Dooring-Fahrradunfälle mit schweren Verletzungsmustern: 10-Jahres-Studie eines Level-1-Traumazentrums

Dooring Bicycle Accidents with Severe Injury Patterns: 10-Year Study of a Level 1 Trauma Cente

Climate data, localisation of the sting, grade of anaphylaxis and therapy of hymenoptera stings.

International epidemiological studies indicate that around 1-7% of the population respond with an allergic reaction to a hymenoptera sting, which is frequently associated with admission to an emergency department. This retrospective study included patients admitted between 2009 and 2013 to an emergency department after a hymenoptera sting. In all, 86 (60.1%) men and 57 (39.9%) women were included in the study. The mean age was 43 years, with a range from 19 to 84 years. The most common localisations of a sting were the head (n = 33; 22.5%), the hands (n = 32; 21.9%) and the arms (n = 26; 17.8%). In women, we recorded significantly more stings in distal extremities (p = 0.033) and in men stings in the rump and head were most frequent. Local swellings were observed in 67.1% (n = 96) of patients and 34.3% (n = 49) patients exhibited an anaphylactic reaction. Of these, 21.7% (n = 31) suffered from a grade I, 6.3% (n = 9) grade II, 4.2% (n = 6) grade III and 2.1% (n = 3) grade IV anaphylactic reactions. 46% (66) of the patients were given antihistamines, 45% (64) intravenous glucocorticoids and only 12.5% (16) epinephrine. Most stings were recorded on days without rainfall (p = 0.013), with more hours of sunshine (p = 0.001), low relative humidity (p = 0.006), with mean air pressure above 954.3 hPa and on days with mean temperature above 24.2 °C (p = 0.001). In conclusion, the most hymenoptera stings induced local swelling only; severe reactions were rare. The most dangerous stings are enoral and result from inattentive drinking. Epinephrine was rarely used in anaphylactic reactions

Quality of life in patients with pancreatic cancer

Titelblatt und Inhaltsverzeichnis Einleitung Fragestellung Methode Ergebnisse Diskussion LiteraturverzeichnisDie Lebensqualität bei Patienten mit Pankreaskarzinom ist verglichen mit der Lebensqualität einer Normpopulation in Deutschland deutlich beeinträchtigt. Beide Messinstrumente, sowohl der EQ-5D als generisches Maß als auch der EORTC als krankheitsspezifisches Maß, verzeichneten eine signifikante Verschlechterung der Lebensqualität bei Patienten mit Pankreaskarzinom. Beim Vergleich der Patienten mit Diagnose Pankreaskarzinom mit einer Normpopulation in Deutschland ergeben sich für alle Bereiche in den fünf Funktionsskalen und in der allgemeinen Lebensqualitätskala des EORTC signifikant höhere Werte für die Normpopulation, außer bei der Einschätzung der kognitiven Funktion der Frauen im Vergleich mit der Normbevölkerung. Die Gegenüberstellung der klinischen Symptomskalen des EORTC zwischen den Patienten mit Pankreaskarzinom und der Normbevölkerung in Deutschland ergibt signifikant höhere Werte und damit stärkere Beschwerden für die Patienten mit Pankreaskarzinom. Ausgenommen davon sind finanzielle Schwierigkeiten, Dyspnoe und Schmerz bei den Frauen. Vergleicht man die Normpopulation Deutschlands mit der vorliegenden Studienpopulation mittels des EQ-5D, so geben in allen 5 Dimensionen Patienten mit Pankreaskarzinom eine merklich höhere Beschwerdesymptomatik sowie einen entsprechend niedrigeren Messwert auf der VAS an. Hervorzuheben gilt hier der größte Unterschied bei der klinischen Symptomatik der Angst / Niedergeschlagenheit bei Patienten mit Pankreaskarzinom im Vergleich mit den Referenzwerten der deutschen Normbevölkerung. Die schlechtere Lebensqualität in der Dimension Angst / Niedergeschlagenheit ist möglicherweise mit dem Vorliegen einer depressiven Symptomatik assoziiert. Ob die Ursache dieser depressiven Symptomatik in einer gestörten Pankreasaktivität zu suchen ist oder von dem Wissen, an einer fast unheilbaren Erkrankung zu leiden, herrührt, sollte im Hinblick auf verbesserte Behandlungsmöglichkeiten in weiteren Forschungsprojekten geklärt werden. Weiterhin gab es eine signifikante Korrelation zwischen der EQ-5D VAS und den EQ- Präferenzwerten mit den Funktionsskalen und der Skala der allgemeinen Lebensqualität des EORTC. Demgegenüber gab es zwischen der EQ-5D VAS und den EQ-Präferenzwerten mit vier der neun Symptomskalen keine signifikante Korrelation. Dies betraf Schlaflosigkeit, Appetitlosigkeit, Diarrhö und finanzielle Schwierigkeiten. Aufgrund der Prognose und der Überlebenszeit der Patienten mit Pankreaskarzinom muss die Aufrechterhaltung und die Wiedererlangung der Lebensqualität dieser Patienten im Rahmen der Behandlung berücksichtigt werden. Dies bedeutet die Früherkennung der primären Symptome. Da Schmerzen und vor allem Depression die häufigsten Symptome - vergesellschaftet mit einer stark beeinträchtigten Lebensqualität - bei Patienten mit Pankreaskarzinom sind, müssen diese Symptome möglichst früh effektiv behandelt werden. Um der Früherkennung dieser depressiven Symptomatik Rechnung zu tragen, muss darüber nachgedacht werden, ob man generell für Patienten mit Pankreaskarzinom ein psychosoziales Screening empfielt. Dieses Screening könnte mit dem Brief Symptom Inventory (BSI) oder bei rein psychoonkologischer Ausrichtung mit dem Fragebogen zur Angst (State Anxiety, STAI-X1) durchgeführt werden. Eine rasch begonnene Behandlung dieser Symptomatik wird möglicherweise mit einem Anstieg der Lebensqualität einhergehen; dies gilt es allerdings noch im Rahmen von Interventionsstudien zu untersuchen. Das frühzeitige Erkennen und Behandeln wäre speziell bei Patienten mit Pankreaskarzinom sehr wünschenswert, da laut Studienlage weniger als 10% der Patienten das erste Jahr nach Diagnosestellung und nur weniger als 5% die weiteren 5 Jahre überleben.Background: Pancreatic cancer is an aggressive cancer with low survival time, with health-related quality of life (HRQoL) being of major importance during that time. Aims: The aim of our study was to assess both generic and disease- specific HRQoL in patients with pancreatic cancer. Patients: Patients with suspected pancreatic cancer were consecutively included at first admission to the hospital. Methods: HRQoL was determined with the disease-specific European Organization for Research and Treatment of Cancer (EORTC) health status instrument and generic EuroQoL (EQ-5D). Scores of patients were compared to those of norm populations in similar age groups. In addition, we calculated correlation coefficients between EORTC and EQ-5D scales scores. Results: A total of 57 patients (mean age 62 years +/- 11, 49% men) were admitted with suspected pancreatic cancer. Of these patients, 45 (79%) had pancreatic cancer as final diagnosis, 11 (19%) pancreatitis, and one patient cystadenoma. With a median survival of 10.9 months, HRQoL was significantly impaired in patients with pancreatic cancer for most EORTC and EQ-5D scales in comparison to norm populations. The ED-5D visual analogue scale (VAS) and utility values were significantly correlated to the five functional scales, to the global health scale and to some but not all of the EORTC symptom scales/items. Conclusions: HRQoL was severely impaired in patients with pancreatic cancer. There was a significant correlation between most EORTC scales and the EQ-5D VAS and utility values. Our results may facilitate further economic evaluations, particularly cost-utility analyses, and aid health policy makers in resource allocation

E-bike injuries: experience from an urban emergency department-a retrospective study from Switzerland.

Background. Between 2005 and 2012, annual sales of E-bikes in Switzerland increased from 1,792 to 52,941. This continuous and rapid transition from human-powered bicycles to an electric bicycle technology may indicate the increasing demand for low-cost transportation technology in combination with a healthy lifestyle. Material and Methods. In the present study, from April 2012 to September 2013, we retrospectively analysed E-bike accidents treated in the Emergency Department of our hospital by focusing on the following parameters: age, gender, time, period, and cause of the accident, as well as injury and outcome. Results. Patients were predominantly male. The mean age of injured E-cyclists was 47.5 years. The main causes of injury were self-accident. Most injuries were to the head/neck. The mean ISS was 8.48. The outcome showed that 9 patients were treated as outpatients, 9 were inpatients, and 5 patients were kept in the Intensive Care Unit (ICU). Only six patients underwent surgery (S). Discussion. This is the first attempt to evaluate E-bike injuries in Switzerland in an acute hospital setting. Since there is increasing popular preference for E-bikes as means of transportation and injuries to the head or neck are prevalent among E-cyclists, the hazard should not to be underestimated

Time for a break: admissions to an urban emergency department after working out-a retrospective study from Switzerland.

Background. The present retrospective study was intended to investigate whether working out and other low-speed sports can provoke cardiovascular, neurological, or traumatic damage. Material and Methods. Patient data from 2007 to 2013 was collected and saved at the university department of emergency medicine in an electronic patient record database. Results. Of the 138 patients included in this study, 83.3% (n = 115) were male and 16.7% female (n = 23). Most admissions were due to musculoskeletal accidents (n = 77; 55.8%), followed by neurological incidents (n = 23; 16.7%), cardiovascular incidents (n = 19; 13.8%), soft tissue injuries (n = 3; 2.2%), and others (n = 16; 11.6%). The mean age of the allover injured people was 36.7 years. The majority of the patients (n = 113; 81.9%) were treated as outpatients; 24 (17.4%) were inpatients. Discussion. In Switzerland, this is the first study that describes emergency department admissions after workout and examines trauma and neurological and cardiovascular incidents. As specific injuries, such as brain haemorrhages, STEMIs, and epileptic seizures, were relatively frequent, it was hypothesised that workout with its physiological changes may be an actual trigger for these injuries, at least for a specific population. Conclusion. Strenuous physical activity may trigger the risk of cardiovascular, neurological, or trauma events

Climate data, localisation of the sting, grade of anaphylaxis and therapy of hymenoptera stings.

International epidemiological studies indicate that around 1-7% of the population respond with an allergic reaction to a hymenoptera sting, which is frequently associated with admission to an emergency department. This retrospective study included patients admitted between 2009 and 2013 to an emergency department after a hymenoptera sting. In all, 86 (60.1%) men and 57 (39.9%) women were included in the study. The mean age was 43 years, with a range from 19 to 84 years. The most common localisations of a sting were the head (n = 33; 22.5%), the hands (n = 32; 21.9%) and the arms (n = 26; 17.8%). In women, we recorded significantly more stings in distal extremities (p = 0.033) and in men stings in the rump and head were most frequent. Local swellings were observed in 67.1% (n = 96) of patients and 34.3% (n = 49) patients exhibited an anaphylactic reaction. Of these, 21.7% (n = 31) suffered from a grade I, 6.3% (n = 9) grade II, 4.2% (n = 6) grade III and 2.1% (n = 3) grade IV anaphylactic reactions. 46% (66) of the patients were given antihistamines, 45% (64) intravenous glucocorticoids and only 12.5% (16) epinephrine. Most stings were recorded on days without rainfall (p = 0.013), with more hours of sunshine (p = 0.001), low relative humidity (p = 0.006), with mean air pressure above 954.3 hPa and on days with mean temperature above 24.2 °C (p = 0.001). In conclusion, the most hymenoptera stings induced local swelling only; severe reactions were rare. The most dangerous stings are enoral and result from inattentive drinking. Epinephrine was rarely used in anaphylactic reactions

Non-acute myocardial infarction-related causes of elevated high-sensitive troponin T in the emergency room: a cross-sectional analysis

To systematically investigate putative causes of non-coronary high-sensitive troponin elevations in patients presenting to a tertiary care emergency department. In this cross-sectional analysis, patients who received serial measurements of high-sensitive troponin T between 1 August 2010 and 31 October 2012 at the Department of Emergency Medicine were included. The following putative causes were considered to be associated with non-acute coronary syndrome-related increases in high-sensitive troponin T: acute pulmonary embolism, renal insufficiency, aortic dissection, heart failure, peri-/myocarditis, strenuous exercise, rhabdomyolysis, cardiotoxic chemotherapy, high-frequency ablation therapy, defibrillator shocks, cardiac infiltrative disorders (e.g., amyloidosis), chest trauma, sepsis, shock, exacerbation of chronic obstructive pulmonary disease, and diabetic ketoacidosis. During the study period a total of 1,573 patients received serial measurements of high-sensitive troponin T. Of these, 175 patients were found to have acute coronary syndrome leaving 1,398 patients for inclusion in the study. In 222 (30 %) of patients, no putative cause described in the literature could be attributed to the elevation in high-sensitive troponin T observed. The most commonly encountered mechanism underlying the troponin T elevation was renal insufficiency that was present in 286 patients (57 %), followed by cerebral ischemia in 95 patients (19 %), trauma in 75 patients (15 %) and heart failure in 41 patients (8 %). Non-acute coronary syndrome-associated elevation of high-sensitive troponin T levels is commonly observed in the emergency department. Renal insufficiency and acute cerebral events are the most common conditions associated with high-sensitive troponin T elevation

Lazy lips: hyperkalemia and acute tetraparesis-a case report from an urban emergency department.

A 58-year-old male patient was admitted to our emergency department at a large university hospital due to acute onset of general weakness. It was reported that the patient was bradycardic at 30/min and felt an increasing weakness of the limbs. At admission to the emergency department, the patient was not feeling any discomfort and denied dyspnoea or pain. The primary examination of the nervous system showed the cerebral nerves II-XII intact, muscle strength of the lower extremities was 4/5, and a minimal sensory loss of the left hemisphere was found. In addition, the patient complained about lazy lips. During ongoing examinations, the patient developed again symptomatic bradycardia, accompanied by complete tetraplegia. The following blood test showed severe hyperkalemia probably induced by use of aldosterone antagonists as the cause of the patient's neurologic symptoms. Hyperkalemia is a rare but treatable cause of acute paralysis that requires immediate treatment. Late diagnosis can delay appropriate treatment leading to cardiac arrhythmias and arrest