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Rothschild M.A.,Universitatsklinikum Cologne AoR

Gunshot injuries to the head usually present special findings due to the anatomical conditions of the head (brain enclosed in a relatively solid skull capsule). From a physical wound ballistic view the brain is a very inelastic and incompressable object/tissue. In general this is the reason why gunshots to the head lead to lethal fluid dynamic effects even when no vitally important structures have been directly injured. Severe brain injuries can occur even distant from the wound canal mainly due to distensional and shearing for-ces during the development of the temporary wound cavity. The lower the cross-sectional density and the more energy a bullet has, the more these effects will be pronounced. Even gunshots with caliber 9 mm Luger can result in hydraulic pressure effects with development of complex fracturing of the skull. © 2011 Springer-Verlag. Source

Rothschild M.A.,Universitatsklinikum Cologne AoR | Kneubuehl B.P.,University of Bern

In ballistics, especially wound ballistics, a large number of misconceptions and false conclusions concerning findings and their causes exist. On the other hand these misconceptions can be easily corrected by using objective scientific methods and tools. For performing experiments in wound ballistics glycerine soap and gelatine should be used when human soft tissue has to be simulated. Gunshots into the air can be dangerous to life as the falling bullets have enough energy to penetrate skin and bones; exceptions are air gun and shotgun pellets which do not have enough energy to penetrate skin when descending. When a bullet hits bone the bone fragments will not receive enough energy to act as secondary projectiles themselves. Shots from handguns are not able to produce enough power to stop a person or throw a person backwards. Blank shots from alarm pistols are dangerous to life when fired at point blank range: the gas jet exiting the muzzle has such a high velocity that a high energy density will result which gives the jet the character of a solid projectile. The effect of a gunshot is an individual event which depends on a number of factors (e.g. localization of the entrance wound and wound canal, psychological state, intoxication and pathological state of organs). Effectiveness means the wounding potential and is dependent on the energy of the bullet and its ability to transfer the energy along the wound canal. © Springer-Verlag 2010. Source

Von Tempelhoff W.,Universitatsklinikum Cologne AoR | Ulrich F.,Neuro Unit | Schwarzmaier H.-J.,VDI Technologiezentrum
Photonics and Lasers in Medicine

Background: The most common type of primary brain tumors are gliomas. For patients unsuitable for open microsurgery having been treated by radiochemotherapy, laser irradiation has proven to be an alternative palliative option. From summer 1997 until winter 2006 we performed about 60 laser-interstitial thermotherapy (LITT) treatments, starting with patients with large recurrent tumors who had no other therapeutic option. In the present article we report about the neurobiological background, the technique and our experience with LITT of cerebral gliomas. Materials and method: For laser irradiation we used a specially designed light guide (LITT standard applicator; Trumpf Medizintechnik, Umkirch, Germany). The tip of this light guide is a special optical diffuser which is characterized by a homogeneous spherical or ellipsoid emission profile. The light guide was introduced into an appropriate protective sheath (Somatex, Teltow, Germany). For the laser light source, we used a continuous wave 1064-nm Nd:YAG laser (mediLas fibertom 4060 N; Dornier MedTech, Weβling, Germany). Laser irradiation was performed under general anesthesia in a 0.5 T open configuration magnetic resonance (MR) system (Signa SP; General Electric, Milwaukee, WI, USA). Usually, the tip of the light guide was positioned in the center of the tumor using the built-in localization system (Flashpoint 3000; IGT, Boulder, CO, USA) in combination, where appropriate, with a specially designed navigation system (Localite, Bonn, Germany). The position of the light guide was then controlled using multiplanar reconstructions of T1-weighted sequences. For near real-time control, temperature monitoring was performed using an experimental software package based on the temperature- dependent shift of the MR signal. Laser irradiation was ceased when the temperature monitoring revealed a steady state temperature profile within the heated tissue. Since 2008 we have used traditional stereotactic targeting and methionine positron emission tomography/computed tomography (MET-PET/CT) instead of the 'open' MR system for planning and follow-up in LITT of brain tumors. Results: We started the LITT treatment of gliomas in the early 1990s (benign gliomas in eloquent regions/not suitable for surgery). In 1997 we started to treat patients with recurrent gliobastomas/anaplastic gliomas. All of these patients had an increased survival in comparison to the natural course of recurrent glioblastomas. There were no procedure-related deaths or permanent neurological deficits. Two factors seem to be important for the overall success of the LITT procedure: 1) an early enrollment in the LITT therapy after diagnosis of a tumor recurrence, and 2) a corresponding smaller tumor mass at the beginning of the therapy. Conclusion: Cytoreduction by laser irradiation seems to be a promising option for patients suffering from gliomas. Source

Jacobi G.,Goethe University Frankfurt | Dettmeyer R.,Justus Liebig University | Banaschak S.,Universitatsklinikum Cologne AoR | Brosig B.,Justus Liebig University
Deutsches Arzteblatt

Background: The findings of studies on the frequency of violence against children imply that many cases go undetected. Methods: Selective literature review based on a search of different databases for publications on all types of violence against children, except sexual abuse. Results: The physical abuse of children can involve blunt trauma, thermal injury, and the so-called shaking trauma syndrome (STS). Physical and psychological child neglect have very serious long-term effects. It can be difficult to draw a clear distinction of child abuse and neglect on the one hand, and acceptable behavior on the other, because of the varying social acceptance of certain child-raising practices. Münchhausen's syndrome by proxy (MSbP) is a rare, special type of child abuse. Conclusion: At the beginning of the 21st century, wellestablished normative structures are in place to protect children against abuse and neglect, and the available help from social organizations can also have a preventive effect. Further improvements will depend on interdisciplinary coordination and better training of specialists in all of the involved disciplines. Source

Braunecker S.,Universitatsklinikum Cologne AoR | Hinkelbein J.,Universitatsklinikum Cologne AoR
Notfall und Rettungsmedizin

Background: Due to the careful selection of astronauts, to their low age and intensive medical care, relevant medical problems in astronauts are rare. Nevertheless, there is a certain risk for a cardiac arrest in space requiring cardiopulmonary resuscitation (CPR). The aim of the present study was to identify and to analyze different known and published techniques for CPR during weightlessness. Material and methods: A systematic search with defined criteria in the PubMed database was performed. For analysis, the keywords (‟reanimation” or ‟CPR” or ‟resuscitation”) and (‟space” or ‟microgravity”) were used. Results: Using the defined keywords for the literature search, five different techniques for CPR in space were identified (microgravity [simulated] or space [real]): (1) standard technique; (2) straddling manoeuvre; (3) reverse-bear-hug technique; (4) Evetts–Russomano technique; (5) hand-stand technique. All studies were performed during parabolic flight or under simulated weightlessness (e.g., underwater) on earth. No study was performed under real space conditions. Conclusions: Concerning CPR quality, the hand-stand technique seems to be most effective to treat cardiac arrest. In some environmental conditions where this technique cannot be used, the Evetts–Russomano technique is a good alternative since CPR quality is only slightly lower. © 2015, Springer-Verlag Berlin Heidelberg. Source

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