J. Windolf

A randomized, double-blind trial for stress ulcer prophylaxis shows no evidence of increased pneumonia

BACKGROUND H2-receptor antagonists are commonly used for stress ulcer prophylaxis on intensive care units. However, there is evidence that via the route of an elevated gastric pH, followed by bacterial overgrowth and subsequent tracheal aspiration, pneumonia could occur. In line with this assumption total gastrectomized patients should develop a very high incidence of pneumonia, which is actually not the case. We therefore formulated the hypothesis that stress ulcer prophylaxis with H2-receptor antagonists does not lead to an increased pneumonia rate. METHODS A total of 158 patients with mechanical ventilation > or =48 hours of a surgical intensive care unit were randomized to the following groups: A, placebo (n = 57); B, pirenzepine (3 x 10 mg intravenously, n = 44); and C, ranitidine (3 x 50 mg intravenously, n = 57). RESULTS The pneumonia rate in ranitidine-, pirenzepine-, and placebo-treated patients is 10 of 57, 10 of 44, and 12 of 57, respectively. CONCLUSIONS Pneumonia rate is not adversely affected by H2-receptor antagonists in stress ulcer prophylaxis.

A prospective, randomised comparison of single- vs. multiple-dose antibiotic prophylaxis in penetrating trauma.

This study was designed to compare the clinical efficacy of a single dose of ceftriaxone with cefoxitin given 3 times a day for 3 days. Methods: Patients had to have a penetrating injury to only one part of the body, reach the hospital within 2 h and be operated on within 16 h after the trauma. Patients were excluded if it appeared likely that they would require mechanical ventilation for more than 24 h. The same applies to open or grade II/III craniocerebral trauma. The end point was the occurrence of infections within 10 days. The costs of antibiotic treatment were also calculated. Results: 96% of the ceftriaxone patients (n = 97) and 95% of the cefoxitin group (n = 98) remained infection-free. In neither treatment group was deep infection, abscess, phlegmon or sepsis seen. No additional surgery or intensive care due to infection was required. At

The Influence of Hyperbaric Oxygenation (HBO) on Proliferation and Differentiation of Human Keratinocyte Cultures In Vitro.

41.83 vs.

Dynamic cerclage wiring of patellar fractures. Complications and midterm functional results

172.16, the average total cost of delivering antibiotic treatment was significantly lower in the ceftriaxone group (p < 0.001). Conclusion: Prophylaxis in penetrating trauma with a single dose of ceftriaxone is safe and has considerable practical and economic advantages.

Einsatz eines elektronischen Datenerfassungssystems in der chirurgischen Intensivtherapie

A drop in tissue oxygen partial pressure below 30 mm Hg as a result of reduced perfusion in an extensive area of acute skin damage, or where a large number of chronic skin defects occur, inhibits collagen synthesis and neoangiogenesis in the various phases of wound healing. Subsequent granulation and epithelialisation are correspondingly impaired.Hyperbaric oxygenation is now recognised as a valuable supplementary method of treatment for problematic wounds. Stimulation of fibroblast and endothelial cell proliferation through Hyperbaric oxygenation has been demonstrated in numerous studies.The aim of this study was to investigate the effect of hyperbaric oxygen treatment on the proliferation and differentiation of human keratinocyte cultures.The influence of hyperbaric oxygenation on the proliferation of human keratinocyte cultures was demonstrated using flow-through cytometry and a fluorescence activated cell sorter, which detects fluorescence intensity following incorporation of 5-bromo-2′-deoxyuridine in cell DNA.The degree of cell differentiation was deduced from the expression of various components of the cytoskeleton, such as cytokeratin 10 and involukrin, the production of which was quantified through the determination of monoclonal antibodies against cytokeratin 10 and involukrin from measurements of fluorescence activity in a flow-through cytometer.Hyperbaric oxygenation of cell cultures in vitro did not produce a significantly higher rate of cell proliferation, so that no increase in vitality was observed.An interesting observation following exposure to hyperbaric oxygen was the marked increase in expression of both cytokeratin 10 and involukrin, as an indication of accelerated cell differentiation.

Berufsunfälle mit möglicher HIV-Kontamination

BACKGROUND Preserving the patella and its accurate anatomic reduction after fracture is extremely important to avoid retropatellar arthrosis. METHODS The data of 50 patients with patellar fractures treated by cerclage wiring was analyzed in relation to complications. In addition, 37 patients were called in for follow-up examination, and the functional results were assessed according to the Tegner and Lyshom scores. RESULTS Minor complications occurred in 50% and major complications in 30% of cases. Despite the high complication rate, 70% of the examined patients revealed excellent to good objective or subjective results, while 10% of the patients showed poor results. No correlation existed between the fracture severity and the complication rate on the one hand or the postoperative objective outcome on the other hand. CONCLUSION Operative treatment of patellar fractures is still demanding. Although most of the examined patients were quite satisfied and demonstrated excellent to good results, the high complication rate is reason to take other methods of internal fixation into consideration to further optimize results.

Klinische Relevanz der MRT bei akuten Handgelenkverletzungen

To assure quality and progression of surgical intensive-care therapy appropriate equipment is mandatory to ensure documentation and quality-control. In our hospital data processing of any information concerning the patients treated in the intensive-care unit has become part of the daily routine. This paper presents and discusses the underlying concept.ZusammenfassungQualitätssicherung und Weiterentwicklung der chirurgischen Intensivtherapie erfordern ein geeignetes Instrument zur Leistungserfassung und Dokumentation in diesem für alle chirurgischen Fachdisziplinen zunehmend zentralen Arbeitsbereich. An unserer Klinik haben wir die elektronische Datenerfassung aller patientenbezogenen Informationen auf der chirurgischen Intensivtherapiestation in die tägliche Routine eingeführt. Das zugrundeliegende Konzept wird in diesem Beitrag vorgestellt und diskutiert.AbstractTo assure quality and progression of surgical intensive-care therapy appropriate equipment is mandatory to ensure documentation and quality-control. In our hospital data processing of any information concerning the patients treated in the intensive-care unit has become part of the daily routine. This paper presents and discusses the underlying concept.

Cardiac Surgery With Extracorporeal Circulation: Neutrophil Transendothelial Migration Is Mediated by β1 Integrin (CD29) in the Presence of TNF-Alpha

From January 1st, 1984 until December 31st, 1988 586 employees of the University Clinic of Frankfurt, West-Germany, were treated after occupational accidents with potentially HIV-contaminated materials. The majority of the patients were admitted because of lacerations that occurred with used injection needles. Up to now the sero-conversion of a patient after this special kind of trauma has not been documented in West-Germany. In our clinic we found an infection in one employee, which is due to an occupationally acquired injury.Zusammenfassung586 Klinikangestellte wurden vom 1.1. 1984 bis zum 31. 12. 1988 in der Unfallchirurgischen Klinik der Johann-Wolfgang-Goethe-Universität Frankfurt wegen Berufsunfällen mit potentiell HIV-infektiösem Material durchgangsärztlich behandelt. In der Mehrzahl der Fäll handelte es sich dabei um Stichverletzungen durch gebrauchte Injektionskanülen. Bislang war in der Bundesrepublik eine Serokonversion, die auf einen solchen Unfall zurückzuführen ist, nicht dokumentiert. In unserer Klinik kam es im Beobachtungszeitraum zur Infektion eines Klinikangestellten, die auf einen Berufsunfall zurückzuführen ist.AbstractFrom January 1st, 1984 until December 31st, 1988 586 employees of the University Clinic of Frankfurt, West-Germany, were treated after occupational accidents with potentially HIV-contaminated materials. The majority of the patients were admitted because of lacerations that occurred with used injection needles. Up to now the sero-conversion of a patient after this special kind of trauma has not been documented in West-Germany. In our clinic we found an infection in one employee, which is due to an occupationally acquired injury.

[Electronic data processing in the hospital: current status, options, "branch packets", customer-specific software and users' needs].

ZusammenfassungZiel. Mit dieser prospektiven Studie sollte die Leistungsfähigkeit der Magnetresonanztomographie gegenüber der konventionellen Radiographie in der Frühdiagnostik akuter Handgelenkverletzungen geprüft werden. Die Dauer der Arbeitsunfähigkeit und deren Beeinflussung durch die MRT wurde dokumentiert. Material und Methode. Bei 54 Patienten (56 Handgelenken) mit klinischem Verdacht auf eine Fraktur des Handgelenks und negativem oder unklarem konventionell-radiologischen Befund wurde im Mittel 6,6 Tage nach der konventionellen Untersuchung eine MRT-Untersuchung mit einem standardisierten Protokoll durchgeführt. Die Auswertung der kernspintomographischen Bilder erfolgte in Unkenntnis der konventionell-radiologischen Befunde. Ergebnisse. Bei 31/56 Handgelenken ergab sich eine Diagnoseänderung.Bei nahezu der Hälfte der Fälle (n=25) handelte es sich im konventionellen Röntgen um eine falschpositive, in nur 6 Fällen um eine falschnegative Diagnose. In 28 Fällen konnte die MRT zur Diagnoseerweiterung in der Weichteildiagnostik beitragen.Bei 35/56 Fällen war eine weitere radiologische Kontrolle nicht mehr erforderlich.Bei 22/54 Patienten konnte durch die MRT Diagnostik die Dauer der Ruhigstellung verkürzt bzw. die Behandlung unmittelbar beendet werden (n=18). Bei 16/54 Patienten konnte die Dauer der Krankschreibung verkürzt, in 7/54 Fällen musste sie verlängert werden.In 31/54 Patienten hatte die MRT-bedingte Therapieänderung keinen Einfluss auf die Dauer der Arbeitsunfähigkeit. Schlussfolgerung. Unsere Ergebnisse dokumentieren eine hohe klinische Relevanz der MRT in der Frühdiagnostik akuter Handgelenkverletzungen. Bei frühzeitiger kernspintomographischer Untersuchung können wirtschaftliche Folgekosten durch eine effiziente Therapie und verkürzte Krankschreibungsdauer vermindert werden.Bei klinischem Verdacht und unklarem radiologischen Befund empfehlen wir daher die Durchführung einer MRT-Untersuchung bereits am Unfalltag.AbstractPurpose. This prospective study was aimed at evaluating the clinical impact of magnetic resonance imaging (MRI) vs conventional radiographs in the early diagnosis of acute wrist fractures.The influence of MRI on the period of being unable to work was demonstrated. Materials and methods. MRI was performed within a mean of 6.6 days after initial radiographs in 54 patients (56 wrists) with clinical suspicion of wrist fractures and normal plain or indistinct radiographs. MRI findings were read without knowledge of the initial radiographs. Results. In 31 of 56 wrists MRI findings resulted in a change of diagnosis.There was a false positive diagnosis on plain radiographs in nearly one-half (n=25) of the cases,whereas only six cases had false negative results. In 28 cases MRI allowed the detection of additional injuries of soft tissues. In 35 of 56 cases radiological follow-up was no longer necessary. In 22 of 54 patients the period of immobilization could be shortened or treatment discontinued (n=18).The period of being unable to work was shortened in 16 of 54 patients, while in 7 of 54 patients this time span had to be prolonged for therapeutic reasons. In 31 of 54 patients MRI-based therapeutic consequences had no influence on the period of being unable to work. Conclusion. Our results show a high clinical impact of MRI in the detection of acute wrist fractures.Early MRI is able to reduce economic costs due to efficient therapeutic treatment and shortened periods of being unable to work.We recommend MRI immediately on the day of trauma in the presence of clinical suspicion and equivocal plain radiographs

Gelenkflächenersatz des lateralen Tibiakopfplateaus mittels Patellatransplantation

Cardiac surgery with extracorporeal circulation is associated with neutrophil activation, inflammation, and edema. Endothelial hyperpermeability elicited by the interaction of activated neutrophils and/or cytokines with endothelial cells may be critical in this regard. However, the immune and cellular mechanisms involved are not fully understood. Cocultures with human endothelial cells and neutrophils from cardiac surgery patients were used to evaluate the role of β1 integrin activity and the proinflammatory cytokine tumor necrosis factor (TNF)-α in neutrophil transendothelial migration and in impairment of the integrity of endothelial cell-to-cell contacts. Blocking of CD29 (heavy chain of β1 integrins) totally prevented neutrophil adhesion and transendothelial migration. Pretreatment of neutrophils with either a CD29-stimulating monoclonal antibody or the addition of TNF-α (0.1–10 U/ml) to the coculture failed to induce transendothelial migration. However, coculture of endothelial cells with CD29-stimulated neutrophils in the presence of 0.1–10 U/ml TNF-α strongly induced neutrophil transmigration. CD29/TNF-α-mediated transmigration was associated with intracellular redistribution of endothelial β-catenin. We further showed that CD29/TNF-α-mediated effects involved PI3K and tyrosine kinase-dependent signaling via MAPK but were independent of nuclear transcription factor (NF)-κB activity. Inhibition of CD29/TNF-α might be a therapeutic option to limit endothelial dysfunction following cardiac surgery with extracorporeal circulation.