I. Marzi

Mediators in polytrauma--pathophysiological significance and clinical relevance.

Abstract Multiple trauma induces an inflammatory response syndrome of the whole body that is triggered by (a) hemorrhage inducing an ischemia/reperfusion (I/R) syndrome and (b) fractures or organ contusions inducing tissue-repair processes. I/R injury generates oxyradical/proteolytic metabolites and adhesion molecules, while tissue and endothelial injury directly stimulate complement, coagulation and kinin pathways. Membrane-derived phospholipase A2 and lipid mediators potentiate cellular interactions and increase microvascular permeability. The tissue-repair process mediates macrophage/monocyte and T-cell activation which releases pro- and anti-inflammatory cytokines. Mediator action follows a “three-level model”, proposing that depending on the degree of traumatic injury cellular and humoral responses may spread from a cellular to an organ and then a systemic level. The systemic response can result in a severe immunological dys-homeostasis that potentially hazards the survival of the trauma patient by uncontrollable cellular dysfunction, appearing clinically as multiple organ-dysfunction syndrome. Blood-mediator concentrations often parallel the inflammatory process; initially, high levels of cytokines are followed by severe organ dysfunction. However, interpretation of these data remains difficult due to distinct beneficial or detrimental effects of mediators on the different levels of inflammation and missing prognostic threshold values, indicating a risk of adverse effects. Future studies must determine pro- and anti-inflammatory mediators directly, during the intensive care therapy, and evaluate their clinical relevance prospectively for the different levels of inflammation at local and systemic sites.

Interventional emergency embolization for severe pelvic ring fractures with arterial bleeding. Integration into the early clinical treatment algorithm

OBJECTIVEnPresentation of our own experiences and results of an early clinical algorithm for treatment integrating emergency embolization (TAE) in cases of unstable pelvic ring fractures with arterial bleeding.nnnMETHODnConsecutive patient series from April 2002 to December 2006 at a level 1 trauma center. The data of the online shock room documentation (Traumawatch) of patients with a pelvic fracture and arterial bleeding detected on multislice computed tomography (MSCT) were examined for the following parameters: demographic data, injury mechanism, fracture classification according to Tile/AO and severity of the pelvic injury assessed with the Abbreviated Injury Score (AIS), accompanying injuries with elevation of the cumulative injury severity according to the Injury Severity Score (ISS), physiological admission parameters (circulatory parameters and initial Hb value) as well as transfusion requirement during treatment in the shock room, time until embolization, duration of embolization, and source of bleeding.nnnRESULTSnOf a total of 162 patients, arterial bleeding was detected in 21 patients by contrast medium extravasation on MSCT, 12 of whom were men and 9 women with an average age of 45 (14-80) years. The mechanism of injury was high energy trauma in all cases. In 33% it involved type B pelvic fractures and in 67% type C fractures with an average AIS pelvis of 4.4 points (3-5) and a total severity of injury with the ISS of 37 points (21-66). Upon admission 47.6% presented hemodynamic instability with an average Hb value of 7.8 g/dl (3.2-12.4) and an average transfusion requirement of 6 red blood cell units (4-13). The time until the TAE was started was on average 62 min (25-115) with a duration period of the TAE of 25 min (15-67). Branches of the internal iliac artery were identified as the sole source of bleeding. The success rate of TAE amounted to over 90%.nnnCONCLUSIONnInterventional TAE represents an effective as well as a fast procedure for hemostasis of arterial bleeding detected on MSCT in patients with pelvic fractures. If an experienced radiologist on 24-h stand-by is assured and the infrastructure is efficient, this can be performed shortly after hospital admission and therefore should be integrated into the early clinical treatment protocol.ZusammenfassungZielsetzungVorstellung eigener Erfahrungen und Ergebnisse eines frühklinischen Behandlungsalgorithmus unter Integration der Notfallembolisation (TAE) bei instabilen Beckenfrakturen mit arterieller Blutung.MethodikRetrospektive Untersuchung einer konsekutiven Patientenserie der Jahre 04/2002-12/2006 an einem Level-1-Traumacenter. Die Daten der Online-Schockraumdokumentation (Traumawatch®) bei Patienten mit Beckenfraktur und einer im Multislice-Computertomographie (MSCT) nachgewiesenen arteriellen Blutung wurden auf folgende Parameter hin untersucht: demographische Daten, Unfallmechanismus, Frakturklassifikation nach Tile/AO und Verletzungsschwere Becken nach „Abbreviated Injury Score“ (AIS), Begleitverletzungen mit Erhebung der Gesamtverletzungsschwere nach „Injury Severety Score“ (ISS), physiologische Aufnahmeparameter (Kreislaufparameter und initialer Hb-Wert) sowie Transfusionsbedarf während der Schockraumversorgung, Zeit bis zur Embolisation, Dauer der Embolisation und identifizierte Blutungsquelle.ErgebnisseVon insgesamt 162 Schockraumpatienten mit instabiler Beckenfraktur wurde bei 21xa0Patienten eine arterielle Blutung durch Kontrastmittelextravasation im MSCT nachgewiesen. 12xa0Patienten waren männlich und 9 weiblich, das Durchschnittsalter lag bei 45 (17–80) Jahre. Als Unfallmechanismus lagen ausschließlich Hochrasanztraumen vor. Es handelte sich zu 33% um Becken-B-Verletzungen und 67% um Typ-C-Verletzungen mit einem durchschnittlichen AISBecken von 4,4xa0Punkte (3-5) und einer Gesamtverletzungsschwere anhand des ISS von 37xa0Punkte (21–66). Bei Aufnahme lag bei 47,6% eine Kreislaufinstabilität vor mit einem durchschnittlichen Hb-Wert von 7,8 (3,2–12,4) g/dl und einem durchschnittlichen Transfusionsbedarf von 6 (4–13) Erythrozytenkonzentraten während der Stabilisierungsphase. Die Zeit von Eintreffen im Schockraum bis zur Durchführung der TAE betrug im Mittel 62 (25–115) min mit einer Durchführungsdauer der TAE von 25 (15–67) min. Als Blutungsquelle wurden ausschließlich Äste der A.xa0iliaca interna identifiziert. Die primäre Erfolgsrate der TAE betrug >90%.SchlussfolgerungDie interventionelle Notfallembolisation (TAE) stellt sowohl ein effektives als auch schnelles Verfahren zur Blutstillung bei einer im MSCT nachgewiesenen arteriellen Blutung bei Schockraumpatienten mit stabilen oder stabilisierbaren Kreislaufverhältnissen und Beckenfrakturen dar. Bei gesicherter 24-h-Bereitschaft durch die Radiologie und effizienter Infrastruktur kann diese zeitnah nach Klinikaufnahme durchgeführt werden und sollte somit in das frühklinische Behandlungsprotokoll integriert werden.AbstractObjectivePresentation of our own experiences and results of an early clinical algorithm for treatment integrating emergency embolization (TAE) in cases of unstable pelvic ring fractures with arterial bleeding.MethodConsecutive patient series from April 2002 to December 2006 at a level 1 trauma center. The data of the online shock room documentation (Traumawatch®) of patients with a pelvic fracture and arterial bleeding detected on multislice computed tomography (MSCT) were examined for the following parameters: demographic data, injury mechanism, fracture classification according to Tile/AO and severity of the pelvic injury assessed with the Abbreviated Injury Score (AIS), accompanying injuries with elevation of the cumulative injury severity according to the Injury Severity Score (ISS), physiological admission parameters (circulatory parameters and initial Hb value) as well as transfusion requirement during treatment in the shock room, time until embolization, duration of embolization, and source of bleeding.ResultsOf a total of 162 patients, arterial bleeding was detected in 21 patients by contrast medium extravasation on MSCT, 12 of whom were men and 9 women with an average age of 45xa0(14–80) years. The mechanism of injury was high energy trauma in all cases. In 33% it involved type B pelvic fractures and in 67% type C fractures with an average AIS pelvis of 4.4 points (3–5) and a total severity of injury with the ISS of 37 points (21–66). Upon admission 47.6% presented hemodynamic instability with an average Hb value of 7.8 g/dl (3.2–12.4) and an average transfusion requirement of 6 red blood cell units (4–13). The time until the TAE was started was on average 62xa0min (25–115) with a duration period of the TAE of 25xa0min (15–67). Branches of the internal iliac artery were identified as the sole source of bleeding. The success rate of TAE amounted to over 90%.ConclusionInterventional TAE represents an effective as well as a fast procedure for hemostasis of arterial bleeding detected on MSCT in patients with pelvic fractures. If an experienced radiologist on 24-h stand-by is assured and the infrastructure is efficient, this can be performed shortly after hospital admission and therefore should be integrated into the early clinical treatment protocol.

Training praktischer Fertigkeiten in der Chirurgie – Ein Ausbildungskonzept für Studierende

BACKGROUNDnDuring undergraduate medical education, the trainee should not only gain theoretical knowledge but also acquire essential skills. Several studies have demonstrated that practical training can be improved. However, only single training concepts for solitary skills have been developed and evaluated. This work presents a training programme for basic surgical skills.nnnMATERIALS AND METHODSnA one-week training of practical skills has been integrated into the obligatory four-week surgical course. Students pass through twelve training units of surgical skills training using the skills lab, simulation and role playing.nnnRESULTSnEvaluations of our training programme were excellent (average grade 1.3). After skill training, students felt more comfortable and secure when actually performing skills on the ward.nnnCONCLUSIONSnA standardised training can help in the provision of basic surgical skills to all undergraduate medical students.

[Changes in geriatric traumatology. An analysis of 14,869 patients from the German Trauma Registry].

ZusammenfassungDas steigende Durchschnittsalter der Bevölkerung in den Industrienationen führt zu einer steigenden Anzahl verunfallter Patienten im höheren Lebensalter, die eine Analyse der altersspezifischen Besonderheiten erfordert. In der vorliegenden Studie erfolgte eine Analyse an 14.869xa0Patienten über 18xa0Jahre, die 1996–2005 prospektiv im Traumaregister der Deutschen Gesellschaft für Unfallchirurgie erfasst wurden. Patienten im Alter zwischen 18 und 59xa0Jahren wurden als Vergleichskollektiv betrachtet; ihr Anteil sank im Jahresvergleich 1996-2000 mit 2001–2005 von 81,1% auf 75,4%. In diesem Kollektiv erwachsener Traumapatienten stieg das Altersmittel von 41,0xa0Jahren in 1996 auf 45,3xa0Jahre in 2005. Mit steigendem Alter zeigte sich eine deutliche Zunahme des Anteils an Patienten mit relevanten Kopfverletzungen bis auf 58,9% beim >80-Jährigen. Patienten im hohen Lebensalter verweilten signifikant kürzer im Krankenhaus und auf der Intensivstation. Bei vergleichbarem „Injury Severity Score“ (ISS) stieg die Letalität nach Trauma mit dem Alter (18–59xa0Jahre 13,8%; 60–69xa0Jahre 24,1%; 70–79xa0Jahre 35,5%; ≥80xa0Jahre 43,6%). Der schwer verletzte Patient im höheren Lebensalter unterscheidet sich hinsichtlich Verletzungsart, Therapie und Outcome signifikant vom erwachsenen Normalkollektiv und sollte unter Berücksichtigung dieser Besonderheiten behandelt werden.AbstractThe increasing average age in the industrialized nations is leading to an increasing number of elderly traumatized patients. Against this background, an analysis of the age-specific characteristics of geriatric traumatized patients is necessary. In this study, 14,869 patients ≥ 18xa0years were analysed, who were prospectively documented in the registry of the German Trauma Society (DGU) between 1996 and 2005. Patients between 18 and 59xa0years were defined as the control group; their proportion declined from 81.1% in 1996–2000 to 75.4% in 2001–2005. The average age rose from 41.0xa0years (1996) to 45.3xa0years (2005). With increasing age a significant increase in severe head injuries of up to 58.9% (≥ 80xa0years) could be observed. Older patients stayed for a significantly shorter time in hospital and on the ICU. With a comparable injury severity, the lethality after trauma increased with age (18–59xa0years 13.8%, 60–69xa0years 24.1%, 70–79xa0years 35.5%, ≥80xa0years 43.6%). The multiply traumatized geriatric patient is different from the normal group in regard to type of injury, therapy and outcome and should therefore be treated taking this fact into consideration.The increasing average age in the industrialized nations is leading to an increasing number of elderly traumatized patients. Against this background, an analysis of the age-specific characteristics of geriatric traumatized patients is necessary. In this study, 14,869 patients > or = 18 years were analysed, who were prospectively documented in the registry of the German Trauma Society (DGU) between 1996 and 2005. Patients between 18 and 59 years were defined as the control group; their proportion declined from 81.1% in 1996-2000 to 75.4% in 2001-2005. The average age rose from 41.0 years (1996) to 45.3 years (2005). With increasing age a significant increase in severe head injuries of up to 58.9% (> or = 80 years) could be observed. Older patients stayed for a significantly shorter time in hospital and on the ICU. With a comparable injury severity, the lethality after trauma increased with age (18-59 years 13.8%, 60-69 years 24.1%, 70-79 years 35.5%, > or = 80 years 43.6%). The multiply traumatized geriatric patient is different from the normal group in regard to type of injury, therapy and outcome and should therefore be treated taking this fact into consideration.

Therapeutic relevance of magnetic resonance imaging in joint injuries in children

ZusammenfassungFragestellungDiese retrospektive Studie untersucht, ob die MRT eine therapeutisch relevante Zusatzinformation in der Diagnostik von Gelenkverletzungen bei Kindern liefert und ob es lokalisationsspezifische Unterschiede gibt.MethodikEs wurden 45 posttraumatische Röntgenbilder und MRT-Aufnahmen von jeweils 2xa0Radiologen und 2xa0Unfallchirurgen anonym, voneinander unabhängig und standardisiert ausgewertet sowie bezüglich der therapeutischen Relevanz beurteilt.ErgebnisseAm Kniegelenk (n=18) erhielten wir in 11xa0Fällen (61%) eine Zusatzinformation durch die MRT mit einer Empfehlung zur Arthroskopie in 7xa0Fällen (39%). Am Sprunggelenk (n=21) ergaben sich in 12xa0Fällen (57%) zusätzliche Informationen durch die MRT, dabei änderte sich die Therapieempfehlung in 6xa0Fällen (29%), wobei keine zusätzliche Operationsindikation daraus abgeleitet wurde. Am Ellbogengelenk (n=6) beobachteten wir in 4xa0Fällen (67%) eine Diagnoseänderung, die jedoch ohne therapeutische Relevanz war.SchlussfolgerungDie MRT liefert als Zusatzuntersuchung zum konventionellen Röntgen am Kniegelenk relevante Informationen im Hinblick auf die Therapie, wohingegen sie am Sprung- und Ellbogengelenk nur eine untergeordnete Rolle spielt.AbstractAim In this retrospective study, we assessed whether the use of MRI in children provides additional, therapeutically relevant information to assist in the diagnosis of joint injuries. In addition, we determined whether the usefulness of this approach is dependant on age of the child and localisation of the trauma.Method MRI of 45 children aged between 3 and 16xa0years were analysed independently by four different investigators (two radiologists, two trauma surgeons) and assessed for their therapeutic relevance.Result MRI of the knee (n=18) gave additional information in 11 patients (61%) and led to a change in the recommended therapy involving arthroscopy in seven patients (39%). MRI of the ankle (n=21) provided additional information in 12 patients (57%) and the decision for further therapy was influenced in six patients (29%), however, the indication for surgery was not influenced. The diagnosis of injuries of the elbow (n=6) was changed in four patients (67%), but the therapeutic decision was not influenced.Conclusion MRI additional to conventional x-ray provides relevant information on the therapeutic procedure to be used for the knee, whereas for the ankle and the elbow MRI it rarely delivers additional information relevant to therapeutic decision making.

Concomitant injuries of distal radius fractures

BACKGROUNDnFollowing treatment of distal radius fractures poor functional results can still be found despite satisfactory radiological findings. This may be due to concomitant carpal lesions occurring together with these fractures. The aim of this prospective study was to analyze the clinical outcome depending on the type of fracture and concomitant carpal lesions.nnnPATIENTS AND METHODSnA total of 66 patients with distal radius fractures treated over a 1-year period could be assessed. The functional results were compared with the uninjured contralateral side. The follow-up examination included patient history, physical and radiographic examination as well as the DASH (Disability of the arm, shoulder and hand) questionnaire and the modified Mayo wrist score.nnnRESULTSnThe average follow-up time was 12.7 months and the mean age of the examined patients was 53 years. The fracture classification according to AO (AO Working party for osteosynthesis questions) showed 32% type A, 10% type B and 58% type C fractures. In 55% a concomitant carpal lesion was found and 44% of the patients required surgical treatment. All fractures united without complications. In all cases X-rays showed no loss of reduction postoperatively. Overall grip strength and wrist motion was reduced to 81% compared to the uninjured side. Patients regained good function represented in a mean DASH score of 24.8 points and a Mayo score of 70.6 points. The number of complete intraarticular fractures (type C) was significantly higher in patients who needed surgical treatment for carpal lesions compared to the groups where concomitant carpal lesions did not require invasive treatment or those where no carpal lesions were found. However, due to the operative treatment a comparable functional result could be obtained in all groups independent of the injury severity.nnnCONCLUSIONSnThe results demonstrate, if a correct restoration and surgical stabilization technique is used, clinical outcome following fractures of the distal radius also depends on an optimized management of concomitant carpal lesions.ZusammenfassungHintergrundTrotz der guten Resultate bzgl. anatomischer Rekonstruktion und radiologischer Ergebnisse nach distaler Radiusfraktur finden sich immer wieder schlechte funktionelle Ergebnisse. Die Ursache hierfür können karpale Begleitverletzungen sein. Ziel dieser prospektiven Studie war es, das klinische Ergebnis nach Osteosynthese in Abhängigkeit vom Frakturtyp und den Begleitverletzungen zu analysieren.Patienten und MethodenNachuntersucht und ausgewertet werden konnten 66xa0Patienten mit distaler Radiusfraktur, die innerhalb eines Jahres behandelt wurden. Bei der Nachuntersuchung wurden die komplette Anamnese erhoben, eine körperliche und radiologische Nachuntersuchung durchgeführt sowie der DASH-Fragebogen (DASH Disability of the Arm, Shoulder and Hand) erhoben und der modifizierte Mayo-Wrist-Score bestimmt.ErgebnisseDie durchschnittliche Nachbeobachtungszeit betrug 12,7xa0Monate und das mittlere Alter der Patienten 53,3xa0Jahre. Der Anteil der Frakturtypen nach der AO-Klassifikation (AO Arbeitsgemeinschaft für Osteosynthesefragen) war zu 32% Typ-A-, 10% Typ-B- und 58% Typ-C-Frakturen. Bei 55% der Patienten wurde eine Begleitverletzung gefunden und bei 44% operativ behandelt. Alle Frakturen heilten knöchern aus und es fand sich im Vergleich zum intraoperativen Befund kein Repositionsverlust im Verlauf. Auf der betroffenen Seite waren die Kraft und die Beweglichkeit auf jeweils 81% reduziert. Die Patienten erreichten ein gutes funktionelles Ergebnis mit einem DASH-Score von 24,8 Punkten und einem Mayo-Score von 70,6xa0Punkten.Komplett intraartikuläre Frakturen waren bei operationspflichtigen karpalen Begleitverletzungen signifikant häufiger als in der Gruppe der Patienten mit nicht operationspflichtigen als auch in der Gruppe der Patienten ohne karpale Begleitverletzungen. Durch die operative Therapie der karpalen Begleitverletzungen konnte ein vergleichbares funktionelles Endergebnis in allen Gruppen ungeachtet der unterschiedlichen Verletzungsschwere erzielt werden.SchlussfolgerungUnsere Ergebnisse zeigten, dass bei korrekter Wiederherstellung und Stabilisierung der Fraktur das Ergebnis von einem optimierten Management der Begleitverletzungen abhängig ist.AbstractBackgroundFollowing treatment of distal radius fractures poor functional results can still be found despite satisfactory radiological findings. This may be due to concomitant carpal lesions occurring together with these fractures. The aim of this prospective study was to analyze the clinical outcome depending on the type of fracture and concomitant carpal lesions.Patients and methodsA total of 66 patients with distal radius fractures treated over a 1-year period could be assessed. The functional results were compared with the uninjured contralateral side. The follow-up examination included patient history, physical and radiographic examination as well as the DASH (Disability of the arm, shoulder and hand) questionnaire and the modified Mayo wrist score.ResultsThe average follow-up time was 12.7 months and the mean age of the examined patients was 53 years. The fracture classification according to AO (AO Working party for osteosynthesis questions) showed 32% type A, 10% type B and 58% type C fractures. In 55% a concomitant carpal lesion was found and 44% of the patients required surgical treatment. All fractures united without complications. In all cases X-rays showed no loss of reduction postoperatively. Overall grip strength and wrist motion was reduced to 81% compared to the uninjured side. Patients regained good function represented in a mean DASH score of 24.8 points and a Mayo score of 70.6 points.The number of complete intraarticular fractures (type C) was significantly higher in patients who needed surgical treatment for carpal lesions compared to the groups where concomitant carpal lesions did not require invasive treatment or those where no carpal lesions were found. However, due to the operative treatment a comparable functional result could be obtained in all groups independent of the injury severity.ConclusionsThe results demonstrate, if a correct restoration and surgical stabilization technique is used, clinical outcome following fractures of the distal radius also depends on an optimized management of concomitant carpal lesions.

Kinetic therapy in multiple trauma patients with severe thoracic trauma: a treatment option to reduce ventilator time and improve outcome

PurposeContinuous lateral rotational therapy (CLRT) has been described as a promising approach for prophylaxis and treatment of respiratory complications in critically ill patients over two decades ago. However, meta-analyses failed to demonstrate any significant benefit on outcome by CLRT, possibly due to the heterogeneity and low overall quality of available studies.MethodsObservational trial over a 3-year period on outcome in trauma patients (Injury Severity Score, ISS ≥16) with severe thoracic injury (Abbreviated Injury Scale, AISThorax ≥3) initially treated with CLRT as standard of care. Epidemiological data, injury severity, and pattern and physiological parameters were recorded. Outcome indicators were time on mechanical ventilation, length of stay, rates of pneumonia, sepsis and acute respiratory distress syndrome, hospital mortality, and rates of re-intubation. Additionally, data are compared with the results from the TraumaRegister® of the German Trauma Society.ResultsOver the 3-year period 76 patients with ISS ≥16/AISThorax ≥3 received CLRT, equaling 24xa0% of all patients with ISS ≥16 between 18 and 80xa0years. Mean ISS was 35.3 (standard deviations, SD 12.2) [71.1xa0% male, 97.4xa0% blunt trauma, mean age 43.9xa0years (SD 18.7)]. Mean time on CLRT was 3.3xa0days (SD 2.2), time on mechanical ventilation 7.8xa0days (SD 7.1), and 9.2xa0% had to be re-intubated due to respiratory complications. CLRT-related complications occurred in 8.9xa0%. Overall 25xa0% of the patients developed pneumonia (VAPxa0=xa013.2xa0%). Despite a significantly higher ISS we observed shorter times on mechanical ventilation and intensive care unit in our collective in comparison to data published from the nationwide TraumaRegister®.ConclusionsCLRT remains a therapeutic option to reduce pulmonary complications after severe chest trauma in our center. However, a RCT is needed to study the effects of other treatment options such as early extubation and non-invasive ventilation or prone/supine positioning.

Bedeutung der korrekten Positionierung eines Beckengurts zur temporären Stabilisierung von Beckenringverletzungen

A 36-year-old motorcyclist sustained multiple severe injuries in a motorcycle accident. The leading injury was a type B open-book pelvic fracture, resulting in a relevant haemodynamic instability. Due to an initial misplacement of the pelvic binder (Samsling®) by the paramedics in the field, a sufficient compression of the fracture and stabilisation of the haemodynamic situation could not be obtained. After repositioning of the pelvic binder in the emergency room, the pelvis was adequately stabilised, leading to a transient stabilisation of the haemorrhagic shock. This example illustrates the benefit of a simple and effective tool for the initial stabilisation of pelvic fractures in haemodynamically compromised patients and in particular the importance of the correct placement of the pelvic binder.

Autologous cell-based therapy for treatment of large bone defects: from bench to bedside

ObjectivesReconstruction of long segmental bone defects is demanding for patients and surgeons, and associated with long-term treatment periods and substantial complication rates in addition to high costs. While defects up to 4–5 cm length might be filled up with autologous bone graft, heterologous bone from cadavers, or artificial bone graft substitutes, current options to reconstruct bone defects greater than 5 cm consist of either vascularized free bone transfers, the Masquelet technique or the Ilizarov distraction osteogenesis. Alternatively, autologous cell transplantation is an encouraging treatment option for large bone defects as it eliminates problems such as limited autologous bone availability, allogenic bone immunogenicity, and donor-site morbidity, and might be used for stabilizing loose alloplastic implants.MethodsThe authors show different cell therapies without expansion in culture, with ex vivo expansion and cell therapy in local bone defects, bone healing and osteonecrosis. Different kinds of cells and scaffolds investigated in our group as well as in vivo transfer studies and BMC used in clinical phase I and IIa clinical trials of our group are shown.ResultsOur research history demonstrated the great potential of various stem cell species to support bone defect healing. It was clearly shown that the combination of different cell types is superior to approaches using single cell types. We further demonstrate that it is feasible to translate preclinically developed protocols from in vitro to in vivo experiments and follow positive convincing results into a clinical setting to use autologous stem cells to support bone healing.

Characterization and economic impact of medical patients presenting at the emergency department of an university hospital

BACKGROUNDnThe number of patients in German emergency departments has been rising for years. This means additional need of staff and infrastructure for hospitals.nnnMETHODSnIn this monocentric retrospective analysis the patient population of the central emergency department (ZNA) at the university hospital Frankfurt was investigated. Major symptoms, diagnoses with respect to diagnose-related groups and modes of admission to the emergency department have been analyzed.nnnRESULTSnDuring 3 months, a total of 7376 patients presented to the ZNA. Analysis focused on 2186 patients referred to the department of internal medicine: most patients presented spontaneously (50.6%), 38.2% were admitted by ambulance services, only 9.7% were admitted by a primary physician. 44.9% of these patients were hospitalized, mainly with cardiological, pneumological and gastroenterological disorders. The predominant major symptoms were acute chest pain (15.4%), abdominal pain (7.1%) and syncope or collapse (6.1%). Patients hospitalized via ZNA contributed 31.9% of the total revenues of internal medicine departments. 31.7% of all hospitalized patients were admitted to the hospital by the ZNA.nnnCONCLUSIONnEmergency departments become more and more a regular part of ambulatory patients health care and contribute efficiently to the economic revenue of hospitals.