Fettemboliesyndrom nach Unterschenkelfraktur trotz sofortiger Versorgung mit einem Fixateur externe: Zwei Kasuistiken und Literaturübersicht

Zusammenfassung: Das Auftreten eines Fettemboliesyndroms (FES) wird mit 0,9-2,2% als bekannte Komplikation bei Frakturen langer Röhrenknochen beschrieben. Die klassische Symptomtrias besteht aus Atemnot, neurologischen Symptomen und Petechien. Gemäß Literatur verringert eine frühzeitige Versorgung der Fraktur die Inzidenz eines FES. Diese Kasuistiken beschreiben jedoch interessanterweise die Entstehung eines FES trotz sofortiger operativer Versorgung der Unterschenkelfrakturen mittels Fixateur externe zweier völlig gesunder junger Männer. Somit sollte nach jeglichem Therapieverfahren bei der Versorgung langer Röhrenknochen an die Komplikation durch ein FES gedacht werde

Perforatationstrauma im Gesichtsschädel. Eine ungewöhnliche Verletzung beim Skifahren

Facial perforation injuries are very rare. We describe a case of a 48-year-old man who sustained a perforation trauma from an 11 cm long wooden tree branch in the middle of the face in a skiing accident. He suffered from additional injuries, such as fractures of the ribs and hand, but was neurologically without pathologic findings and was cardiopulmonary stable.The branch penetrated the head from the sinus maxillaris through the maxilla just missing the internal and external carotid arteries and ending just short of the cervical vertebra. The patient was transported to a center for oral and maxillofacial surgery and underwent several operations.He could return to his normal social and professional life 8 months after the accident

Minimal-invasive, ballonassistierte Aufrichtung und innere Fixation von Tibiaplateaufrakturen

Zusammenfassung: Aufgrund der häufig insuffizienten Weichteilsituation im Rahmen von Tibiaplateaufrakturen und der damit assoziierten höheren Rate an postoperativen Wundheilungsstörungen und Weichteilinfektionen ist ihre operative Behandlung nicht selten eine herausfordernde Aufgabe. Die klassische offene Reposition und Plattenosteosynthese beinhaltet eine ausgiebige Weichteilpräparation und partielle Periostablösung, um so die abgesunkenen Fragmente zu bergen und aufzurichten. Die Wiederherstellung der Gelenkfläche gestaltet sich dabei häufig als schwierig. In der vorliegenden Arbeit beschreiben wir eine neuartige operative Technik, in der das eingesunkene Tibiaplateau durch einen perkutan eingebrachten Ballon in Kombination mit einer minimal-invasiven Plattenosteosynthese versorgt wird. Darüber hinaus berichten wir über 5Fälle, welche mit diesem Verfahren bislang behandelt wurde

Ear, nose and throat manifestations of Lyme disease

The manifestations of Lyme disease as they may present to the ENT surgeon are discussed. The most important ENT symptom is facial palsy. Particularly when combined with other cranial palsies, systemic illness or signs of meningeal irritation, the diagnosis must be considered. Three case reports are used to illustrate the presentation and diagnosis and treatment of Lyme disease. The characteristics of the disease are reviewed and the limitations of serological testing outlined. The literature has concentrated on bilateral or relapsing facial palsy. A review of palsies in Zurich that presented to the ENT clinic found only unilateral and partial palsies. The diagnosis should be considered in every case of facial palsy of unknown aetiology especially in childre

Nephrotoxicity, high frequency ototoxicity, efficacy and serum kinetics of once versus thrice daily dosing of netilmicin in patients with serious infections

The effect of dosing regimen on nephrotoxicity, high frequency ototoxicity, efficacy and serum kinetics was studied in a prospective, randomised clinical study. Therapy was started with total daily doses of 6 mg/kg given once (od) or thrice (tid) daily to 56 and 57 patients, respectively. Subsequent doses were adjusted according to serum levels. No major differences in toxicity or efficacy were noticed between od and tid regimens: clinical failures occurred in two and two patients, four and five patients suffered from a decrease of ≥20 dB at least unilaterally at one frequency between 8 and 18 kHz, six and seven patients had a >25 μmol/L or >25% increase in serum creatinine, respectively. Serum creatinine or creatinine clearance did not change significantly during either therapy. Major differences between the two study groups were limited to pharmacokinetic parameters. Od dosing resulted in higher peak (mean of 21.6 vs 7.2 mg/L) and lower trough levels (0.5 vs 1.4mg/L). Half-lives of netilmicin determined between 1 and 8 h increased significantly during therapy with tid (from a mean of 2.75 to a mean of 3.33 h, P<0.01) but not significantly with od (rise from 2.8 to 3.03 h). Much longer half-lives were determined between 8 and 24 h in the od group (mean of 5.7 h, P<0.01). In conclusion, only minimal differences in toxicity and efficacy were observed. Their clinical relevance appears to be minima

The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

Background: With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw') has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications. Methods: Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-. Results: Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M). Humeral head necrosis occurred in 6 (C+, 15.4%) and 3 (C-, 14.3%) cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7%) and 1 (C-, 4.8%) cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01). Conclusions: The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown

Asymptotic Level Density of the Elastic Net Self-Organizing Feature Map

Whileas the Kohonen Self Organizing Map shows an asymptotic level density following a power law with a magnification exponent 2/3, it would be desired to have an exponent 1 in order to provide optimal mapping in the sense of information theory. In this paper, we study analytically and numerically the magnification behaviour of the Elastic Net algorithm as a model for self-organizing feature maps. In contrast to the Kohonen map the Elastic Net shows no power law, but for onedimensional maps nevertheless the density follows an universal magnification law, i.e. depends on the local stimulus density only and is independent on position and decouples from the stimulus density at other positions.Comment: 8 pages, 10 figures. Link to publisher under http://link.springer.de/link/service/series/0558/bibs/2415/24150939.ht

Zweizeitige Milzruptur am 13. postraumatischen Tag nach initial unauffällig befundener CT-Untersuchung

Zusammenfassung: Zweizeitige Milzrupturen sind seltene, gleichwohl bekannte und potentiell sehr gefährliche Komplikationen nach stumpfen abdominalen Traumata. Ihre Inzidenz ist zwischen dem 4. und 8. posttraumatischen Tag am höchsten, wobei in der Literatur auch Fälle mit einer Latenz von Wochen beschrieben werden. Wir berichten im Folgenden über eine zweizeitige Milzruptur am 13. posttraumatischen Tag, wobei die dem Ereignis vorangegangenen computertomographischen Befunde sich in der überwiegenden Zahl als unauffällig präsentierten und geben einen Überblick über die pathophysiologischen Mechanismen, die Diagnostik sowie Therapi

Young adults with mild traumatic brain injury--the influence of alcohol consumption--a retrospective analysis

PURPOSE: Alcohol abuse has been associated with aggressive behavior and interpersonal violence. Aim of the study was to investigate the role of alcohol consumption in a population of young adults with mild traumatic brain injuries and the attendant epidemiological circumstances of the trauma. SUBJECTS AND METHODS: All cases of mild traumatic brain injury among young adults under 30 with an injury severity score <16 who were treated as inpatients between 2009 and 2012 at our trauma center were analyzed with regard to the influence of alcohol consumption by multiple regression analysis. RESULTS: 793 patients, 560 men, and 233 women were included. The age median was 23 (range 14-30). Alcohol consumption was present in 302 cases. Most common trauma mechanism was interpersonal violence followed by simple falls on even ground. Alcohol consumption was present more often in men, unemployed men, patients who had interpersonal violence as a trauma mechanism, and in patients who were admitted to the hospital at weekends or during night time. It also increased the odds ratio to suffer concomitant injuries, open wounds, or fractures independently from the trauma mechanism. Length of hospital stay or incapacity to work did not increase with alcohol consumption. CONCLUSIONS: Among young adults men and unemployed men have a higher statistical probability to have consumed alcohol prior to suffering mild traumatic brain injury. The most common trauma mechanism in this age group is interpersonal violence and occurs more often in patients who have consumed alcohol. Alcohol consumption and interpersonal violence increase the odds ratio for concomitant injuries, open wounds, and fractures independently from another

Calcifediol versus vitamin D3 effects on gait speed and trunk sway in young postmenopausal women: a double-blind randomized controlled trial

UNLABELLED In this double-blind RCT, 4-month treatment with calcifediol compared with vitamin D3 improved gait speed by 18 % among young postmenopausal women. Consistently, change in 25(OH)D blood levels over time were significantly correlated with improvement in gait speed in these women. No effect could be demonstrated for trunk sway. INTRODUCTION The aim of this study is to test the effect of calcifediol compared with vitamin D3 on gait speed and trunk sway. METHODS Twenty healthy postmenopausal women with an average 25(OH)D level of 13.2 ng/ml (SD = ±3.9) and a mean age of 61.5 years (SD = ±7.2) were randomized to either 20 μg of calcifediol or 20 μg (800 IU) of vitamin D3 per day in a double-blind manner. At baseline and at 4 months of follow-up, the same physiotherapist blinded to treatment allocation tested 8-m gait speed and a body sway test battery (Sway star pitch and roll angle plus velocity while walking 8 m, and standing on both legs on a hard and soft surface). All analyses adjusted for baseline measurement, age, and body mass index. RESULTS Mean 25(OH)D levels increased to 69.3 ng/ml (SD = ±9.5) in the calcifediol group and to 30.5 ng/ml (SD = ±5.0) in the vitamin D3 group (p < 0.0001). Women receiving calcifediol compared with vitamin D3 had an 18 % greater improvement in gait speed at 4-month follow-up (p = 0.046) adjusting for baseline gait speed, age, and body mass index. Also, change in gait speed was significantly correlated with change in serum 25(OH)D concentrations (r = 0.5; p = 0.04). Across three tests of trunk sway, there were no consistent differences between groups and no significant correlation between change in 25(OH)D serum concentrations and change in trunk sway. CONCLUSIONS Calcifediol improved gait speed in early postmenopausal women compared with vitamin D3 and change in 25(OH)D level was moderately correlated with improvement in gait speed. A benefit on trunk sway could not be demonstrated