Detektion und akustikophysikalische Analyse von mikroembolischen Signalen mittels transkranieller Zweikanal-Dopplersonographie bei terminal herzinsuffizienten Patienten:mit pulsatilem linksventrikulären Unterstützungssystem und deren Korrelation zu klinischen und hämostaseologischen Parametern

Anzahl und signalmorphologische Eigenschaften von MES wurden bei 15 Patienten mit LVAD (Novacor N 100® oder TCI HeartMate®) mittels serieller TCD detektiert und beide LVAD hinsichtlich MES-Rate und -Morphologie in Korrelation mit effektiver Antikoagulation und thrombembolischen Komplikationen verglichen. Während der kumulativen Unterstützungszeit von 3499 Tagen traten 12 Thrombembolien bei 5 der 9 Novacor®- und 9 Thrombembolien bei 3 der 6 TCI HeartMate®-Patienten auf (p = 0,95). Die MES-Prävalenz zeigte zum Auftreten von thrombembolischen Insulten und zum Anteil effektiv antikoagulierter Tage im Gesamt- (r = 0,37), TCI HeartMate®- (r = 0,27) Novacor®-Kollektiv (r = 0,47) keine signifikante Korrelation. Der MES-Mittelwert korrelierte beim Gesamt- und TCI HeartMate®-Kollektiv (r = 0,54; p = 0,04 und r = 0,88; p = 0,03) signifikant mit der Insultanzahl. In dem Novacor®-Kollektiv ist signalmorphologisch ein größerer Anteil an soliden Mikroembolien anzunehmen als im TCI Heartmate®-Kollektiv (p-Wert <0,0001)

The core planar cell polarity gene, Vangl2, directs adult corneal epithelial cell alignment and migration

This work was supported by a Biotechnology and Biological Sciences Research Council (BBSRC) DTG PhD studentship to A.F., an Anatomical Society PhD Studentship (‘The Roles of planar cell polarity genes in a classical anatomical system: the cornea’) to D.A.P./J.M.C. and BBSRC Project Grants BB/J015172/1 and BB/J015237/1 to J.D.W. and J.M.C., respectively.Peer reviewedPublisher PD

Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms?

Background: Physical impairment is well-known to last for many years after a severe injury, and there is a high impact on the quality of the survivor's life. The purpose of this study was to examine if this is also true for psychological impairment with symptoms of posttraumatic stress disorder or depression after polytrauma. Design: Retrospective cohort outcome study. Setting: Level I trauma centre. Population: 637 polytrauma trauma patients who were treated at our Level I trauma centre between 1973 and 1990. Minimum follow-up was 10 years after the injury. Methods: Patients were asked to fill in a questionnaire, including parts of the Posttraumatic Stress Diagnostic Scale, the Impact of Event Scale-Revised and the German Hospital Anxiety and Depression Scale, to evaluate mental health. Clinical outcome was assessed before by standardised scores. Results: Three hundred and twenty-four questionnaires were evaluated. One hundred and forty-nine (45.9%) patients presented with symptoms of mental impairment. Quality of life was significantly higher in the mentally healthy group, while the impaired group achieved a lower rehabilitation status. Conclusions: Mental impairment can be found in multiple trauma victims, even after 10 years or more. Treating physicians should not only focus on early physical rehabilitation but also focus on early mental rehabilitation to prevent long-term problems in both physical and mental disability

Injury situation of novice drivers in road traffic : a medical and technical analysis

Novice drivers are at high risk for crash involvement. We performed an analysis of causations, injury patterns and distributions of novice drivers in cars and on motorcycles in road traffic as a basis for proper measurements. Method Data of accident and hospital records of novice drivers (licence < 2 years) were analysed focusing the following parameters: injury type, localisation and mechanism, Abbreviated Injury Scale (AIS), maximum AIS (MAIS), delta-v, collision speed and other technical parameters and have been compared to those of experienced drivers. In 18352 accidents in the area of Hannover (years1985"2004), 2602 novice drivers and 18214 experienced drivers were recorded having an accident. Novice car drivers were more often and severe injured than experienced and on motorcycles the experienced riders were at higher risk. Novice drivers of both groups sustained more often extremity injuries. 4.5 % novice car drivers were not restraint compared to 3.7 % of the experienced drivers and 6.1 % novice motorcycle drivers did not wear a proper helmet (versus 6.5 %). Severe injuries sustained at a rate of 20 % at collision speeds below 30 km/h and in 80% at collision speeds above 50 km/h. Novice car drivers drove significant older cars. The risk profile of novice drivers is similar to those of drivers older than 65 years. Structural protection and special lectures like skidding courses could be proper remedial action next to harder punishment of violations

Spine injuries in motor vehicle accidents - an analysis of 18353 traffic accidents between 1985 and 2004 with special consideration of injuries of the thoracolumbar spine in relation to injury mechanisms

This study aims to analyze spine injuries in motor vehicle accidents. Between 1985 and 2004 the Hannover accident research unit documented 18353 accidents. We identified 161 front passengers (0.53%) with cervical spine injuries, 84 (0.28%) with thoracic and 95 (0.31%) with lumbar injuries. Technical and medical data was reviewed. Patients" records were retrieved. X-rays were evaluated and fractures were classified according to the Magerl classification. 68% and 57% of thoracic and lumbar fractures occurred in accidents with multiple impacts. Delta-v was 50, 40 and 40 kph in passengers with cervical, thoracic and lumbar spine, resp. Passengers with spinal fractures frequently showed numerous concomitant injuries, e.g. additional vertebral fractures. The influence of seat belts and airbags is discussed. Patient work-up has to include a thorough investigation for additional injuries

Spine injuries in motor vehicle accidents - an analysis of 34188 injured front passengers with special consideration of injuries of the thoracolumbar spine in relation to injury mechanisms

Introduction: Spine injuries pose a considerable risk to life and quality of life. The total number of road deaths in developed countries has markedly decreased, e.g. in Germany from over 20000 in 1970 to less than 4000 in 2010, but little is known how this is reflected in the burden of spine fractures of motor vehicle users. In this study, we aimed to show the actual incidence of spine injuries among drivers and front passengers and elucidate possible dependencies between crash mechanisms and types of injuries