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Ludwigshafen am Rhein, Germany

Study design:Retrospective cohort study.Objectives:The aims of the current study were (i) to analyze prehospital and emergency room treatment of patients with acute traumatic spinal cord injury (SCI) and (ii) to analyze whether recommendations given by the current guidelines are implemented.Setting:German level I trauma center.Methods:All patients suffering from traumatic SCI who were initially surgically treated in our hospital in the period from January 2008 to December 2013 were included in this study. Available data documented as a standard procedure in our trauma center included patient’s demographic and medical information, as well as trauma mechanisms, cause of injury, neurological diagnosis and detailed clinical information about prehospital and early hospital management procedures. Retrospectively, statistical analysis was performed to describe spinal immobilization rates, transportation times and methylprednisolone administration.Results:A total of 133 patients (mean age: 50.5±21.2 years) met the inclusion criteria. Immobilization was performed on 69.9% of the patients with traumatic SCI. From 60 patients suffering from cervical traumatic SCI, 47 patients had a cervical collar. Full immobilization was only performed in 34 of these 60 patients. Mean time from accident site to emergency room was 61.3±28.7 min. In 25 out of the 133 patients included in the current study, early surgery was not possible because of insufficient circulation and/or increased intracranial pressure. A total of 108 patients could be prepared for early surgery within 322.8±254.1 min after the accident.Conclusion:The current study shows that recommendations of the current literature and guidelines are mostly followed.Spinal Cord advance online publication, 31 May 2016; doi:10.1038/sc.2016.84. © 2016 International Spinal Cord Society Source

Hirche C.,Robert Rossle Hospital | Hirche C.,Trauma Center Ludwigshafen | Dresel S.,Robert Rossle Hospital | Krempien R.,Robert Rossle Hospital | Hunerbein M.,Robert Rossle Hospital
Annals of Surgical Oncology

Background: There is some evidence that sentinel lymph node (SLN) biopsy guided by dye injection and/or radioisotopes can improve staging of inguinal lymph nodes (LNs) in anal cancer. This study was performed to investigate the feasibility of fluorescence detection of SLN and lymphatic mapping in anal cancer. Methods: Twelve patients with anal cancer without evidence for inguinal LN involvement were included in the study. Intraoperatively, all patients received a peritumorous injection of 25 mg indocyanine green (ICG) for fluorescence imaging of the SLN with a near-infrared camera. For comparison, conventional SLN detection by technetium-99m-sulfur radiocolloid injection in combination with blue dye was also performed in all patients. The results of both techniques and the effect on the therapeutic regimen were analyzed. Results: Overall, ICG fluorescence imaging identified at least one SLN in 10 of 12 patients (detection rate, 83%). With the combination of radionuclide and blue dye, SLN were detected in 9 of 12 patients (detection rate, 75%). Metastatic involvement of the SLN was found in 2 of 10 patients versus 2 of 9 patients. Patients with metastatic involvement of the SLN received extended radiation field with inguinal boost. Conclusions: ICG fluorescence imaging allows intraoperative lymphatic mapping and transcutaneous SLN detection for selective biopsy of inguinal SLN in anal cancer. This technique should be further evaluated in comparative studies with larger patient numbers. © 2010 Society of Surgical Oncology. Source

Suda A.J.,Trauma Center Ludwigshafen | Heppert V.,Trauma Center Ludwigshafen
Journal of Bone and Joint Surgery - Series B

We evaluated the potential of a vastus lateralis muscle flap in controlling infection after resection arthroplasty of the hip. We retrospectively reviewed 119 patients with 120 chronic infections after resection arthroplasty treated with this procedure. The flap was fixed with Mitek anchors in the acetabular cavity. The mean duration of infection after resection before the muscle flap procedure was 6.5 months (2 to 13). The patients had previously undergone a mean of 4.9 operations (2 to 25). In all patients the infected cavity was the origin of the persistent infection. The mean follow-up was for 2.6 years (1.0 to 4.7). No patient had recurrent infection post-operatively and all had an improvement in the pain and better quality of life. ©2010 British Editorial Society of Bone and Joint Surgery. Source

Westhauser F.,University of Heidelberg | Zimmermann G.,Theresienkrankenhaus und St. Hedwigs Klinik GmbH | Moghaddam S.,University of Heidelberg | Bruckner T.,University of Heidelberg | And 3 more authors.
Archives of Orthopaedic and Trauma Surgery

Abstract: The analysis of peripheral serum cytokine expression patterns has been shown to be a possible method for demonstrating changes in bone metabolism. The aim of this study is to evaluate the effectiveness of this method within the treatment of long bone non-union with intramedullary reaming, a well-established non-union treatment concept. Materials and methods: Three groups were added to this study: group one (G1) suffered from long bone non-unions, treated successfully with intramedullary reaming; group two (G2) consisted of long bone fractures with proper fracture healing; and group three (G3) included long bone fractures resulting in non-unions. We took blood samples on day 2, and after week 1, 4, 6, month 3 and 6 after initial treatment. Clinical and radiological follow-up were provided for 6 months. We measured transforming growth factor ß-1 (TGFß-1), platelet-derived growth factor (PDGF-AB), and insulin like growth factor-1 (IGF-1) at all-time points. Results: TGF-ß1 levels in G1 and G2 increased from day 2 to 6 weeks after surgery. In general, G1 and G2 showed parallel TGF-ß1 expression patterns, and G3 had a significant peak during first week compared to G1 (p = 0.023). PDGF peaked in G3 during first week after treatment, whereas G1 had its maximum after 4 weeks and G2 after 6 weeks. We were able to detect a significantly lower PDGF concentration at 3 months in G1 compared to G3 (p = 0.029). IGF-1 showed a peak concentration in G1 during the first 4 weeks. Afterwards, concentration levels in both G1 and G2 were higher. Conclusions: Our study was able to show that the cytokine expression pattern in physiological bone healing is similar to that in successful non-union treatment with intramedullary reaming. Our results show that the effect of non-union therapy could be observed objectively by measuring cytokine expression patterns in peripheral blood even in a small group of patients. © 2015, Springer-Verlag Berlin Heidelberg. Source

Hogan A.,Trauma Center | Heppert V.G.,Trauma Center Ludwigshafen | Suda A.J.,Trauma Center Ludwigshafen
Archives of Orthopaedic and Trauma Surgery

Introduction: Osteomyelitis is a challenging diagnosis for every patient because of its protracted treatment process. Very experienced orthopaedic surgeons are needed to diagnose and treat this bacteria-related severe disorder in a right and proper way. Materials and methods: Different treatment options are possible for osteomyelitis at any stage: antibiotics in the acute and chronic stage for conservative treatment or radical debridement, bone fenestration, reaming, bone troughing, the Masquelet-technique, segmental resection with callus distraction, bone grafting and even amputation as surgical therapy. Results: Depending on different stages of the disease, there are good results with every technique available - on condition that radical debridement was performed. The complication rate is remarkable so that soft tissue defects should be assessed by using flaps to close the wounds in early stages. Conclusions: The treatment of osteomyelitis should be done in centres with expertise in the treatment of this challenging disease. Different methods should be offered by surgeons and individual treatment concepts acquired together with the patient. The treatment of complications like soft tissue defects should be provided in the same centre and performed in short time lag to the prior surgery. The cooperation of the patient and surgeons of different specialities is mandatory in these cases. © 2013 Springer-Verlag Berlin Heidelberg. Source

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