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Frankfurt am Main, Germany

Mutschler M.,Cologne Merheim Medical Center | Nienaber U.,Surgery Academy | Brockamp T.,Cologne Merheim Medical Center | Wafaisade A.,Cologne Merheim Medical Center | And 5 more authors.
Resuscitation | Year: 2013

Aim: The aim of this study was to validate the classification of hypovolaemic shock given by the Advanced Trauma Life Support (ATLS). Methods: Patients derived from the TraumaRegister DGU® database between 2002 and 2010 were analyzed. First, patients were allocated into the four classes of hypovolaemic shock by matching the combination of heart rate (HR), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) according to ATLS. Second, patients were classified by only one parameter (HR, SBP or GCS) according to the ATLS classification and the corresponding changes of the remaining two parameters were assessed within these four groups. Analyses of demographic, injury and therapy characteristics were performed as well. Results: 36,504 patients were identified for further analysis. Only 3411 patients (9.3%) could be adequately classified according to ATLS, whereas 33,093 did not match the combination of all three criteria given by ATLS. When patients were grouped by HR, there was only a slight reduction of SBP associated with tachycardia. The median GCS declined from 12 to 3. When grouped by SBP, GCS dropped from 13 to 3 while there was no relevant tachycardia observed in any group. Patients with a GCS=15 presented normotensive and with a HR of 88/min, whereas patients with a GCS<12 showed a slight reduced SBP of 117. mmHg and HR was unaltered. Conclusion: This study indicates that the ATLS classification of hypovolaemic shock does not seem to reflect clinical reality accurately. © 2012 Elsevier Ireland Ltd. Source


Kuhbier J.W.,Hand and Reconstructive Surgery | Weyand B.,Hannover Medical School | Radtke C.,Hannover Medical School | Vogt P.M.,Hannover Medical School | And 2 more authors.
Advances in Biochemical Engineering/Biotechnology | Year: 2010

While bone marrow-derived mesenchymal stem cells are known and have been investigated for a long time, mesenchymal stem cells derived from the adipose tissue were identified as such by Zuk et al. in 2001. However, as subcutaneous fat tissue is a rich source which is much more easily accessible than bone marrow and thus can be reached by less invasive procedures, adipose-derived stem cells have moved into the research spotlight over the last 8 years. Isolation of stromal cell fractions involves centrifugation, digestion, and filtration, resulting in an adherent cell population containing mesenchymal stem cells; these can be subdivided by cell sorting and cultured under common conditions. They seem to have comparable properties to bone marrow-derived mesenchymal stem cells in their differentiation abilities as well as a favorable angiogenic and anti-inflammatory cytokine secretion profile and therefore have become widely used in tissue engineering and clinical regenerative medicine. © Springer-Verlag Berlin Heidelberg 2010. Source


Hauschild O.,Albert Ludwigs University of Freiburg | Muenzberg M.,University of Heidelberg | Knothe D.,Tuttlingen Hospital | Konstantinidis L.,Albert Ludwigs University of Freiburg | And 3 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Purpose: The aim of the present study was to assess the changes in rotational alignment introduced by total knee arthroplasty (TKA) and the reproducibility of pre- and postoperative CT measurements of rotational limb alignment. Methods: For this purpose we analyzed data from 196 consecutive cruciate-retaining, fixed bearing Columbus TKA procedures. Both pre- and postoperative scans torsion difference CT scans were available for measurements in 89 cases. Using these CT scans the neck-malleolar angle (NMA), the femoral posterior condylar angle (fPCA), the tibial posterior condylar axis (tPCA) and the tibial torsion angle (TTA) were independently assessed by three raters. CT scans were re-evaluated 8 weeks later by the most experienced rater for assessment of intraobserver agreement. Results: Measurements of all angles were prone to high standard deviations reflecting interindividual variability. Mean fPCA changed from 1.3° to 2.7° internal rotation preoperatively to 0.1°-1.9° internal rotation postoperatively. Based on a relative external rotation of the tibial base plate as compared to the preoperative situation, we found a relative internal rotation of the postoperative NMA and tibial torsion of 3°-5.4° and 6°-7.5°, respectively. Intra- and interobserver agreement was strong for all angles assessed (ICCs 0.7-1.0) except for fPCA (ICC 0.2-0.6). However, mean absolute measurement differences for fPCA were clinically acceptable (1.2°-2.6°). Conclusions: Reproducibility of CT rotational limb alignment measurements was found to be clinically acceptable. Rotational alignment of the femoral and even more so of the tibial component will ultimately affect the rotational alignment of the entire limb-at least when fixed bearings are used. Level of evidence: Diagnostic study, Level III. © 2012 Springer-Verlag Berlin Heidelberg. Source


Wirbel R.,Hand and Reconstructive Surgery | Hermans K.,St Elisabeth Hospital
African Journal of Paediatric Surgery | Year: 2014

Background: The surgical management of chronic osteomyelitis in children is still challenging in developing countries. This study analysed the extent of the disease and the therapeutic regime.Subjects and Methods: This was a retrospective study in two primary health care hospitals from January 2009 to December 2013, 27 children (20 males and 7 females, mean age 7 years) admitted from developing countries who were treated for chronic osteomyelitis. Localization, duration of the disease, extent of the osseous involvement, spectrum of germs, number of previous and required surgical procedures and duration of hospital stay are reported.Results: A total of 16 cases had haematogenous and 11 cases post-traumatic aetiology. The mean duration of the disease was 18 months. On average, three (range, 1-12) previous surgical procedures were performed. The affected bones were: Tibia in 11, femur in 8, forearm in 6 cases, spine and humerus each in 1 case. Staphylococcus aureus was the responsible germ in 75%. On average, four (range, 2-8) surgical procedures were required. Osseous stabilizations were necessary in 17, plastic soft tissue reconstructions in 8 cases. In three cases with metaphyseal/diaphyseal defect, bone transfers had to be performed (2 × fibula-pro-tibia, 1 × rib for radius). The mean hospital stay took 8 (range, 4-20) weeks. Three local recurrences occurred within 3 months, all could be cured surgically.Conclusions: The surgical treatment of chronic osteomyelitis in children requires a radical osseous debridement. The knowledge of different plastic-surgical procedures is necessary to reconstruct osseous and/or soft tissue defects. Source


Pinder R.,Hand and Reconstructive Surgery | Barlow G.,Castle Hill Hospital
Journal of Hand Surgery: European Volume | Year: 2015

Osteomyelitis of the hand is uncommon, but if not adequately and promptly treated the detrimental effects on hand function can be devastating. The majority of literature on osteomyelitis relates to the lower limb, but the principles of management are applicable to the hand, with good surgical debridement and culture-guided antimicrobial therapy. For osteomyelitis in general, antibiotic therapy of 4-6 weeks' duration (intravenous and/or oral) is typically recommended. In the hand, length and mode of antibiotic administration are still under study. © The British Society for Surgery of the Hand. Source

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