth factor. The effect of pheophytin a on neurite outgrowth of PC12 cells was completely blocked by U0126, a representative mitogen-activated protein kinase kinase inhibitor. These results suggest that pheophytin a enhances the neurodifferentiation of PC12 cells in the presence of a low level of nerve growth factor and that this effect is mediated by activation of a mitogen-activated protein kinase signaling pathway.     

Multimodale Behandlung einer Alopecia universalis

Alopecia universalis is characterized by total loss of body hair and can occur at any age, causing significant psychological morbidity in most cases. Though there is evidence to suggest that alopecia universalis is an autoimmune disease, the cause of the disease is still not known with certainty. Spontaneous recovery is unusual (<10%), and the long-term prognosis in cases not responding to therapy is poor, despite the variety of therapies available. Experience of immunosuppressive treatment in children with alopecia universalis is limited. We report on a 4-year-old boy, who was successfully treated for refractory alopecia universalis with prednisolone and cyclosporine A by mouth combined with topical application of tacrolimus. Our case report shows that systemic immunosuppression may be a promising treatment option for some children with alopecia universalis who are badly distressed by their condition. However, potential treatment-related risks have to be weighed against the psychosocial stress experienced by these patients and their families.     

Current determinants of 30-day and 3-month mortality in over 2000 aortic valve replacements: Impact of routine laboratory parameters.

OBJECTIVE: Haematological and biochemical measurements are performed routinely before surgery to exclude organ malfunction and blood cell and coagulation abnormalities. We aimed to test routinely obtained laboratory data as factors predicting operative risk. METHODS: Between 1996 and 2003, 2198 patients underwent aortic valve replacement (AVR) (908 of them with concomitant CABG) in our institute. The mean age of the study population was 69+/-11 years (range 13-91, 43% female). Clinical and laboratory parameters based on the consolidated data mart set were evaluated by multiple logistic regression analysis. RESULTS: The overall operative mortality (within 30 days) was 3.8% and the mortality after 3 months was 5.9%. In addition to clinical characteristics, the following laboratory values were identified as independent predictors of 30-day mortality: fasting blood glucose, antithrombine III, partial thromboplastine time and creatinine kinase. As independent predictors of 3-month mortality, the following laboratory values were indentified: fasting blood glucose, serum creatinine, antithrombine III, partial thromboplastine time, lactate dehydrogenase, sodium concentration and serum proteins. The discriminative power of the models increased if laboratory parameters were included in addition to preoperative clinical characteristics (from 0.75 to 0.79 and from 0.75 to 0.78 for 30-day and 3-month mortality, respectively). The discriminative power using the logistic EuroScore was lower (0.71 and 0.7, for 30-day and 3-month mortality, respectively). CONCLUSIONS: Laboratory parameters as objective markers for organ function and nutritional status are useful data for the prediction of 30-day and 3-month mortality after aortic valve replacement. Using modern methods of information technology, these valuable data which are stored electronically in most hospitals, can be used efficiently for research and quality control.     

„Scalping“

An 18-month-old boy was brought to hospital because of massive swelling and extensive haematoma of the forehead and eyelids. At first the mother reported that the child had fallen from his tricycle. Cranial computed tomographyy revealed an extensive subgaleal haematoma but bony injuries were not found. The results of police investigations revealed that the mother had locked the child’s head firmly between her arm and chest and jerked it backwards and forwards several times. The mother was convicted of child abuse.