A rat model of concurrent combined injuries (polytrauma)

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Akscyn, Robert M; Franklin, J Lee; Gavrikova, Tatyana A; Schwacha, Martin G; Messina, Joseph L

2015-01-01

Polytrauma, a combination of injuries to more than one body part or organ system, is common in modern warfare and in automobile and industrial accidents. The combination of injuries can include burn injury, fracture, hemorrhage, trauma to the extremities, and trauma to specific organ systems. To investigate the effects of combined injuries, we have developed a new and highly reproducible model of polytrauma. This model combines burn injury with soft tissue and gastrointestinal (GI) tract trauma. Male Sprague Dawley rats were subjected to a 15-20% total body surface area scald burn, or a single puncture of the cecum with a G30 needle, or the combination of both injuries (polytrauma). Unlike many ‘double hit’ models, the injuries in our model were performed simultaneously. We asked whether multiple minor injuries, when combined, would result in a distinct phenotype, different from single minor injuries or a more severe single injury. There were differences between the single injuries and polytrauma in the maintenance of blood glucose, body temperature, body weight, hepatic mRNA and circulating levels of TNF-α, IL-1β and IL-6, and hepatic ER-stress. It has been suggested that models utilizing combinatorial injuries may be needed to more accurately model the human condition. We believe our model is ideal for studying the complex sequelae of polytrauma, which differs from single injuries. Insights gained from this model may suggest better treatment options to improve patient outcomes. PMID:26884923

Nitric oxide as an indicator for severity of injury in polytrauma.

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Beitl, E; Banasova, A; Vlcek, M; Mikova, D; Hampl, V

2016-01-01

Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide the prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated in tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide could serve as an indicator for severity of injury in polytrauma. We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers. On admission, serum NOx was higher in patients with moderate polytrauma than both in controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In the groups, where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on admission were elevated in proportion to the severity of subsequent clinical course. Elevated serum NOx and blood lactate in patients with polytrauma are markers of serious clinical course, while normal NOx combined with a very high lactate may signal a fatal prognosis (Fig. 4, Ref. 8).

Induced Hypothermia Does Not Harm Hemodynamics after Polytrauma: A Porcine Model

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Matthias Weuster

2015-01-01

Full Text Available Background. The deterioration of hemodynamics instantly endangers the patients’ life after polytrauma. As accidental hypothermia frequently occurs in polytrauma, therapeutic hypothermia still displays an ambivalent role as the impact on the cardiopulmonary function is not yet fully understood. Methods. We have previously established a porcine polytrauma model including blunt chest trauma, penetrating abdominal trauma, and hemorrhagic shock. Therapeutic hypothermia (34°C was induced for 3 hours. We documented cardiovascular parameters and basic respiratory parameters. Pigs were euthanized after 15.5 hours. Results. Our polytrauma porcine model displayed sufficient trauma impact. Resuscitation showed adequate restoration of hemodynamics. Induced hypothermia had neither harmful nor major positive effects on the animals’ hemodynamics. Though heart rate significantly decreased and mixed venous oxygen saturation significantly increased during therapeutic hypothermia. Mean arterial blood pressure, central venous pressure, pulmonary arterial pressure, and wedge pressure showed no significant differences comparing normothermic trauma and hypothermic trauma pigs during hypothermia. Conclusions. Induced hypothermia after polytrauma is feasible. No major harmful effects on hemodynamics were observed. Therapeutic hypothermia revealed hints for tissue protective impact. But the chosen length for therapeutic hypothermia was too short. Nevertheless, therapeutic hypothermia might be a useful tool for intensive care after polytrauma. Future studies should extend therapeutic hypothermia.

Induced Hypothermia Does Not Harm Hemodynamics after Polytrauma: A Porcine Model

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Mommsen, Philipp; Pfeifer, Roman; Mohr, Juliane; Ruchholtz, Steffen; Flohé, Sascha; Fröhlich, Matthias; Keibl, Claudia; Seekamp, Andreas; Witte, Ingo

2015-01-01

Background. The deterioration of hemodynamics instantly endangers the patients' life after polytrauma. As accidental hypothermia frequently occurs in polytrauma, therapeutic hypothermia still displays an ambivalent role as the impact on the cardiopulmonary function is not yet fully understood. Methods. We have previously established a porcine polytrauma model including blunt chest trauma, penetrating abdominal trauma, and hemorrhagic shock. Therapeutic hypothermia (34°C) was induced for 3 hours. We documented cardiovascular parameters and basic respiratory parameters. Pigs were euthanized after 15.5 hours. Results. Our polytrauma porcine model displayed sufficient trauma impact. Resuscitation showed adequate restoration of hemodynamics. Induced hypothermia had neither harmful nor major positive effects on the animals' hemodynamics. Though heart rate significantly decreased and mixed venous oxygen saturation significantly increased during therapeutic hypothermia. Mean arterial blood pressure, central venous pressure, pulmonary arterial pressure, and wedge pressure showed no significant differences comparing normothermic trauma and hypothermic trauma pigs during hypothermia. Conclusions. Induced hypothermia after polytrauma is feasible. No major harmful effects on hemodynamics were observed. Therapeutic hypothermia revealed hints for tissue protective impact. But the chosen length for therapeutic hypothermia was too short. Nevertheless, therapeutic hypothermia might be a useful tool for intensive care after polytrauma. Future studies should extend therapeutic hypothermia. PMID:26170533

Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach.

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Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

2017-09-11

Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ -6.0], coagulopathy [partial thromboplastin time ≥ 40 s or international normalized ratio ≥ 1.4], and age [≥70 years]). Methods: We retrieved detailed data on 369 polytrauma patients and 1260 non-polytrauma patients with an overall Injury Severity Score (ISS) ≥ 18 who were hospitalized between 1 January 2009 and 31 December 2015 for the treatment of all traumatic injuries, from the Trauma Registry System at a level I trauma center. Patients with burn injury or incomplete registered data were excluded. Categorical data were compared with two-sided Fisher exact or Pearson chi-square tests. The unpaired Student t -test and the Mann-Whitney U -test was used to analyze normally distributed continuous data and non-normally distributed data, respectively. Propensity-score matched cohort in a 1:1 ratio was allocated using the NCSS software with logistic regression to evaluate the effect of polytrauma on patient outcomes. Results: The polytrauma patients had a significantly higher ISS than non-polytrauma patients (median (interquartile range Q1-Q3), 29 (22-36) vs. 24 (20-25), respectively; p Polytrauma patients had a 1.9-fold higher odds of mortality than non-polytrauma patients (95% CI 1.38-2.49; p polytrauma patients, polytrauma patients had a substantially longer hospital length of stay (LOS). In addition, a higher proportion of polytrauma patients were admitted to the intensive

Avoiding Errors in the Management of Pediatric Polytrauma Patients.

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Chin, Kenneth; Abzug, Joshua; Bae, Donald S; Horn, Bernard D; Herman, Martin; Eberson, Craig P

2016-01-01

Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment. Diagnoses may be missed most frequently because of a surgeon's inability to reliably assess patients who have traumatic brain injuries and painful distracting injuries. Cervical spine injuries are particularly difficult to identify in a child with polytrauma and may have devastating consequences. In children who have multiple injuries, the stabilization of long bone fractures with pediatric fixation techniques, such as elastic nails and other implants, allows for easier care and more rapid mobilization compared with cast treatments. Adolescent polytrauma patients who are approaching skeletal maturity, however, are ideally treated as adults to avoid complications, such as loss of fixation, and to speed rehabilitation.

Tertiary survey in polytrauma patients should be an ongoing process

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Ferree, Steven; Houwert, Roderick M.; van Laarhoven, Jacqueline J E M; Smeeing, Diederik; Leenen, Luke P H; Hietbrink, Falco

INTRODUCTION: Due to prioritisation in the initial trauma care, non-life threatening injuries can be overlooked or temporally neglected. Polytrauma patients in particular might be at risk for delayed diagnosed injuries (DDI). Studies that solely focus on DDI in polytrauma patients are not available.

Injury mechanisms, patterns and outcomes of older polytrauma patients—An analysis of the Dutch Trauma Registry

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Reininga, Inge H. F.; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus

2018-01-01

Background Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Methods Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18–59) and older (Group B: ages ≥60) polytrauma patients were compared. Differences in injury severity, trauma mechanism (only data for the year 2014), vital signs, injury patterns, ICU characteristics and hospital mortality were analyzed. Results Data of 25,304 polytrauma patients were analyzed. The older patients represented 47.8% of the polytrauma population. Trauma mechanism in the older patients was more likely to be a bicycle accident (A: 17%; B: 21%) or a low-energy fall (A: 13%; B: 43%). Younger polytrauma patients were more likely to have the worst scores on the Glasgow coma scale (EMV = 3, A: 20%, B: 13%). However, serious head injuries were seen more often in the older patients (A: 53%; B: 69%). The hospital mortality was doubled for the older polytrauma patients (19.8% vs. 9.6%). Conclusion Elderly are involved more often in polytrauma. Although injury severity did not differ between groups, the older polytrauma patients were at a higher risk of dying than their younger counterparts despite sustaining less high-energy accidents. PMID:29304054

Injury mechanisms, patterns and outcomes of older polytrauma patients-An analysis of the Dutch Trauma Registry.

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de Vries, Rob; Reininga, Inge H F; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus

2018-01-01

Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18-59) and older (Group B: ages ≥60) polytrauma patients were compared. Differences in injury severity, trauma mechanism (only data for the year 2014), vital signs, injury patterns, ICU characteristics and hospital mortality were analyzed. Data of 25,304 polytrauma patients were analyzed. The older patients represented 47.8% of the polytrauma population. Trauma mechanism in the older patients was more likely to be a bicycle accident (A: 17%; B: 21%) or a low-energy fall (A: 13%; B: 43%). Younger polytrauma patients were more likely to have the worst scores on the Glasgow coma scale (EMV = 3, A: 20%, B: 13%). However, serious head injuries were seen more often in the older patients (A: 53%; B: 69%). The hospital mortality was doubled for the older polytrauma patients (19.8% vs. 9.6%). Elderly are involved more often in polytrauma. Although injury severity did not differ between groups, the older polytrauma patients were at a higher risk of dying than their younger counterparts despite sustaining less high-energy accidents.

Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer.

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Ferree, Steven; van der Vliet, Quirine M J; Nawijn, Femke; Bhashyam, Abhiram R; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

2018-03-01

For several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. A total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients. Higher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

Neuronale Korrelate sozialer Interaktion beim Menschen und deren genetische Modulation unter besonderer Berücksichtigung des Spiegelneuronensystems

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Cordes, Andrea

2013-01-01

Die in vielen Lebenssituationen über Erfolg und Misserfolg, Sympathie und Antipathie entscheidende, unterschiedlich ausgeprägte Fähigkeit zur sozialen Interaktion ist Gegenstand neurowissenschaftlicher Untersuchungen. Die Versuche einer kortikalen Lokalisierung führten zur Beschreibung des Spiegelneuronensystems (SNS) in Hirnregionen, die sowohl beim Ausführen einer Aktion Aktivität zeigten als auch beim Beobachten derselben beim Gegenüber. Die stärkste Aktivierung dieser Areale wurde bei sch...

Mitochondrial and Nuclear DNA in Patients with Severe Polytrauma

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M. Sh Khubutia

2013-01-01

Full Text Available The components of mitochondria from the cells damaged by injury are a key component for the development of systemic inflammatory response syndrome (SIRS under aseptic conditions. At the same time, there is a significant increase in the plasma level of mitochondrial DNA (mtDNA, which may be a prognostic marker for infectious complications in patients with severe polytrauma. Objective: to study the time course of changes in the serum levels of mtDNA and nuclear DNA (nDNA in healthy individuals and patients with polytrauma and to reveal its possible association with the development of infectious pulmonary complications and with mortality. Subjects and methods. Seven healthy volunteers and 25 polytrauma with polytrauma of a mean injury severity score (ISS of 40.2±9.2. Sixteen (64% patients developed purulent tracheobronchitis and pneumonia; 5 (20% patients died. The amount of mtDNA and nDNA was determined within the first at 12 and 24 hours, then on days 3 and 5—7 after injury by the authors’ modified procedure using as the exogenous control of a circular DNA molecule. The content of mtDNA and nDNA was expressed as absolute values, by taking the arithmetic mean values as 100% for the volunteers. Results. There was a more than 2.5-fold increase in mtDNA levels in dead patients as compared to survivors (p<0.05; the differences in nDMA levels were insignificant (p=0.1. Within the first 12 hours, the mean mtDNA level in patients with pneumonia was 34 times greater than the reference values and continued to rise in the following 12 hours whereas in those without pneumonia, it was only 17 times higher with its further decrease in the comparable time periods. In the first 12 hours, nDNA was increased in both groups, but 24 hours after injury it was 2555 times more than the reference value only in patients with pneumonia whereas it was decreased 3-fold in those without this condition. Conclusion. This paper is the first to describe the time course of

Color coded duplex sonography. Interdisciplinary vascular ultrasonography; Farbkodierte Duplexsonographie. Interdisziplinaerer vaskulaerer Ultraschall

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Kubale, R. [Institut fuer Radiologie, Sonographie und Nuklearmedizin, Pirmasens (Germany); Stiegler, H. [Staedtisches Krankenhaus Schwabing, Muenchen (Germany). 7. Medizinische Abt.

2002-07-01

An interdisciplinary team of experts impart the state of the art in color coded duplex sonography applied for examination of all anatomic areas. Detailed information is given for every vascular area, describing the examination procedure, possible origins of mistakes or faults, and means to avoid them. In addition to the classical applications, eg. for examination of the extra- and intracranial vessels, vessels of the limbs, visceral vessels and the vessels of liver and kidney, there are chapters devoted to: haemodialysis shunts, arteriovenous malformations, duplex sonography of the penis, tumor vascularisation. (orig./CB) [German] Ein interdisziplinaeres Autorenteam vermittelt Ihnen den State of the Art der FKDS fuer alle anatomischen Regionen. Fuer jede der Gefaessregionen werden detaillierte Angaben zum Untersuchungsablauf, zu moeglichen Fehlerquellen und zu deren Vermeidung geboten. Neben den klassischen Anwendungen bei der Untersuchung - der extra- und intrakraniellen Gefaesse, - der Extremitaetengefaesse, - der viszeralen Gefaesse sowie der Gefaesse von Niere und Leber finden Sie Kapitel zu den Themen: Haemodialyseshunt, arteriovenoese Malformationen, Duplexsonographie des Penis und Tumorvaskularisation. (orig./AJ)

[Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience].

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Vodička, J; Doležal, J; Vejvodová, Š; Šafránek, J; Špidlen, V; Třeška, V

2016-01-01

PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma

Family Care Map: Sustaining family-centered care in Polytrauma Rehabilitation Centers

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Ford, James H.; Wise, Meg; Krahn, Dean; Oliver, Karen Anderson; Hall, Carmen; Sayer, Nina

2015-01-01

The study assessed sustainability of the Family Care Map, a family-centered approach to providing care for Veterans with polytrauma-related injuries, in four Department of Veterans Affairs Polytrauma Rehabilitation Centers. We applied a mixed-methods approach. Staff surveys used standardized measures of sustainability, commitment to change, information, and participation during implementation. Qualitative inquiry assessed Family Care Map implementation and facilitators and barriers to sustainability. Staff sustainability perceptions had a significant positive correlation with affective commitment to change, participation, and information received about the change process. Family Care Map integration into standard practices and use of its concepts with patients and families related to staff perceptions about sustainability. The degree of use and integration of the Family Care Map in traumatic brain injury/polytrauma care varied among the Polytrauma Rehabilitation Centers. Some successful sustainability strategies included integration into daily workflow and organizational culture. Examples of sustainability barriers included staff awareness and use and outdated information. Some practices, such as measuring and documenting the use of the Family Care Map in treatment plans, may not routinely occur. The focus on family-centered care will require further evaluation of organization-, staff-, and innovation-level attributes that influence sustainability of changes designed to improve family-centered care. PMID:25671632

Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

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Halbgebauer, Rebecca; Eisele, Philipp; Messerer, David A. C.; Weckbach, Sebastian; Schultze, Anke; Braumüller, Sonja; Gebhard, Florian

2017-01-01

Evidence is emerging that systemic inflammation after trauma drives structural and functional impairment of cardiomyocytes and leads to cardiac dysfunction, thus worsening the outcome of polytrauma patients. This study investigates the structural and molecular changes in heart tissue 4 h after multiple injuries with additional hemorrhagic shock using a clinically relevant rodent model of polytrauma. We determined mediators of systemic inflammation (keratinocyte chemoattractant, macrophage chemotactic protein 1), activated complement component C3a and cardiac troponin I in plasma and assessed histological specimen of the mouse heart via standard histomorphology and immunohistochemistry for cellular and subcellular damage and ongoing apoptosis. Further we investigated spatial and quantitative changes of connexin 43 by immunohistochemistry and western blotting. Our results show significantly increased plasma levels of both keratinocyte chemoattractant and cardiac troponin I 4 h after polytrauma and 2 h after induction of hypovolemia. Although we could not detect any morphological changes, immunohistochemical evaluation showed increased level of tissue high-mobility group box 1, which is both a damage-associated molecule and actively released as a danger response signal. Additionally, there was marked lateralization of the cardiac gap-junction protein connexin 43 following combined polytrauma and hemorrhagic shock. These results demonstrate a molecular manifestation of remote injury of cardiac muscle cells in the early phase after polytrauma and hemorrhagic shock with marked disruption of the cardiac gap junction. This disruption of an important component of the electrical conduction system of the heart may lead to arrhythmia and consequently to cardiac dysfunction. PMID:29084268

Evaluation of standardized and applied variables in predicting treatment outcomes of polytrauma patients.

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Aksamija, Goran; Mulabdic, Adi; Rasic, Ismar; Muhovic, Samir; Gavric, Igor

2011-01-01

Polytrauma is defined as an injury where they are affected by at least two different organ systems or body, with at least one life-threatening injuries. Given the multilevel model care of polytrauma patients within KCUS are inevitable weaknesses in the management of this category of patients. To determine the dynamics of existing procedures in treatment of polytrauma patients on admission to KCUS, and based on statistical analysis of variables applied to determine and define the factors that influence the final outcome of treatment, and determine their mutual relationship, which may result in eliminating the flaws in the approach to the problem. The study was based on 263 polytrauma patients. Parametric and non-parametric statistical methods were used. Basic statistics were calculated, based on the calculated parameters for the final achievement of research objectives, multicoleration analysis, image analysis, discriminant analysis and multifactorial analysis were used. From the universe of variables for this study we selected sample of n = 25 variables, of which the first two modular, others belong to the common measurement space (n = 23) and in this paper defined as a system variable methods, procedures and assessments of polytrauma patients. After the multicoleration analysis, since the image analysis gave a reliable measurement results, we started the analysis of eigenvalues, that is defining the factors upon which they obtain information about the system solve the problem of the existing model and its correlation with treatment outcome. The study singled out the essential factors that determine the current organizational model of care, which may affect the treatment and better outcome of polytrauma patients. This analysis has shown the maximum correlative relationships between these practices and contributed to development guidelines that are defined by isolated factors.

Characteristics of polytrauma patients with posttraumatic stress disorder in a level 1 trauma center

NARCIS (Netherlands)

B.E. Kreis; N.J.Y. Castano; W.E. Tuinebreijer (Wim); L.C.A. Hoogenboom; S.A.G. Meylaerts (Sven); S. Rhemrev (Steven)

2011-01-01

textabstractAims: The aims of this study were to determine if the severity of injury is related to the prevalence of posttraumatic stress disorder (PTSD) in polytrauma patients and to review the personality traits of patients with PTSD. Methods: During 2006 and 2007, 252 polytrauma patients were

Oxidative Distress in Patients with Polytrauma

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M. Sh. Khubutia

2014-01-01

Full Text Available Polytrauma is a serious threat to human life not only due to its direct damage to vital organs, but also to the development of significant oxidative distress that gives rise to multiple organ dysfunction. At the same time, the risk of lifethreatening infectious complications increases.Objective: to study oxidative distress over time and its association with early pulmonary infectious complications in patients with polytrauma.Subjects and methods. The authors examined 35 patients with polytrauma in the first 6—12 and 12—24 hours and 3, 5—7, and 10 days after injury and 25 healthy volunteers. Having regard to the development of pulmonary infectious complications, they formed two comparison groups of patients: 1 15 patients without pneumonia and 2 20 patients with pneumonia. The investigation used the antioxidant  index  (AOI  considering  the  activity  of  erythrocyte  enzymes  (superoxide  dismutase,  catalase,  glutathione peroxidase, and glutathione reductase and the degree of lipid peroxidation in the plasma (dienic conjugates and malonic dialdehyde to estimate the balance between oxidative lesions and the performance of the body's antioxidant systems.Results. In both groups, the AOI reflects the oxidative stress state, as substantiated by negative values for the AOI with its normal value equal to zero. However, with the virtually parallel nature of AOI changes after injury in the patients with pneumonia, the values of the index were significantly lower than in those without complications within the first 6—12 and 12—24 hours and 5—7 days (p<0.05.Conclusion. This investigation has indicated that the AOI is an early candidate biomarker for the risk of infectious complications and its values are of prognostic value just within the first hours after injury.

The value of precontrast thoraco-abdominopelvic CT in polytrauma patients

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Esposito, A.A., E-mail: rxandreaesposito@yahoo.it [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy); Zilocchi, M., E-mail: massimo.zilocchi@gmail.com [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy); Fasani, P., E-mail: fasapier65@gmail.com [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy); Giannitto, C., E-mail: caterina.giannitto@gmail.com [School of Radiology, University of Milan, Via A. di Rudinì 8, Milan (Italy); Maccagnoni, S., E-mail: maccagnnisara@libero.it [School of Radiology, University of Milan, Via A. di Rudinì 8, Milan (Italy); Maniglio, M., E-mail: marinamaniglio@gmail.com [School of Radiology, University of Milan, Via A. di Rudinì 8, Milan (Italy); Campoleoni, M., E-mail: campoleoni@policlinico.mi.it [Medical Phisic Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20121 Milan (Italy); Brambilla, R., E-mail: roberto.brambilla@policlinico.mi.it [Medical Phisic Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20121 Milan (Italy); Casiraghi, E., E-mail: casiraghi@di.unimi.it [Computer Science Department, University of Milan, Via Comelico 39, Milan (Italy); Biondetti, P.R., E-mail: pibionde@tin.it [Department of Radiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20121 Milan (Italy)

2015-06-15

Highlights: • We evaluated the additional value of precontrast CT in polytrauma patient. • We evaluated the radiation dose CT in polytrauma patient. • Precontrast CT scan does not have an additional value in polytrauma patient. • Precontrast CT expose patient to an unjustified radiation dose. - Abstract: Purpose: To evaluate the utility and radiation dose of thoraco-abdominopelvic precontrast CT in polytrauma patients. Materials and methods: We examined retrospectively 125 patients who underwent a thoraco-abdominopelvic CT for trauma. Two radiologists, independently, evaluated precontrast CT acquisition and two other radiologists examined the contrast-enhanced scans. A further two radiologists assessed both the acquisitions. Mean value of sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated by each group of radiologists. For 104 patients, CTDIvol, DLP data and individual mean size were collected to calculate effective dose. Results: Mean values of SE, SP, PPV and NPV of findings of radiologists who assessed contrast-enhanced acquisitions were respectively: SE = 85%, SP = 98%, PPV = 86%, NPV = 88% versus: SE = 43%, SP = 95%, PPV = 69%, NPV = 88% of radiologists who examined non-contrast-enhanced scans. Mean values of radiologists who analyzed both acquisitions were: SE = 80%, SP = 97%, PPV = 80%, NPV = 88%. Neither the precontrast scans nor the precontrast and postcontrast scans together provided additional useful information compared to the single contrast-enhanced acquisition. Patients received a mean dose of 12 mSv for the precontrast CT. Conclusions: Precontrast CT acquisition did not provide significant information in trauma patients, exposing them to an unjustified radiation dose.

The value of precontrast thoraco-abdominopelvic CT in polytrauma patients

International Nuclear Information System (INIS)

Esposito, A.A.; Zilocchi, M.; Fasani, P.; Giannitto, C.; Maccagnoni, S.; Maniglio, M.; Campoleoni, M.; Brambilla, R.; Casiraghi, E.; Biondetti, P.R.

2015-01-01

Highlights: • We evaluated the additional value of precontrast CT in polytrauma patient. • We evaluated the radiation dose CT in polytrauma patient. • Precontrast CT scan does not have an additional value in polytrauma patient. • Precontrast CT expose patient to an unjustified radiation dose. - Abstract: Purpose: To evaluate the utility and radiation dose of thoraco-abdominopelvic precontrast CT in polytrauma patients. Materials and methods: We examined retrospectively 125 patients who underwent a thoraco-abdominopelvic CT for trauma. Two radiologists, independently, evaluated precontrast CT acquisition and two other radiologists examined the contrast-enhanced scans. A further two radiologists assessed both the acquisitions. Mean value of sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated by each group of radiologists. For 104 patients, CTDIvol, DLP data and individual mean size were collected to calculate effective dose. Results: Mean values of SE, SP, PPV and NPV of findings of radiologists who assessed contrast-enhanced acquisitions were respectively: SE = 85%, SP = 98%, PPV = 86%, NPV = 88% versus: SE = 43%, SP = 95%, PPV = 69%, NPV = 88% of radiologists who examined non-contrast-enhanced scans. Mean values of radiologists who analyzed both acquisitions were: SE = 80%, SP = 97%, PPV = 80%, NPV = 88%. Neither the precontrast scans nor the precontrast and postcontrast scans together provided additional useful information compared to the single contrast-enhanced acquisition. Patients received a mean dose of 12 mSv for the precontrast CT. Conclusions: Precontrast CT acquisition did not provide significant information in trauma patients, exposing them to an unjustified radiation dose

Advances in Biomarkers in Critical Ill Polytrauma Patients.

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Papurica, Marius; Rogobete, Alexandru F; Sandesc, Dorel; Dumache, Raluca; Cradigati, Carmen A; Sarandan, Mirela; Nartita, Radu; Popovici, Sonia E; Bedreag, Ovidiu H

2016-01-01

The complexity of the cases of critically ill polytrauma patients is given by both the primary, as well as the secondary, post-traumatic injuries. The severe injuries of organ systems, the major biochemical and physiological disequilibrium, and the molecular chaos lead to a high rate of morbidity and mortality in this type of patient. The 'gold goal' in the intensive therapy of such patients resides in the continuous evaluation and monitoring of their clinical status. Moreover, optimizing the therapy based on the expression of certain biomarkers with high specificity and sensitivity is extremely important because of the clinical course of the critically ill polytrauma patient. In this paper we wish to summarize the recent studies of biomarkers useful for the intensive care unit (ICU) physician. For this study the available literature on specific databases such as PubMed and Scopus was thoroughly analyzed. Each article was carefully reviewed and useful information for this study extracted. The keywords used to select the relevant articles were "sepsis biomarker", "traumatic brain injury biomarker" "spinal cord injury biomarker", "inflammation biomarker", "microRNAs biomarker", "trauma biomarker", and "critically ill patients". For this study to be carried out 556 original type articles were analyzed, as well as case reports and reviews. For this review, 89 articles with relevant topics for the present paper were selected. The critically ill polytrauma patient, because of the clinical complexity the case presents with, needs a series of evaluations and specific monitoring. Recent studies show a series of either tissue-specific or circulating biomarkers that are useful in the clinical status evaluation of these patients. The biomarkers existing today, with regard to the critically ill polytrauma patient, can bring a significant contribution to increasing the survival rate, by adapting the therapy according to their expressions. Nevertheless, the necessity remains to

A New Experimental Polytrauma Model in Rats: Molecular Characterization of the Early Inflammatory Response

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Sebastian Weckbach

2012-01-01

Full Text Available Background. The molecular mechanisms of the immune response after polytrauma are highly complex and far from fully understood. In this paper, we characterize a new standardized polytrauma model in rats based on the early molecular inflammatory and apoptotic response. Methods. Male Wistar rats (250 g, 6–10/group were anesthetized and exposed to chest trauma (ChT, closed head injury (CHI, or Tib/Fib fracture including a soft tissue trauma (Fx + STT or to the following combination of injuries: (1 ChT; (2 ChT + Fx + STT; (3 ChT + CHI; (4 CHI; (5 polytrauma (PT = ChT + CHI + Fx + STT. Sham-operated rats served as negative controls. The inflammatory response was quantified at 2 hours and 4 hours after trauma by analysis of “key” inflammatory mediators, including selected cytokines and complement components, in serum and bronchoalveolar (BAL fluid samples. Results. Polytraumatized (PT rats showed a significant systemic and intrapulmonary release of cytokines, chemokines, and complement anaphylatoxins, compared to rats with isolated injuries or selected combinations of injuries. Conclusion. This new rat model appears to closely mimic the early immunological response of polytrauma observed in humans and may provide a valid basis for evaluation of the complex pathophysiology and future therapeutic immune modulatory approaches in experimental polytrauma.

A New Experimental Polytrauma Model in Rats: Molecular Characterization of the Early Inflammatory Response

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Weckbach, Sebastian; Perl, Mario; Heiland, Tim; Braumüller, Sonja; Stahel, Philip F.; Flierl, Michael A.; Ignatius, Anita; Gebhard, Florian; Huber-Lang, Markus

2012-01-01

Background. The molecular mechanisms of the immune response after polytrauma are highly complex and far from fully understood. In this paper, we characterize a new standardized polytrauma model in rats based on the early molecular inflammatory and apoptotic response. Methods. Male Wistar rats (250 g, 6–10/group) were anesthetized and exposed to chest trauma (ChT), closed head injury (CHI), or Tib/Fib fracture including a soft tissue trauma (Fx + STT) or to the following combination of injuries: (1) ChT; (2) ChT + Fx + STT; (3) ChT + CHI; (4) CHI; (5) polytrauma (PT = ChT + CHI + Fx + STT). Sham-operated rats served as negative controls. The inflammatory response was quantified at 2 hours and 4 hours after trauma by analysis of “key” inflammatory mediators, including selected cytokines and complement components, in serum and bronchoalveolar (BAL) fluid samples. Results. Polytraumatized (PT) rats showed a significant systemic and intrapulmonary release of cytokines, chemokines, and complement anaphylatoxins, compared to rats with isolated injuries or selected combinations of injuries. Conclusion. This new rat model appears to closely mimic the early immunological response of polytrauma observed in humans and may provide a valid basis for evaluation of the complex pathophysiology and future therapeutic immune modulatory approaches in experimental polytrauma. PMID:22481866

Rheumatische Erkrankungen beim älteren Patienten

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Köller M

2008-01-01

Full Text Available Muskuloskeletale Erkrankungen stellen beim älteren Menschen die häufigste Ursache für Aktivitätseinschränkungen dar. Die Prävalenz der Osteoarthrose (OA steigt mit dem Lebensalter sprunghaft an. Nach den Allgemeinmaßnahmen ist bei der medikamentösen Therapie der OA Paracetamol der Vorzug zu geben. Die rheumatoide Arthritis (RA als häufigste entzündliche Gelenkerkrankung des Erwachsenenalters zeigt im Alter oft atypische Verlaufsformen und ist unter Umständen von der Polymyalgia rheumatica schwer abzugrenzen. Jedenfalls erscheint die RA beim älteren Patienten oft nicht adäquat behandelt. Auch hier sind konventionelle Therapien wie Methotrexat Mittel der Wahl und Biologika erscheinen ebenso sicher bei älteren Patienten. Das Infektrisiko wird vorwiegend durch die begleitende Kortikosteroid-Dosis bestimmt. Die Polymyalgia rheumatica betrifft in 90 % der Fälle Patienten älter als 60 Jahre. Kortikosteroide sind hier nach wie vor die wichtigste Therapie, welche meist über ein bis zwei Jahre erforderlich ist. Eine Riesenzellarteriitis muss bei Patienten mit PMR immer ausgeschlossen werden. Bei Vorliegen dieser Vaskulitis muss im Falle einer Mitbeteiligung der Augengefäße möglichst rasch eine hoch dosierte Steroidgabe erfolgen. Die Biopsie der Schläfenarterie kann auch einige Zeit nach Therapiebeginn erfolgen, ohne dass die diagnostische Aussagekraft darunter leidet.

Effects of exogenous ubiquitin in a polytrauma model with blunt chest trauma

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Baker, Todd A.; Romero, Jacqueline; Bach, Harold H.; Strom, Joel A.; Gamelli, Richard L.; Majetschak, Matthias

2013-01-01

Objective To determine whether treatment with the CXC chemokine receptor (CXCR) 4 agonist ubiquitin results in beneficial effects in a polytrauma model consisting of bilateral femur fractures plus blunt chest trauma (Injury Severity Score 18-25). Design Treatment study. Setting Research Laboratory. Subjects Seventeen Yorkshire pigs. Interventions Intravenous (i.v.) injection of 1.5 mg/kg ubiquitin or albumin (=control) at 60 min after polytrauma. Measurements and Main Results Anesthetized, mechanically ventilated pigs underwent polytrauma, followed by a simulated 60 min shock phase. At the end of the shock phase ubiquitin or albumin were administered and animals were resuscitated to a mean arterial blood pressure of 70 mmHg until t = 420 min. After i.v. ubiquitin, ubiquitin plasma concentrations increased sixteen-fold to 2870 ± 1015 ng/mL at t = 90 min and decreased with t1/2 = 60 min. Endogenous plasma ubiquitin increased two-fold in the albumin group with peak levels of 359 ± 210 ng/mL. Plasma levels of the cognate CXCR4 ligand stromal cell-derived factor (SDF)-1α were unchanged in both groups. Ubiquitin treatment reduced arterial lactate levels and prevented a continuous decrease in arterial oxygenation, which occurred in the albumin group during resuscitation. Wet weight to dry weight ratios of the lung contralateral from the injury, heart, spleen and jejunum were lower with ubiquitin. With ubiquitin treatment, tissue levels of IL-8, IL-10, TNFα and SDF-1α were reduced in the injured lung and of IL-8 in the contralateral lung, respectively. Conclusions Administration of exogenous ubiquitin modulates the local inflammatory response, improves resuscitation, reduces fluid shifts into tissues and preserves arterial oxygenation after blunt polytrauma with lung injury. This study further supports the notion that ubiquitin is a promising protein therapeutic and implies CXCR4 as a drug target after polytrauma. PMID:22622399

Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients.

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Elbaih, Adel Hamed; Housseini, Ahmed Mohamed; Khalifa, Mohamed E M

2018-03-26

"Polytrauma" patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography (pan-CT) were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support (ATLS) guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock (64%), followed by obstructive shock (14%), distributive shock (12%) and cardiogenic shock (10%) respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT. Copyright © 2018 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Injury mechanisms, patterns and outcomes of older polytrauma patients : An analysis of the Dutch Trauma Registry

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de Vries, Rob; Reininga, Inge H. F.; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus

2018-01-01

Background Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Methods Data from

Qualität beim E-Learning: Der Lernende als Grundkategorie bei der Qualitätssicherung

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Ulf Ehlers

2002-03-01

Full Text Available Qualität wird über die zukünftigen Erfolgschancen des E-Learning entscheiden. Das ist das Ergebnis vieler Analysen und Entwicklungen der letzten Zeit. So stellte etwa die KPMG-Studie heraus, dass es beim E-Learning nicht nur auf gute Technologie ankommt, sondern die betriebliche Lernkultur und der Lerner wesentlich mehr als bisher einzubeziehen sind. Dieser Beitrag beschäftigt sich damit, was Qualität beim E-Learning eigentlich ist und welche Konzepte zur Beschreibung und Sicherung von Qualität bestehen.

Abdominal polytrauma and parenchymal organs

International Nuclear Information System (INIS)

Krestan, C.R.

2014-01-01

The acute radiological diagnostics of polytrauma patients has become an essential part of the interdisciplinary treatment in the emergency room. The incidence of polytrauma patients with an injury severity score (ISS) > 16 is approximately 450 cases/million inhabitants/year in Europe. Injuries of the parenchymal organs are of utmost importance for the prognosis and treatment of these patients. The injury patterns are complex and a great deal of experience is necessary to be able to obtain the correct diagnosis within minutes. This review article deals with the radiological diagnostics and grading of the severity of injuries to the spleen, liver, pancreas and kidneys. The use of ultrasound for the evaluation of polytraumatized patients will be discussed. The most important trauma-associated findings for the above mentioned organs using multidetector computed tomography (MDCT) will be described and illustrated by dedicated case findings. Ultrasound contrast agents can supply valuable, additional diagnostic information in the evaluation of polytraumatized patients. Computed tomography has become established as the most relevant imaging modality in severe trauma. Innovative organ-adapted and contrast application protocols improve the diagnostic performance of MDCT. The use of focused assessment sonography for trauma (FAST) scanning as a screening tool is in agreement with the other clinical disciplines of the trauma team. The use of MDCT is trauma-dependent and the classification of the severity of the different parenchymal organ injuries is ultimately decisive for further treatment and prognosis of trauma victims. (orig.) [de

Fractures and dislocations of the hand in polytrauma patients: Incidence, injury pattern and functional outcome.

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Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

2017-04-01

Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients. A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS). Copyright © 2017 Elsevier Ltd. All

PAIN RELIEF IN POLYTRAUMA PATIENTS

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M. C. Rajesh

2016-09-01

Full Text Available BACKGROUND Pain management in Polytrauma is a poorly-addressed concern at the time of active resuscitation. But, very often, pain assessment is also a challenge! Opioids belong to conventional analgesics of choice in any acute pain conditions. But, recently application of regional anaesthesia techniques and subanaesthetic doses of ketamine are satisfactorily employed. A clear understanding of neuropathic element of pain must be made as they require specific therapy. It must be emphasised that effective pain therapy is a multidisciplinary team work with active involvement of pain psychologist.

Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture.

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Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P H; Houwert, Roderick M

2017-01-01

Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality. A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered. Polytrauma patients, defined as an Injury Severity Score ≥16, and those with an isolated clavicle fracture were compared. Fracture healing disorders (nonunion and delayed union) and delayed fixation rates were determined. Functional outcome was assessed by the Quick Disability of the Arm, Shoulder, and Hand questionnaire. A total of 152 patients were analyzed, 71 polytrauma patients and 81 patients with an isolated DMCF. Questionnaire response of 121 patients (80%) was available (mean, 53 months; standard deviation, 22 months). No differences were found between polytrauma patients and those with an isolated DMCF with regard to nonunion (7% vs. 5%, respectively), delayed union (4% vs. 4%), and delayed fixation rate (13% vs. 13%). Polytrauma patients had an overall worse functional outcome, regardless of initial nonoperative treatment or delayed operative fixation. Polytrauma patients had a similar nonunion and delayed fixation rate but had an overall worse functional outcome compared with patients with an isolated DMCF. For polytrauma patients, a wait and see approach can be advocated without the risk of decreased upper extremity function after delayed fixation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Catecholamine dependency in a polytrauma patient : relative adrenal insufficiency?

NARCIS (Netherlands)

Nieboer, P.; van der Werf, T.S.; Beentjes, J.A.M.; Tulleken, J.E.; Zijlstra, J.G.; Ligtenberg, J.J.M.

A 65-year-old polytrauma patient was admitted post-operatively to the intensive care unit. His situation deteriorated with hemodynamic instability and continuous high fever. An infectious focus could not be found and repeated cultures remained negative. Empirical administration of antibiotics and

Crucial role of IL1beta and C3a in the in vitro-response of multipotent mesenchymal stromal cells to inflammatory mediators of polytrauma.

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Nina-Emily Hengartner

Full Text Available Multipotent mesenchymal stromal cells (MSC exert immune-modulatory effects and support tissue regeneration in various local trauma models. In case of a polytrauma, high amounts of danger-associated molecular patterns are released, leading to a systemic increase of inflammatory mediators. The influence of such a complex inflammatory microenvironment on human MSC is mainly unknown so far. Therefore, we investigated the effects of a defined serum-free polytrauma "cocktail" containing IL beta, IL6, IL8 and the anaphylatoxins C3a and C5a, in concentrations corresponding to those measured in the blood of polytrauma patients, on human MSC in vitro. The polytrauma cocktail induced directed migration of MSC with C3a representing its major soluble chemoattractive agent. Furthermore, the polytrauma cocktail and IL1beta upregulated the expression of MMP1 indicating a potential role of IL1beta to enhance MSC migration in the tissue context. COX2, PTGES and TSG6 were also found to be upregulated upon stimulation with the polytrauma cocktail or IL1beta, but not through other single factors of the polytrauma cocktail in pathophysiologically relevant concentrations. An RNA expression array of 84 inflammation-related genes revealed that both the polytrauma cocktail and IL1beta induced C3, CSF1, TLR3 and various chemokines without major qualitative or quantitative differences. These results indicate that IL1beta is a crucial mediator of the polytrauma cocktail in terms of immune-modulation and MMP1 expression. Thus, upon encountering the primary sterile, inflammatory milieu of a polytrauma, endogenous or systemically transfused MSC might be able to migrate to sites of injury, secrete TSG6 and PGE2 and to influence macrophage biology as observed in local trauma models.

[Definition of polytrauma in the German DRG system 2006. Up to 30% "incorrect classifications"].

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Flohé, S; Buschmann, C; Nabring, J; Merguet, P; Luetkes, P; Lefering, R; Nast-Kolb, D; Ruchholtz, S

2007-07-01

Severely injured patients represent a relevant financial cost factor in the health system especially for high level trauma centres. The introduction of a"diagnosis-related group" (DRG) system in Germany further revealed the potential negative economic impact of severely injured patients for trauma centres. In recent years several changes of the specific DRG for severely injured patients occurred with the aim of a convenient reimbursement for the trauma patient. The present study analysed 38 multiply injured patients admitted in the first half of the year 2004. These patients were analysed in terms of the respective DRG that was attributed to the patient on the basis of the definition criteria for 2004 and 2005. In addition for the same patient group the total inpatient treatment costs were calculated according to the algorithm developed by the Working Group on Polytrauma of the German Trauma Society. The analysis revealed three major problems in the reimbursement for severely injured patients according to the German DRG system: (1) In spite of the additional payment for blood compounds on top of the DRG reimbursement in 2005 a mean economic deficit of more than 4000 euro remains for each severely injured patient. (2) In 30% of the analysed trauma patients the combination of the diagnosis and operations did not lead to a specific polytrauma DRG or to an intensive care medicine DRG. (3) In the patients that could not be attributed to a polytrauma DRG, the economic deficit was with an average of more than 9000 euro even higher. This attribution aspect is also currently relevant, since the definition criteria for a polytrauma DRG were not changed in 2006 or 2007. We conclude that besides the recent changes in the reimbursement for polytrauma DRGs, which have been at least partly adapted to the real financial burden of these patients, the definition of a severely injured patient in the German DRG system may also need to be revised.

Ellbogen- und Handgelenksendoprothetik beim Rheumatiker - Richtlinien und Rehabilitation

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Chochole M

2008-01-01

Full Text Available Die Endoprothetik an Ellbogen und Handgelenk ist seit etwa drei Jahrzehnten etabliert. An beiden Gelenken haben sich einzelne Implantate oder Designs durchgesetzt. Operationstechniken und Nachuntersuchungsergebnisse sind publiziert. Wenig ist jedoch zum Thema Nachbehandlung und Nachsorge veröffentlicht. Diese Arbeit beschäftigt sich detailliert mit der ärztlichen und therapeutischen Betreuung nach Implantation einer Ellbogen- oder Handgelenksendoprothese beim Patienten mit rheumatischer Arthritis unter Aufgliederung in Krankenhausaufenthalt, ambulanter Nachsorge sowie stationärer Rehabilitation. Dabei werden Zeitrahmen, Therapieziele und Behandlungen gesondert angeführt.

Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study.

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Briet, Jan Paul; Houwert, Roderick Marijn; Smeeing, Diederik P J; Dijkgraaf, Marcel G W; Verleisdonk, Egbert Jan; Leenen, Luke P H; Hietbrink, Falco

Although fracture type and treatment options for ankle fractures are well defined, the differences between mono- and polytrauma patients and low- and high-energy trauma have not been addressed. The aim of the present study was to compare the fracture type and trauma mechanism between mono- and polytrauma and low- and high-energy trauma patients with an ankle fracture. We performed a single-center retrospective cohort study. Fractures were classified according to the Lauge-Hansen classification and a descriptive classification. High-energy trauma (HET) was defined using triage criteria. All other patients were classified as having experienced low-energy trauma (LET). The patients were divided into 2 groups according to the injury severity score (ISS). Monotrauma patients were defined as patients with an ISS of 4 to 11 with an isolated ankle fracture or an ankle fracture with a minor contusion or laceration. Polytrauma patients were defined as patients with an ISS of ≥16 with ≥2 body regions involved. Patients with an ISS from 12 to 15 were excluded. A total of 96 patients were eligible for analysis. Of the 96 patients, 62 had experienced monotrauma and 34 had experienced polytrauma. A significant difference was found between the mono- and polytrauma patients in the Lauge-Hansen classification (p polytrauma patients. The same pattern was observed for ankle fractures after HET compared with LET (p polytrauma patients sustain different types of ankle fractures than patients with an isolated ankle fracture. This difference likely results from the high-energy transfer associated with polytrauma, because pronation abduction and supination adduction injuries were only observed after HET. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

”DAMAGE CONTROL“ STRATEGY IN THE TREATMENT OF POLYTRAUMA PATIENTS WITH OPEN FEMORAL SHAFT FRACTURE COMBINED WITH SPLENIC RUPTURE - A CASE REPORT

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Ivan Golubović

2011-09-01

Full Text Available Polytrauma represents the most difficult form of trauma epidemic. Appropriate treatment of the femoral shaft fracture in polytrauma patients can significantly reduce mortality and morbidity. External skeletal fixation in patients with femoral shaft fracture presents a minor surgical trauma with minimal blood loss. In modern trauma centres, external skeletal fixation in polytrauma patients is a temporary method (as a part of „damage control“strategy where immediate extensive internal fixation could be risky. It is usually postponed until the patient status is stable with normal vital parameters.This paper presents a polytrauma patient with dominant abdominal injury and femoral shaft fracture. During the same operation, external skeletal fixation was applied after abdominal surgery was done. Conversion of external into internal fixation was carried out because of postoperative febrile state that lasted for 14 days. External skeletal fixation was a definitive method of treatment. Fracture of the femoral shaft healed after 7 months with good functional outcome.External skeletal fixation is a successful method of treatment for femoral shaft fracture in polytrauma patients. It is a temporary method as a part of „damage control“ strategy and is usually followed by internal fixation. Sometimes, it is a definitive treatment method in patients with open and comminuted fractures of the femoral shaft and in polytrauma patients when the above mentioned conversion is not safe.

Outcomes of polytrauma patients with diabetes mellitus

Science.gov (United States)

2014-01-01

Background The impact of diabetes mellitus in patients with multiple system injuries remains obscure. This study was designed to increase knowledge of outcomes of polytrauma in patients who have diabetes mellitus. Methods Data from the Trauma Audit and Research Network was used to identify patients who had suffered polytrauma during 2003 to 2011. These patients were filtered to those with known outcomes, then separated into those with diabetes, those known to have other co-morbidities but not diabetes and those known not to have any co-morbidities or diabetes. The data were analyzed to establish if patients with diabetes had differing outcomes associated with their diabetes versus the other groups. Results In total, 222 patients had diabetes, 2,558 had no past medical co-morbidities (PMC), 2,709 had PMC but no diabetes. The diabetic group of patients was found to be older than the other groups (P <0.05). A higher mortality rate was found in the diabetic group compared to the non-PMC group (32.4% versus 12.9%), P <0.05). Rates of many complications including renal failure, myocardial infarction, acute respiratory distress syndrome, pulmonary embolism and deep vein thrombosis were all found to be higher in the diabetic group. Conclusions Close monitoring of diabetic patients may result in improved outcomes. Tighter glycemic control and earlier intervention for complications may reduce mortality and morbidity. PMID:25026864

Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

International Nuclear Information System (INIS)

Schlorhaufer, C.; Behrends, M.; Diekhaus, G.; Keberle, M.; Weidemann, J.

2012-01-01

Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

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Schlorhaufer, C., E-mail: Schlorhaufer.Celia@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Behrends, M., E-mail: behrends.marianne@mh-hannover.de [Peter L. Reichertz Department of Medical Informatics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Diekhaus, G., E-mail: Diekhaus.Gesche@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Keberle, M., E-mail: m.keberle@bk-paderborn.de [Department of Diagnostic and Interventional Radiology, Brüderkrankenhaus St. Josef Paderborn, Husener Str. 46, 33098 Paderborn (Germany); Weidemann, J., E-mail: Weidemann.Juergen@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany)

2012-12-15

Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

Outcome differences in adolescent blunt severe polytrauma patients managed at pediatric versus adult trauma centers.

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Rogers, Amelia T; Gross, Brian W; Cook, Alan D; Rinehart, Cole D; Lynch, Caitlin A; Bradburn, Eric H; Heinle, Colin C; Jammula, Shreya; Rogers, Frederick B

2017-12-01

Previous research suggests adolescent trauma patients can be managed equally effectively at pediatric and adult trauma centers. We sought to determine whether this association would be upheld for adolescent severe polytrauma patients. We hypothesized that no difference in adjusted outcomes would be observed between pediatric trauma centers (PTCs) and adult trauma centers (ATCs) for this population. All severely injured adolescent (aged 12-17 years) polytrauma patients were extracted from the Pennsylvania Trauma Outcomes Study database from 2003 to 2015. Polytrauma was defined as an Abbreviated Injury Scale (AIS) score ≥3 for two or more AIS-defined body regions. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. ATC were defined as adult-only centers, whereas standalone pediatric hospitals and adult centers with pediatric affiliation were considered PTC. Multilevel mixed-effects logistic regression models assessed the adjusted impact of center type on mortality and total complications while controlling for age, shock index, Injury Severity Score, Glasgow Coma Scale motor score, trauma center level, case volume, and injury year. A generalized linear mixed model characterized functional status at discharge (FSD) while controlling for the same variables. A total of 1,606 patients met inclusion criteria (PTC: 868 [54.1%]; ATC: 738 [45.9%]), 139 (8.66%) of which died in-hospital. No significant difference in mortality (adjusted odds ratio [AOR]: 1.10, 95% CI 0.54-2.24; p = 0.794; area under the receiver operating characteristic: 0.89) was observed between designations in adjusted analysis; however, FSD (AOR: 0.38, 95% CI 0.15-0.97; p = 0.043) was found to be lower and total complication trends higher (AOR: 1.78, 95% CI 0.98-3.32; p = 0.058) at PTC for adolescent polytrauma patients. Contrary to existing literature on adolescent trauma patients, our results suggest patients aged 12-17 presenting with polytrauma may experience

Trauma and Injury Severity Score in Predicting Mortality of Polytrauma Patients

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Bambang Gunawan

2018-01-01

Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Abstract TRISS (Trauma and Injury Severity Score is one of the most commonly used trauma score. Currently, there is no data about using TRISS in the care of polytrauma patients at emergency department of dr. Cipto Mangunkusumo Hospital (CMH. This research was intended to evaluate whether TRISS can predict the mortality of polytrauma patients at CMH. This was an analytic descriptive study with retrospective cohort design. Data was collected from medical records of polytrauma patients who were admitted to emergency department of CMH from 2011-201 4 then we analyzed the relationship between TRISS and patient’s prognosis. Furthermore, we conducted bivariate and multivariate analysis by SPSS 20 software. Seventy medical records were included in this study. The majority of patients were male (65% in young age. There were 69 patients who experienced blunt trauma, with the majority (94.3% were caused by motor vehicle accident. After receiving trauma care, there were 26 deaths, while other 44 patients survived. From bivariate and multivariate analysis, we found a significant difference between TRISS and patient’s prognosis. TRISS strongly predicts polytrauma patient’s mortality (AUC 0,899; IK95% 0,824-0,975. TRISS has 84,6% sensitivity and 81.8% specificity with optimal intersection point ≤ 90,5. TRISS is able to predict the mortality of polytrauma patients at CMH. TRISS untuk Memprediksi Mortalitas Pasien Politrauma Abstrak TRISS merupakan salah satu penilaian trauma yang paling sering digunakan. Namun, saat ini belum ada data penggunaan TRISS dalam penanganan pasien politrauma di Instalasi Gawat Darurat (IGD Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSUPNCM. Penelitian ini bertujuan untuk mengetahui kemampuan TRISS dalam memprediksi mortalitas pasien politrauma di IGD RSUPNCM. Penelitian ini adalah studi analitik deskriptif dengan menggunakan desain kohort retrospektif. Data diambil

Does the applied polytrauma definition notably influence outcome and patient population? - a retrospective analysis.

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Frenzel, Stephan; Krenn, Philipp; Heinz, Thomas; Negrin, Lukas Leopold

2017-08-31

Although the term "polytrauma" has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient population result in diverse subgroups of individuals, who in turn present a varying outcome. All patients (≥18 years) treated at our level I trauma center within a time period of three years were classified according to 11 selected polytrauma definitions and included in our study, if they were rated "polytraumatized" by at least one of these definitions. All patients, who met the criteria of a certain definition, were combined to the relevant definition-positive group, thus resulting in 11 patient subgroups. Their demographic data (number of patients, mean patient age, mean Injury Severity Score value, median number of ventilator days, median length of stay at the intensive care unit and at the hospital, mortality rate and odds ratio) were statistically compared. Three hundred seventy-five patients (73% male) with a mean age of 47 years met the inclusion criteria and were allocated to the relevant subgroups; their patient number varied from 55 to 346 and their mean Injury Severity Score value ranged from 4 to 75. Not surprisingly, all examined parameters were subject to variations. Whereas most definition-positive groups showed a mortality rate of about 21% to 30%, 18% of the individuals, who met the criteria according to Blacker, and 40% of the polytrauma victims according to Schalamon died. The Pape 1-, Schalamon-, and Berlin-positive groups presented a significant odds ratio with regard to mortality that considerably exceeded 1. A polytrauma definition can only be a reliable tool in classifying trauma victims if it provides a significant odds ratio with regard to mortality that considerably exceeds 1 and if it succeeds in capturing patients with multiple severe injuries and a higher mortality rate without reducing the number of polytraumatized

Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients.

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Aveta, Achille; Casati, Paolo

2008-01-01

Facial injuries are often accompanied by soft tissue injuries. The complexity of these injuries is represented by the potential for loss of relationships between the functional and the aesthetic subunits of the head. Most reviews of craniofacial trauma have concentrated on fractures. With this article, we want to emphasize the importance of early aesthetic reconstruction of the face in polytrauma patients. We present 13 patients with soft tissue injuries of the face, treated in our emergency department in the 'day one surgery", without "second look"procedures. The final result always restored a sense of normalcy to the face. The face is the first most visible part of the human anatomy, so, in emergency, surgeons must pay special attention also to the reconstruction of the face, in polytrauma patients.

Experimental investigations of tyre-road interactions during braking; Experimentelle Untersuchungen zur Interaktion zwischen Pkw-Reifen und Fahrbahn beim Bremsen

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Chunyang Xie

2002-07-01

Tyre-road interactions during braking were investigated experimentally. The measurements were found to be highly accurate. In the first stage, the braking force is enhanced by elastic deformation of the profile elements at the onset of tyre contact. In case of high slip or a high sliding velocity, frictional vibration of the tyre section in contact with the road may occur, which is enhanced by the reduction of braking pressure in case of automatic brake control. The eigenfreequency of the frictional vibration also depends on the road texture and friction coefficient. The measured movements of the profile elements provide a good explanation of the causes of tyre noise. [German] In der Dissertation wurde die Interaktion Reifen/Fahrbahn beim Bremsen experimentell untersucht. Die Messungen zeigen, dass die mit dem neuen Reifensensor erfassten Profilelementverformungen den Reibungszustand zwischen Reifen und Fahrbahn gut widerspiegeln. Die Bremskraft wird zunaechst durch die elastischen Verformungen der Profilelemente am Anfang des Reifenlatsches wesentlich aufgebaut. Beim hohen Bremsschlupf bzw. der hohen Gleitgeschwindigkeit kann die Reibungsschwingung des Laufstreifens des Reifens auftreten. Der Bremsdruckabbau der ABS-Regelung beguenstigt die Entstehung dieser Reibungsschwingung. Die Eigenfrequenz der Reibungsschwingung ist auch abhaengig von der Fahrbahntextur und dem Reibwert. Die aus den Signalen des Profilrillensensors berechneten Beschleunigungen der Profilelemente zeigen deutlich den Aufschlag beim Einlauf des Reifens und das Ausschnappen beim Auslauf. Durch die gemessenen Bewegungen der Profilelemente laesst sich die Entstehung des Reifengeraeusches in einigen Frequenzbereichen gut erklaeren. (orig.)

Comparative Analysis of the Regulatory T Cells Dynamics in Peripheral Blood in Human and Porcine Polytrauma

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Rafael Serve

2018-03-01

Full Text Available BackgroundSeverely injured patients experience substantial immunological stress in the aftermath of traumatic insult, which often results in systemic immune dysregulation. Regulatory T cells (Treg play a key role in the suppression of the immune response and in the maintenance of immunological homeostasis. Little is known about their presence and dynamics in blood after trauma, and nothing is known about Treg in the porcine polytrauma model. Here, we assessed different subsets of Treg in trauma patients (TP and compared those to either healthy volunteers (HV or data from porcine polytrauma.MethodsPeripheral blood was withdrawn from 20 TP with injury severity score (ISS ≥16 at the admittance to the emergency department (ED, and subsequently on day 1 and at day 3. Ten HV were included as controls (ctrl. The porcine polytrauma model consisted of a femur fracture, liver laceration, lung contusion, and hemorrhagic shock resulting in an ISS of 27. After polytrauma, the animals underwent resuscitation and surgical fracture fixation. Blood samples were withdrawn before and immediately after trauma, 24 and 72 h later. Different subsets of Treg, CD4+CD25+, CD4+CD25+FoxP3+, CD4+CD25+CD127−, and CD4+CD25+CD127−FoxP3+ were characterized by flow cytometry.ResultsAbsolute cell counts of leukocytes were significantly increasing after trauma, and again decreasing in the follow-up in human and porcine samples. The proportion of human Treg in the peripheral blood of TP admitted to the ED was lower when compared to HV. Their numbers did not recover until 72 h after trauma. Comparable data were found for all subsets. The situation in the porcine trauma model was comparable with the clinical data. In porcine peripheral blood before trauma, we could identify Treg with the typical immunophenotype (CD4+CD25+CD127−, which were virtually absent immediately after trauma. Similar to the human situation, most of these cells expressed FoxP3, as assessed by

Cambridge Polytrauma Pathway: Are we making appropriately guided decisions?

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Wynell-Mayow, William; Guevel, Borna; Quansah, Benjamin; O'Leary, Ronan; Carrothers, Andrew D

2016-10-01

Addenbrooke's Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion. It facilitates provision of best practice Early Appropriate Care, encompassing - multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries. Re-audit was conducted of 15 patients meeting selection criteria, admitted between 1st October 2014 and 31st March 2015. Significant improvements in recording of lactate and fibrinogen were demonstrated, both on admission (lactate - ppolytrauma patients and it is recommended that either the GOS-E, or the EQ-5D scoring systems be introduced to assess this. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Clinical information seeking in traumatic brain injury: a survey of Veterans Health Administration polytrauma care team members.

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Hogan, Timothy; Martinez, Rachael; Evans, Charlesnika; Saban, Karen; Proescher, Eric; Steiner, Monica; Smith, Bridget

2018-03-01

The polytraumatic nature of traumatic brain injury (TBI) makes diagnosis and treatment difficult. To (1) characterise information needs among Veterans Health Administration (VHA) polytrauma care team members engaged in the diagnosis and treatment of TBI; (2) identify sources used for TBI related information; and (3) identify barriers to accessing TBI related information. Cross-sectional online survey of 236 VHA polytrauma care team members. Most respondents (95.8%) keep at least somewhat current regarding TBI, but 31.5% need more knowledge on diagnosing TBI and 51.3% need more knowledge on treating TBI. Respondents use VHA affiliated sources for information, including local colleagues (81.7%), VHA offsite conferences/meetings (78.3%) and onsite VHA educational offerings (73.6%); however, limited time due to administrative responsibilities (50.9%), limited financial resources (50.4%) and patient care (50.4%) were prominent barriers. Medical librarians are in a unique position to develop information services, resources and other electronic tools that reflect the clinical context in which polytrauma care team members practice, and the different tasks they perform. Polytrauma care team members could benefit from additional information regarding the diagnosis and treatment of TBI. Addressing their information needs and supporting their information seeking requires a mulit-pronged approach to time and financial constraints. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Randzonenveränderung beim Bohren und ihre Auswirkung auf Folgebearbeitungsverfahren

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Schmier, Marcus

2004-01-01

In der Praxis kommt es bei der spanenden Bearbeitung immer wieder zu großen Standwegunterschieden identischer Werkzeuge bei vordergründig identischen Bearbeitungsrandbedingungen. Insbesondere bei Fertigungsschritten, die das Bohren als Vorbearbeitung erfordern, kommt es gelegentlich zu atypischen Verschleißerscheinungen, die auf das Entstehen einer Neuhärtezone an der Werkstückoberfläche beim Bohren zurückgeführt werden. Grundsätzlich sind Randzonenveränderungen eine Folge der mechanischen un...

Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center.

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El Mestoui, Zainab; Jalalzadeh, Hamid; Giannakopoulos, Georgios F; Zuidema, Wietse P

2017-02-01

Earlier studies assessing mortality in polytrauma patients have focused on improving trauma care and reducing complications during hospital stay. The same studies have shown that the complication rate in these patients is high, often resulting in death. The aim of this study was to assess the incidence and causes of mortality in polytrauma patients in our institute. Secondarily, we assessed the donation and autopsy rates and outcome in these patients. All polytrauma patients (injury severity score≥16) transported to and treated in our institute during a period of 6 years were retrospectively analyzed. We included all patients who died during hospital stay. Prehospital and in-hospital data were collected on patients' condition, diagnostics, and treatment. The chance of survival was calculated according to the TRISS methodology. Patients were categorized according to the complications during treatment and causes of death. Logistic regression analysis was used to design a prediction model for mortality in major trauma. A statistical analysis was carried out. Of the 1073 polytrauma patients who were treated in our institute during the study period, 205 (19.1%) died during hospital stay. The median age of the deceased patients was 58.8 years and 125 patients were men. Their mean injury severity score was 30.4. The most common mechanism of injury involved fall from height, followed by bicycle accidents. Almost 50% of the patients underwent an emergency intervention. Almost 92% of the total population died because of the effects of the accident (primary trauma). Of these, 24% died during primary assessment in the emergency department. Most patients died because of the effects of severe head injury (63.4%), followed by exsanguination (17.6%). The most common type of complications causing death during treatment was respiratory failure (6.3%), followed by multiple organ failure (1.5%). Autopsy was performed in 10.4%. Organ donation procedure was performed in 14

[Is polytrauma affordable these days? G-DRG system vs per diem charge based on 1,030 patients with multiple injuries].

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Qvick, B; Buehren, V; Woltmann, A

2012-10-01

The introduction of diagnosis-related groups (DRG) in Germany comprises the risk of a non-cost-effective reimbursement in complex medical treatments. The aim of this study was to compare the reimbursement between the DRG system and the system of hospital per diem charge in effect until now. The G-DRG (Version 2004) reimbursement was calculated for 1,030 polytrauma patients (average ISS 26.4) treated at the BGU Murnau from 2000 to 2004, using a base value of 2900 euros, and compared to the reimbursement of hospital per diem charge. Just half of all polytrauma patients are classified as a polytrauma according to the DRG (18.7%) or as requiring artificial respiration based on the DRG (29.1%). The average G-DRG reimbursement was 27,157 euros vs 36,387 euros (74.6%). Patients with minor trauma, increasing age, high GCS, ICU stay without artificial respiration, trauma of the upper extremity and patients who survived show the greatest discrepancy. A revision of the G-DRG definition of polytrauma is necessary to ensure adequate reimbursement for management of patients with multiple injuries. The severity of a trauma has to be considered in the DRG system.

Whole-body MSCT of patients after polytrauma: abdominal injuries

International Nuclear Information System (INIS)

Roehrl, B.; Sadick, M.; Diehl, S.; Dueber, C.; Obertacke, U.

2005-01-01

Purpose: The goal of this retrospective study was to evaluate the spectrum of abdominal injuries and the reliability of computed tomography-based diagnosis in patients after polytrauma. Material and methods: CT findings and clinical reports for 177 patients after polytrauma were evaluated with regard to abdominal injuries. Clinical patient reports at the time of discharge from the hospital were utilized as the standard of reference. Abdominal injuries resulting from an accident, frequent additional traumas and following therapeutic procedures were recorded. In the case of discrepancies in the reports, the CT scans were viewed retrospectively. Results: In 30 out of 177 patients, 42 abdominal injuries were detected. 69% of the injuries were caused by traffic accidents while 31% resulted from falls. Liver and spleen injuries were the most common. 50% of the cases were treated surgically, and the other half of the cases underwent non-surgical conservative therapy. Massive chest traumas, pelvic injuries, cerebral traumas and injuries to extremities were commonly associated with abdominal injuries. Evaluation of the discrepancies in the clinical reports showed that injury to the pancreas and the small intestine were not successfully detected on CT, thus resulting in a false negative diagnosis. Early stages of organ parenchyma laceration were also initially misdiagnosed on CT. (orig.)

Zu einigen entwicklungstendenzen beim ausdruck der gewissheits modalität

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Stojan Bračič

1981-12-01

Full Text Available Das verfolgte Ziel in diesem Artikel - einem für den Druck bear­ beiteten Kapitel aus der Magisterarbeit des Verfassers - ist es, möglichst viele Ausdrucksmittel zum Ausdruck der Gewissheits­ modälitat (im weiteren GMO zu finden und sie sys.tematisch zu behandeln. Ausserdem soll durch statistische Bearbeitung der im Korpus gefundenen Belege festgestellt werden, ob man in der Zeit­ spanne derletzten siebzig Jahre beim Ausdruck der GMO in der deutschen Sprache mit Entwicklungstendenzen /ET/ rechnen kann.

Damage Control Resuscitation Supplemented with Vasopressin in a Severe Polytrauma Model with Traumatic Brain Injury and Uncontrolled Internal Hemorrhage.

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Dickson, J Michael; Wang, Xu; St John, Alexander E; Lim, Esther B; Stern, Susan A; White, Nathan J

2018-03-14

Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of traumatic death worldwide and particularly on the battlefield. They are especially challenging when present simultaneously (polytrauma), and clear blood pressure end points during fluid resuscitation are not well described for this situation. The goal of this study is to evaluate for any benefit of increasing blood pressure using a vasopressor on brain blood flow during initial fluid resuscitation in a swine polytrauma model. We used a swine polytrauma model with simultaneous TBI, femur fracture, and HS with uncontrolled noncompressible internal bleeding from an aortic tear injury. Five animals were assigned to each of three experimental groups (hydroxyethyl starch only [HES], HES + 0.4 U/kg vasopressin, and no fluid resuscitation [No Fluids]). Fluids were given as two 10 mL/kg boluses according to tactical field care guidelines. Primary outcomes were mean arterial blood pressure (MAP) and brain blood flow at 60 min. Secondary outcomes were blood flows in the heart, intestine, and kidney; arterial blood lactate level; and survival at 6 hr. Organ blood flow was measured using injection of colored microspheres. Five animals were tested in each of the three groups. There was a statistically significant increase in MAP with vasopressin compared with other experimental groups, but no significant increase in brain blood flow during the first 60 min of resuscitation. The vasopressin group also exhibited greater total internal hemorrhage volume and rate. There was no difference in survival at 6 hours. In this experimental swine polytrauma model, increasing blood pressure with vasopressin did not improve brain perfusion, likely due to increased internal hemorrhage. Effective hemostasis should remain the top priority for field treatment of the polytrauma casualty with TBI.

Tranexamic Acid Attenuates The Loss of Lung Barrier Function in a Rat Model of Polytrauma And Hemorrhage With Resuscitation.

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Wu, Xiaowu; Dubick, Michael A; Schwacha, Martin G; Cap, Andrew P; Darlington, Daniel N

2017-04-01

Severe trauma, hemorrhage, and resuscitation can lead to a trauma-related acute lung injury that involves rapid infiltration of immune cells and platelets. This infiltration involves exymatic degradation of matrix proteins, including plasmin, and causes loss of barrier function. Since tranexamic acid (TXA) inhibits plasminogen/ plasmin binding to target substrates, it may attenuate loss of barrier function after severe trauma, hemorrhage, and resuscitation. Sprague-Dawley rats were subjected to polytrauma (laparotomy, and trauma to intestines, liver, right leg skeletal muscle, and right femur fracture), then bled 40% of their blood volume. One hour after completion of polytrauma and hemorrhage, resuscitation was begun with fresh whole blood (FWB) or FWB with prior bolus administration of TXA (10 mg/kg in 0.2 mL). Polytrauma, hemorrhage, and resuscitation with FWB led to an elevation in lung water content that was significantly reduced with TXA administration. Polytrauma and hemorrhage led to rise in the number of neutrophils/monocytes and platelets in the lungs, and a rise in myeloperoxidase (MPO), neutrophil elastase and complement C5a content. While resuscitation with FWB significantly reduced the cellular infiltrate and MPO, FWB/TXA further reduced the levels of neutrophil/monocytes, neutrophil elastase, and complement C5a. Polytrauma and hemorrhage led to rise in lung plasmin activity that was significantly reduced with either FWB or FWB/TXA resuscitation. Severe trauma and hemorrhage leads to increases in lung water content, and immune cell, platelets, MPO, elastase, and C5a content in lung tissue, all markers of inflammation and acute lung injury. The addition of TXA to FWB resuscitation markedly attenuated the rise in these parameters suggesting its utility in treating acute lung injury.

Interleukin-6 and interleukin-10 plasma levels and mRNA expression in polytrauma patients

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Heber B. Sapan

2017-12-01

Conclusion: The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient's outcome.

The use of the Statscan digital X-ray unit in paediatric polytrauma

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Pitcher, Richard D. [University of Cape Town, Division of Paediatric Radiology, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); Wilde, Jim C.H. [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); University of Amsterdam, Paediatric Surgical Centre of Amsterdam, Emma Children' s Hospital, Academic Medical Centre, Amsterdam (Netherlands); Douglas, Tania S. [University of Cape Town, MRC/UCT Medical Imaging Research Unit, Department of Human Biology, Cape Town (South Africa); As, Arjan Bastiaan van [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa)

2009-05-15

We present a 3-year review of clinical paediatric experience with the statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided. (orig.)

The use of the Statscan digital X-ray unit in paediatric polytrauma

International Nuclear Information System (INIS)

Pitcher, Richard D.; Wilde, Jim C.H.; Douglas, Tania S.; As, Arjan Bastiaan van

2009-01-01

We present a 3-year review of clinical paediatric experience with the statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided. (orig.)

Systemic release of cytokines and heat shock proteins in porcine models of polytrauma and hemorrhage

Science.gov (United States)

Baker, Todd A.; Romero, Jacqueline; Bach, Harold H.; Strom, Joel A.; Gamelli, Richard L.; Majetschak, Matthias

2011-01-01

Objective To define systemic release kinetics of a panel of cytokines and heat shock proteins (HSP) in porcine polytrauma/hemorrhage models and to evaluate whether they could be useful as early trauma biomarkers. Design and Setting Prospective study in a research laboratory. Subjects Twenty-one Yorkshire pigs. Measurements and Main Results Pigs underwent polytrauma (femur fractures/lung contusion, P), hemorrhage (mean arterial pressure 25-30mmHg, H), polytrauma plus hemorrhage (P/H) or sham procedure (S). Plasma was obtained at baseline, in 5-15min intervals during a 60min shock period without intervention and in 60-120min intervals during fluid resuscitation for up to 300min. Plasma was assayed for IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12/IL-23p40, IL-13, IL-17, IL-18, IFNγ, TGFβ, TNFα, HSP40, HSP70 and HSP90 by ELISA. All animals after S, P and H survived (n=5/group). Three of six animals after P/H died. IL-10 increased during shock after P and this increase was attenuated after H. TNFα increased during the shock period after P, H and also after S. P/H abolished the systemic IL-10 and TNFα release and resulted in 20-30% increased levels of IL-6 during shock. As fluid resuscitation was initiated TNFα and IL-10 levels decreased after P, H and P/H, HSP 70 increased after P, IL-6 levels remained elevated after P/H and also increased after P and S. Conclusions Differential regulation of the systemic cytokine release after polytrauma and/or hemorrhage, in combination with the effects of resuscitation, can explain the variability and inconsistent association of systemic cytokine/HSP levels with clinical variables in trauma patients. Insults of major severity (P/H) partially suppress the systemic inflammatory response. The plasma concentrations of the measured cytokines/HSPs do not reflect injury severity or physiological changes in porcine trauma models and are unlikely to be able to serve as useful trauma biomarkers in patients. PMID:21983369

Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem?

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Chrysou, Konstantina; Halat, Gabriel; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

2017-04-20

Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients' mortality. In this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included. A total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AIS thorax 3), 19.1% a severe chest injury (AIS thorax 4) and 15.5% a moderate chest injury (AIS thorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AIS thorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AIS thorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality. Although 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AIS

Hopp, hopp, hopp im Schweinsgalopp? Klauen- und Gliedmaßengesundheit beim Schwein

OpenAIRE

Leeb, Christine; Bernardi, Florian; Winckler, Christoph

2009-01-01

Immer wieder kommen aus der Praxis Anfragen, über Lahmheitbeim Schwein zu berichten, auch ein Klauenpflegekurs wurde bereits durchgeführt, um akute Probleme lösen zu können. Doch was sind die Ursachen für Lahmheiten beim Schwein? Dieser Beitrag soll nicht nur die klinischen Symptome aufzählen und rasche Lösungen vermitteln (die es selten gibt), sondern Fragen stellen und zum selbst Beobachten und Nachdenken anregen. Dazu wird vom Wildschwein ausgehend das Normalverhalten betrac...

The definition of polytrauma: variable interrater versus intrarater agreement--a prospective international study among trauma surgeons.

Science.gov (United States)

Butcher, Nerida E; Enninghorst, Natalie; Sisak, Krisztian; Balogh, Zsolt J

2013-03-01

The international trauma community has recognized the lack of a validated consensus definition of "polytrauma." We hypothesized that using a subjective definition, trauma surgeons will not have substantial agreement; thus, an objective definition is needed. A prospective observational study was conducted between December 2010 and June 2011 (John Hunter Hospital, Level I trauma center). Inclusion criteria were all trauma call patients with subsequent intensive care unit admission. The study was composed of four stages as follows: (1) four trauma surgeons assessed patients until 24 hours, then coded as either "yes" or "no" for polytrauma, and results compared for agreement; (2) eight trauma surgeons representing the United States, Germany, and the Netherlands graded the same prospectively assessed patients and coded as either "yes" or "no" for polytrauma; (3) 12 months later, the original four trauma surgeons repeated assessment via data sheets to test intrarater variability; and (4) individual subjective definitions were compared with three anatomic scores, namely, (a) Injury Severity Score (ISS) of greater than 15, (b) ISS of greater 17, and (c) Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions. A total of 52 trauma patients were included. Results for each stage were as follows: (1) κ score of 0.50, moderate agreement; (2) κ score of 0.41, moderate agreement; (3) Rater 1 had moderate intrarater agreement (κ score, 0.59), while Raters 2, 3, 4 had substantial intrarater agreement (κ scores, 0.75, 0.66, and 0.71, respectively); and (4) none had most agreement with ISS of greater than 15 (κ score, 0.16), while both definitions ISS greater than 17 and Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions had on average fair agreement (κ scores, 0.27 and 0.39, respectively). Based on subjective assessments, trauma surgeons do not agree on the definition of polytrauma, with the subjective

Untersuchungen ausgewählter Nierenkrankheiten beim Frettchen (Mustela putorius f. furo L. 1758)

OpenAIRE

Riechert, Maren

2005-01-01

Um Häufigkeit, Bedeutung und diätetische Ursachen veränderter Nieren beim Frettchen zu erarbeiten, wurden die Nieren von 63 Heimtieren und 120 Labortieren sonographisch untersucht und Fütterungsanalysen durchgeführt. Anatomische Studien an gesunden Nieren wurden für den Vergleich mit den veränderten Nieren angefertigt. Die Untersuchungen zur Anatomie ergaben für das Frettchen Nieren vom einfachen glatten und einwarzigen Typ. Des Weiteren konnten mithilfe von anatomischen ...

Radiological management of blunt polytrauma with computed tomography and angiography: an integrated approach

Energy Technology Data Exchange (ETDEWEB)

Kurdziel, J.C.; Dondelinger, R.F.; Hemmer, M.

1987-01-01

107 polytraumatized patients, who had experienced blunt trauma have been worked up at admission with computed tomography of the thorax, abdomen and pelvis following computed tomography study of the brain: significant lesions were revealed in 98 (90%) patients. 79 (74%) patients showed trauma to the thorax, in 69 (64%) patients abdominal or pelvic trauma was evidenced. No false positive diagnosis was established. 5 traumatic findings were missed. Emergency angiography was indicated in 3 (3%) patients, following computed tomography examination. 3 other trauma patients were submitted directly to angiography without computed tomography examination during the time period this study was completed. Embolization was carried out in 5/6 patients. No thoracotomy was needed. 13 (12%) patients underwent laparotomy following computed tomography. Overall mortality during hospital stay was 14% (15/107). No patient died from visceral bleeding. Conservative management of blunt polytrauma patients can be advocated in almost 90% of visceral lesions. Computed tomography coupled with angiography and embolization represent an adequate integrated approach to the management of blunt polytrauma patients.

Radiological management of blunt polytrauma with computed tomography and angiography: an integrated approach

International Nuclear Information System (INIS)

Kurdziel, J.C.; Dondelinger, R.F.; Hemmer, M.

1987-01-01

107 polytraumatized patients, who had experienced blunt trauma have been worked up at admission with computed tomography of the thorax, abdomen and pelvis following computed tomography study of the brain: significant lesions were revealed in 98 (90%) patients. 79 (74%) patients showed trauma to the thorax, in 69 (64%) patients abdominal or pelvic trauma was evidenced. No false positive diagnosis was established. 5 traumatic findings were missed. Emergency angiography was indicated in 3 (3%) patients, following computed tomography examination. 3 other trauma patients were submitted directly to angiography without computed tomography examination during the time period this study was completed. Embolization was carried out in 5/6 patients. No thoracotomy was needed. 13 (12%) patients underwent laparotomy following computed tomography. Overall mortality during hospital stay was 14% (15/107). No patient died from visceral bleeding. Conservative management of blunt polytrauma patients can be advocated in almost 90% of visceral lesions. Computed tomography coupled with angiography and embolization represent an adequate integrated approach to the management of blunt polytrauma patients

Is the golden hour optimally used in South Africa for children presenting with polytrauma?

NARCIS (Netherlands)

J. Zuidgeest (J.); A. Jonkheijm (Annabel); M. van Dijk (Monique); A.B. van As (Àrjan Bastiaan)

2013-01-01

textabstractBackground. The major paediatric public health problem worldwide is injury or trauma. In 2004, 950 000 children died as a result of injury. Objective. The aim of this study was to evaluate the logistics of medical care after paediatric polytrauma within the first hours after arrival into

Early Detection of Junctional Adhesion Molecule-1 (JAM-1 in the Circulation after Experimental and Clinical Polytrauma

Directory of Open Access Journals (Sweden)

Stephanie Denk

2015-01-01

Full Text Available Severe tissue trauma-induced systemic inflammation is often accompanied by evident or occult blood-organ barrier dysfunctions, frequently leading to multiple organ dysfunction. However, it is unknown whether specific barrier molecules are shed into the circulation early after trauma as potential indicators of an initial barrier dysfunction. The release of the barrier molecule junctional adhesion molecule-1 (JAM-1 was investigated in plasma of C57BL/6 mice 2 h after experimental mono- and polytrauma as well as in polytrauma patients (ISS ≥ 18 during a 10-day period. Correlation analyses were performed to indicate a linkage between JAM-1 plasma concentrations and organ failure. JAM-1 was systemically detected after experimental trauma in mice with blunt chest trauma as a driving force. Accordingly, JAM-1 was reduced in lung tissue after pulmonary contusion and JAM-1 plasma levels significantly correlated with increased protein levels in the bronchoalveolar lavage as a sign for alveolocapillary barrier dysfunction. Furthermore, JAM-1 was markedly released into the plasma of polytrauma patients as early as 4 h after the trauma insult and significantly correlated with severity of disease and organ dysfunction (APACHE II and SOFA score. The data support an early injury- and time-dependent appearance of the barrier molecule JAM-1 in the circulation indicative of a commencing trauma-induced barrier dysfunction.

Early Detection of Junctional Adhesion Molecule-1 (JAM-1) in the Circulation after Experimental and Clinical Polytrauma

Science.gov (United States)

Denk, Stephanie; Wiegner, Rebecca; Hönes, Felix M.; Messerer, David A. C.; Radermacher, Peter; Kalbitz, Miriam; Braumüller, Sonja; McCook, Oscar; Gebhard, Florian; Weckbach, Sebastian; Huber-Lang, Markus

2015-01-01

Severe tissue trauma-induced systemic inflammation is often accompanied by evident or occult blood-organ barrier dysfunctions, frequently leading to multiple organ dysfunction. However, it is unknown whether specific barrier molecules are shed into the circulation early after trauma as potential indicators of an initial barrier dysfunction. The release of the barrier molecule junctional adhesion molecule-1 (JAM-1) was investigated in plasma of C57BL/6 mice 2 h after experimental mono- and polytrauma as well as in polytrauma patients (ISS ≥ 18) during a 10-day period. Correlation analyses were performed to indicate a linkage between JAM-1 plasma concentrations and organ failure. JAM-1 was systemically detected after experimental trauma in mice with blunt chest trauma as a driving force. Accordingly, JAM-1 was reduced in lung tissue after pulmonary contusion and JAM-1 plasma levels significantly correlated with increased protein levels in the bronchoalveolar lavage as a sign for alveolocapillary barrier dysfunction. Furthermore, JAM-1 was markedly released into the plasma of polytrauma patients as early as 4 h after the trauma insult and significantly correlated with severity of disease and organ dysfunction (APACHE II and SOFA score). The data support an early injury- and time-dependent appearance of the barrier molecule JAM-1 in the circulation indicative of a commencing trauma-induced barrier dysfunction. PMID:26556956

Fractures and dislocations of the hand in polytrauma patients : Incidence, injury pattern and functional outcome

NARCIS (Netherlands)

Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence,

Handlungsmuster von Lehrerinnen und Lehrern beim Einsatz neuer Medien. Grundlagen eines Projekts zur empirischen Unterrichtsforschung

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Sigrid Blömeke

2017-08-01

Full Text Available Ziel des vorzustellenden Projekts ist es in einem ersten Schritt, Handlungsmuster von Lehrpersonen beim Einsatz von neuen Medien im Unterricht der Fächer Deutsch, Mathematik und Informatik der Sekundarstufe II zu identifizieren. Zu diesem Zweck werden Videoaufnahmen von 30 Unterrichtsstunden im Hinblick auf zugrunde liegende ‚Unterrichtsscripts’ (i.e. didaktische Routinen analysiert und die subjektiven Theorien der Lehrkräfte zum Lehren und Lernen erhoben. Bei der Zusammensetzung der Stichprobe findet neben der Variation der Fachzugehörigkeit der Expertisegrad der Lehrpersonen bezogen auf den Einsatz neuer Medien Berücksichtigung, und zwar in zwei Abstufungen (hoch – niedrig. Auf diese Weise wird ermöglicht, in einem zweiten Schritt begründet Hypothesen zu Zusammenhängen zwischen Handlungsmustern sowie Fach und Expertise als Kontextfaktoren zu generieren und mögliche Geltungsbereiche zu beschreiben. Über diese Grundlagenforschung hinausgehend sollen in einem dritten Schritt anhand der gewonnenen Erkenntnisse Interventionen entwickelt werden, die eine Weiterentwicklung von Lehrerhandeln beim Einsatz neuer Medien im Unterricht ermöglichen. Hier stellt sich allerdings die Frage, wie sich Handeln grundsätzlich verändern lässt.

Patterns and Outcome of Missed Injuries in Egyptians Polytrauma Patients

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Adel Hamed Elbaih

2018-01-01

Full Text Available Introduction: “polytrauma” patients are higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, missed injuries still significant affect modern trauma services and its outcome. Aim: to improve outcome and determine the incidence and nature of missed injuries in polytrauma patients. Methods: the study is a cross-sectional, prospective study included 600 polytraumatized patients admitted in Suez Canal University Hospital. Firstly assessed and treated accordingly to Advanced Trauma Life Support (ATLS guidelines and treat the life threading conditions if present with follow-up short outcome for 28 days. Results: The most common precipitate factor for missed injuries in my study was clinical evaluation error due to Inadequate diagnostic workup in 42.9%. And the second risk factor was Deficiency in Physical Examination in 35.7%. Lastly Incomplete assessment due to patient instability in 10.7% and incorrect interpretation of imaging10.7%.low rates of missed injuries (40.8% in patients arriving during the day compared with (59.2% of night arrivals. Conclusion: the incidence of missed injuries in the study is 9.0 % which is still high compared to many trauma centers. And mostly increase the period of stay in the hospital and affect the outcome of polytrauma patients.

Fresh Frozen Plasma Resuscitation Provides Neuroprotection Compared to Normal Saline in a Large Animal Model of Traumatic Brain Injury and Polytrauma

DEFF Research Database (Denmark)

Imam, Ayesha; Jin, Guang; Sillesen, Martin

2015-01-01

Abstract We have previously shown that early treatment with fresh frozen plasma (FFP) is neuroprotective in a swine model of hemorrhagic shock (HS) and traumatic brain injury (TBI). However, it remains unknown whether this strategy would be beneficial in a more clinical polytrauma model. Yorkshire...... as well as cerebral perfusion pressures. Levels of cerebral eNOS were higher in the FFP-treated group (852.9 vs. 816.4 ng/mL; p=0.03), but no differences in brain levels of ET-1 were observed. Early administration of FFP is neuroprotective in a complex, large animal model of polytrauma, hemorrhage...

The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.

Science.gov (United States)

Licht, Heather; Murray, Mark; Vassaur, John; Jupiter, Daniel C; Regner, Justin L; Chaput, Christopher D

2015-11-18

With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Zum Erleben von Thrills und anderen starken emotionalen Reaktionen beim Musikhören

OpenAIRE

Schönberger, Jörg

2003-01-01

Obwohl unbestritten ist, dass Musik in der Lage ist, starke emotionale Reaktionen auszulösen, hat sich die Musikpsychologie wenig mit den Emotionen beschäftigt, die Menschen beim Musikhören erleben. Zwei mögliche Zugänge zum Erfassen solch starker emotionaler Reaktionen sind die Ansätze von John A. Sloboda und Alf Gabrielsson. Sloboda nutzt für seinen Ansatz das Phänomen der "Thrills" — physiologische Begleiterscheinungen starker emotionaler Reaktionen wie z.B. Gänsehaut, Schauer, die ü...

The practicality of including the systemic inflammatory response syndrome in the definition of polytrauma: experience of a level one trauma centre.

Science.gov (United States)

Butcher, Nerida E; Balogh, Zsolt J

2013-01-01

The systemic inflammatory response syndrome (SIRS) has been advocated as a significant predictor of outcome in trauma. Recent trauma literature has proposed SIRS as a surrogate for physiological derangements characteristic of polytrauma with some authors recommending its inclusion into the definition of polytrauma. The practicality of daily SIRS collection outside of specifically designed prospective trials is unknown. The purpose of this study was to assess the availability of SIRS variables and its appropriateness for inclusion into a definition of polytrauma. We hypothesised SIRS variables would be readily available and easy to collect, thus represent an appropriate inclusion into the definition of polytrauma. A prospective observational study of all trauma team activation patients over 7-months (August 2009 to February 2010) at a University affiliated level-1 urban trauma centre. SIRS data (temperature>38°C or 90 bpm; RR>20/min or a PaCO(2)12.0×10(9)L(-1), or 10 immature bands) collected from presentation, at 24 h intervals until 72 h post injury. Inclusion criteria were all patients generating a trauma team activation response age >16. 336 patients met inclusion criteria. In 46% (155/336) serial SIRS scores could not be calculated due to missing data. Lowest rates of missing data observed on admission [3% (11/336)]. Stratified by ISS>15 (132/336), in 7% (9/132) serial SIRS scores could not be calculated due to missing data. In 123 patients ISS>15 with complete data, 81% (100/123) developed SIRS. For Abbreviated Injury Scale (AIS)>2 in at least 2 body regions (64/336) in 5% (3/64) serial SIRS scores could not be calculated, with 92% (56/61) of patients with complete data developing SIRS. For Direct ICU admissions [25% (85/336)] 5% (4/85) of patients could not have serial SIRS calculated [mean ISS 15(±11)] and 90% (73/81) developed SIRS at least once over 72 h. Based on the experience of our level-1 trauma centre, the practicability of including SIRS into the

Evaluation of a dual-room sliding gantry CT concept for workflow optimisation in polytrauma and regular in- and outpatient management

Energy Technology Data Exchange (ETDEWEB)

Frellesen, Claudia; Boettcher, Marie; Wichmann, Julian L.; Drieske, Martina; Kerl, J. Matthias; Lehnert, Thomas [Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany); Nau, Christoph; Geiger, Emmanuel; Wutzler, Sebastian [Department of Trauma, Reconstructive and Hand Surgery, Clinic of the Goethe University, Frankfurt (Germany); Ackermann, Hanns [Department of Biostatistics and Mathematical Modelling, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany); Bauer, Ralf W., E-mail: ralfwbauer@aol.com [Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany)

2015-01-15

Highlights: • A sliding gantry trauma room CT solution facilitates significantly faster polytrauma management. • Faster and more efficient resumption of regularly scheduled patients due to a two room solution is supported. • Sliding gantry CT achieves the same patient throughput as two separate conventional CT devices. - Abstract: Objectives: To reveal the impact on workflow from introducing a dual-room sliding gantry CT to the trauma room for polytrauma and regularly scheduled in- outpatients with regard to efficiency and degree of capacity utilisation. Materials and methods: Time analysis was performed for 30 polytrauma patients each in 2 different trauma room settings, the new trauma room comprising a sliding gantry CT, the old one a stationary single-room CT. Complete trauma room and diagnostic workup times were manually measured and compared for both groups. In a third scenario, the number of CT scans performed with one single sliding gantry CT and the two-room concept was compared to the number of CT scans performed on two separate regular CT units in a 5 days clinical routine sample. Results: Patients demographics and type of CT examinations were comparable for all patient groups. The median time from patient arrival in the trauma room until beginning of CT scanning was 6 min shorter for the sliding gantry CT group (21 vs.15 min). Sliding gantry CT embedded in a two-room solution achieved 252 CT scans in 5 working days, compared to 250 CT scans on two separate regular CT units with the same man power. Conclusions: Sliding gantry CT in the trauma room allows for significant time saving in the diagnostic workup of polytrauma patients and faster resumption of the regular in- outpatient's CT schedule is possible. With the same man power, the dual-room solution is able to generate the same throughput as two separate CT units.

Evaluation of a dual-room sliding gantry CT concept for workflow optimisation in polytrauma and regular in- and outpatient management

International Nuclear Information System (INIS)

Frellesen, Claudia; Boettcher, Marie; Wichmann, Julian L.; Drieske, Martina; Kerl, J. Matthias; Lehnert, Thomas; Nau, Christoph; Geiger, Emmanuel; Wutzler, Sebastian; Ackermann, Hanns; Vogl, Thomas J.; Bauer, Ralf W.

2015-01-01

Highlights: • A sliding gantry trauma room CT solution facilitates significantly faster polytrauma management. • Faster and more efficient resumption of regularly scheduled patients due to a two room solution is supported. • Sliding gantry CT achieves the same patient throughput as two separate conventional CT devices. - Abstract: Objectives: To reveal the impact on workflow from introducing a dual-room sliding gantry CT to the trauma room for polytrauma and regularly scheduled in- outpatients with regard to efficiency and degree of capacity utilisation. Materials and methods: Time analysis was performed for 30 polytrauma patients each in 2 different trauma room settings, the new trauma room comprising a sliding gantry CT, the old one a stationary single-room CT. Complete trauma room and diagnostic workup times were manually measured and compared for both groups. In a third scenario, the number of CT scans performed with one single sliding gantry CT and the two-room concept was compared to the number of CT scans performed on two separate regular CT units in a 5 days clinical routine sample. Results: Patients demographics and type of CT examinations were comparable for all patient groups. The median time from patient arrival in the trauma room until beginning of CT scanning was 6 min shorter for the sliding gantry CT group (21 vs.15 min). Sliding gantry CT embedded in a two-room solution achieved 252 CT scans in 5 working days, compared to 250 CT scans on two separate regular CT units with the same man power. Conclusions: Sliding gantry CT in the trauma room allows for significant time saving in the diagnostic workup of polytrauma patients and faster resumption of the regular in- outpatient's CT schedule is possible. With the same man power, the dual-room solution is able to generate the same throughput as two separate CT units

The Effect Of Supraphysiologic Blood Pressure on Traumatic Brain Injury and Proximal Tissue Beds During Resuscitative Balloon Occlusion of the Aorta and Variable Aortic Control in a Porcine Model (Sus scrofa) of Polytrauma.

Science.gov (United States)

2017-04-27

Control In A Porcine Model (Sus Scrofa) Of Polytrauma . PRINCIPAL INVESTIGATOR (PI) / TRAINING COORDINATOR (TC): Lt Col Timothy Williams DEPARTMENT...Mandatory) The Effect of REBOA, Partial Aortic Occlusion and Aggressive Blood Transfusion on Traumatic Brain Injury in a Swine Polytrauma Model

IDENTIFICATION AND DESCRIPTION OF A NOVEL MURINE MODEL FOR POLYTRAUMA AND SHOCK

Science.gov (United States)

Gentile, Lori F; Nacionales, Dina C; Cuenca, Alex G; Armbruster, Michael; Ungaro, Ricardo F; Abouhamze, Amer S; Lopez, Cecelia; Baker, Henry V; Moore, Frederick A; Ang, Darwin N; Efron, Philip A

2013-01-01

Objective To develop a novel polytrauma model that better recapitulates the immunological response of the severely injured patient by combining long-bone fracture, muscle tissue damage and cecectomy with hemorrhagic shock, resulting in an equivalent Injury Severity Score of greater than 15. We compared this new polytrauma/shock model to historically-used murine trauma-hemorrhage models. Design Pre-clinical controlled in vivo laboratory study. Setting Laboratory of Inflammation Biology and Surgical Science. Subjects 6–10 wk old C57BL/6 (B6) mice Interventions Mice underwent 90 minutes of shock (MAP 30 mmHg) and resuscitation via femoral artery cannulation followed by either laparotomy (TH), laparotomy with femur fracture (H+FFx), or laparotomy with cecetomy and femur fracture with muscle tissue damage (PT). Mice were euthanized at two hours, one day and three days post injury. Measurements and Main Results The spleen, bone marrow, blood, and serum were collected from mice for analysis at the above time points. None of the models were lethal. Mice undergoing PT exhibited a more robust inflammatory response with significant elevations in cytokine/chemokine concentrations when compared to traditional models. PT was the only model to induce neutrophilia (Ly6G+CD11b+ cells) on days 1 and 3 (ppolytrauma model better replicates the human leukocyte, cytokine, and overall inflammatory response following injury and hemorrhagic shock. PMID:23399937

Bladder injuries frequently missed in polytrauma patients

Directory of Open Access Journals (Sweden)

Tanweer Karim

2010-05-01

Full Text Available Tanweer Karim, Margaret Topno, Vinod Sharma, Raymond Picardo, Ankur HastirSurgery, MGM Medical College, Kamothe, Navi Mumbai, IndiaAbstract: Bladder injuries are very common in patients who have had road traffic accidents. The method of diagnosis and management of such injuries is well established and accepted. However, trauma to the bladder can be associated with other life-threatening injuries which are frequently missed, and often diagnosed during laparotomy for other reasons. The aim of this study was to diagnose bladder injury in polytrauma patients as early as possible, taking into consideration the fact that these patients are hemodynamically unstable and require rapid evaluation and management. In order to achieve our objective, we used bedside sonography with retrograde instillation of normal saline to diagnose bladder injury in addition to use of the conventional retrograde cystogram.Keywords: bladder injury, bladder rupture, retrograde cystogram

The Relationship between Training and Mental Health among Caregivers of Individuals with Polytrauma

Directory of Open Access Journals (Sweden)

Lillian Flores Stevens

2015-01-01

Full Text Available This was a hypothesis-generating exploration of relationships between caregiver training during TBI/polytrauma rehabilitation and caregiver mental health. In this cross-sectional study, 507 informal caregivers to US service members with TBI who received inpatient rehabilitation care in a Veterans Affairs’ Polytrauma Rehabilitation Center from 2001 to 2009 completed a retrospective, self-report survey. Embedded in the survey were measures of caregiver mental health, including the National Institutes of Health’s Patient Reported Outcome Measurement Information System (PROMIS Anxiety and Depression Short Forms, the Rosenberg Self-Esteem scale, and the Zarit Burden Short Form. Though no groups endorsed clinical levels, mental health symptoms varied by caregiver training category (Trained, Not Trained, and Did Not Need Training. Caregivers who did not receive training on how to navigate healthcare systems endorsed higher depression and burden and lower self-esteem than those who did. Caregivers who did not receive training in supporting their care recipients’ emotions endorsed higher anxiety, depression, and burden and lower self-esteem than those who did. Analyses also suggested a different association between training and mental health based on caregivers’ relationship to the care recipient and the intensity of care recipient needs. Potential hypotheses for testing in future studies raised by these findings are discussed.

The Relationship between Training and Mental Health among Caregivers of Individuals with Polytrauma

Science.gov (United States)

Pickett, Treven C.; Wilder Schaaf, Kathryn P.; Taylor, Brent C.; Gravely, Amy; Van Houtven, Courtney Harold; Friedemann-Sánchez, Greta; Griffin, Joan M.

2015-01-01

This was a hypothesis-generating exploration of relationships between caregiver training during TBI/polytrauma rehabilitation and caregiver mental health. In this cross-sectional study, 507 informal caregivers to US service members with TBI who received inpatient rehabilitation care in a Veterans Affairs' Polytrauma Rehabilitation Center from 2001 to 2009 completed a retrospective, self-report survey. Embedded in the survey were measures of caregiver mental health, including the National Institutes of Health's Patient Reported Outcome Measurement Information System (PROMIS) Anxiety and Depression Short Forms, the Rosenberg Self-Esteem scale, and the Zarit Burden Short Form. Though no groups endorsed clinical levels, mental health symptoms varied by caregiver training category (Trained, Not Trained, and Did Not Need Training). Caregivers who did not receive training on how to navigate healthcare systems endorsed higher depression and burden and lower self-esteem than those who did. Caregivers who did not receive training in supporting their care recipients' emotions endorsed higher anxiety, depression, and burden and lower self-esteem than those who did. Analyses also suggested a different association between training and mental health based on caregivers' relationship to the care recipient and the intensity of care recipient needs. Potential hypotheses for testing in future studies raised by these findings are discussed. PMID:26770015

The quest for a universal definition of polytrauma: a trauma registry-based validation study.

Science.gov (United States)

Butcher, Nerida E; D'Este, Catherine; Balogh, Zsolt J

2014-10-01

A pilot validation recommended defining polytrauma as patients with an Abbreviated Injury Scale (AIS) score greater than 2 in at least two Injury Severity Score (ISS) body regions (2 × AIS score > 2). This study aimed to validate this definition on larger data set. We hypothesized that patients defined by the 2 × AIS score > 2 cutoff have worse outcomes and use more resources than those without 2 × AIS score > 2 and that this would therefore be a better definition of polytrauma. Patients injured between 2009 and 2011, with complete documentation of AIS by New South Wales Trauma Registry and 16 years and older were selected. Age and sex were obtained in addition to outcomes of ISS, hospital length of stay (LOS), intensive care unit (ICU) admission, ICU LOS, and mortality. We compared demographic characteristics and outcomes between patients with ISS greater than 15 who did and did not meet the 2 × AIS score > 2 definition. We then undertook regression analyses (logistic regression for binary outcomes [ICU admission and death] and linear regression for hospital and ICU LOS) to compare outcomes for patients with and without 2 × AIS score > 2, adjusting for sex and age categories. In the adjusted analyses, patients with 2 × AIS score > 2 had twice the odds of being admitted to the ICU compared with those without 2 × AIS score > 2 (odds ratio, 2.5; 95% confidence interval [CI], 2.2-2.8) and 1.7 times the odds of dying (95% CI, 1.4-2.0; p 2 also had a mean difference of 1.5 days longer stay in the hospital compared with those without 2 × AIS score > 2 (95% CI, 1.4-1.7) and 1.6 days longer ICU stay (95% CI, 1.4-1.8; p 2 had higher mortality, more frequent ICU admissions, and longer hospital and ICU stay than those without 2 × AIS score > 2 and represents a superior definition to the definitions for polytrauma currently in use. Diagnostic test/ criteria, level III.

The utilization of dual source CT in imaging of polytrauma

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Nicolaou, S. [University of British Columbia, Vancouver General Hospital, Department of Radiology, 899 West 12th Avenue, Vancouver, British Columbia, V5Z1M9 (Canada)], E-mail: savvas.nicolaou@vch.ca; Eftekhari, A.; Sedlic, T.; Hou, D.J.; Mudri, M.J.; Aldrich, John; Louis, L. [University of British Columbia, Vancouver General Hospital, Department of Radiology, 899 West 12th Avenue, Vancouver, British Columbia, V5Z1M9 (Canada)

2008-12-15

Despite the growing role of imaging, trauma remains the leading cause of death in people below the age of 45 years in the western industrialized countries. Trauma has been touted as the largest epidemic in the 20th century. The advent of MDCT has been the greatest advance in trauma care in the last 25 years. However, there are still challenges in CT imaging of the polytrauma individual including time restraints, diagnostic errors, radiation dose effects and bridging the gap between anatomy and physiology. This article will analyze these challenges and provide possible solutions offered by the unique design of the dual source CT scanner.

The utilization of dual source CT in imaging of polytrauma

International Nuclear Information System (INIS)

Nicolaou, S.; Eftekhari, A.; Sedlic, T.; Hou, D.J.; Mudri, M.J.; Aldrich, John; Louis, L.

2008-01-01

Despite the growing role of imaging, trauma remains the leading cause of death in people below the age of 45 years in the western industrialized countries. Trauma has been touted as the largest epidemic in the 20th century. The advent of MDCT has been the greatest advance in trauma care in the last 25 years. However, there are still challenges in CT imaging of the polytrauma individual including time restraints, diagnostic errors, radiation dose effects and bridging the gap between anatomy and physiology. This article will analyze these challenges and provide possible solutions offered by the unique design of the dual source CT scanner

Pattern of cytokine (IL-6 and IL-10) level as inflammation and anti-inflammation mediator of multiple organ dysfunction syndrome (MODS) in polytrauma.

Science.gov (United States)

Sapan, Heber Bombang; Paturusi, Idrus; Jusuf, Irawan; Patellongi, Ilhamjaya; Massi, Muh Nasrum; Pusponegoro, Aryono Djuned; Arief, Syafrie Kamsul; Labeda, Ibrahim; Islam, Andi Asadul; Rendy, Leo; Hatta, Mochammad

2016-01-01

Massive injury remains the most common cause of death for productive age group globally. The current immune, inflammatory paradigm, based on an incomplete understanding of the functional integration of the complex host response, remains a major impediment to the development of effective innovative diagnostic and therapeutic effort. This study attempt to investigate the pattern of inflammatory and anti-inflammatory cytokines such as interleukin-6 and 10 (IL-6 and IL-10) and their interaction in severe injury condition with its major complication as multiple organ dysfunction syndrome (MODS) and failure (MOF) after polytrauma. This is multicenter study held at 4 academic Level-1 Trauma center included 54 polytrauma participants. Inclusion criteria were age between 16-60 years old, had new acute episode of polytrauma which defined as injury in ≥2 body region with Injury Severity Score (ISS) ≥16, and the presence of Systemic Inflammation Response Syndrome (SIRS). Serum level of IL-6 and IL-10 were taken on day 2, 3, and 5 after trauma. During hospitalization, samples were observed for the occurrence of MODS or MOF using Sequential Organ Failure Assessment (SOFA) and mortality rate were also noted. Participant were mostly male with mean of age of 35, 9 years old, endured polytrauma caused by traffic accident. Elevation of cytokines (IL-6, IL-10, and IL-6/IL-10 ratio) had directly proportional with MODS and mortality. Threshold level of compensation for severe trauma is IL-6 of 50 pg/mL and trauma load of ISS ≥30. Inflammation reaction greater than this threshold level would result in downhill level of IL-6, IL-10, or IL-6/IL-10 ratio which associated with poor outcome (MODS and death). The elevation of these cytokines level were represent as compensation/adaptive immune system and its fall represent decompensating/failure of immune system after severe trauma. The pattern of IL-6 and IL-10 after polytrauma represent immune system effort to restore homeostasis

Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients.

Science.gov (United States)

Elbaih, Adel Hamed; Abu-Elela, Sameh T

2017-12-01

The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynamically unstable polytraumatized patients and to determine its role as an indication of laparotomy. This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS (advanced trauma life support) guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

[Polytrauma following a truck accident : How to save lives by guideline-oriented emergency care].

Science.gov (United States)

Kippnich, M; Jelting, Y; Markus, C; Kredel, M; Wurmb, T; Kranke, P

2017-12-01

Identification and immediate treatment of life-threatening conditions is fundamental in patients with multiple trauma. In this context, the S3 guidelines on polytrauma and the S1 guidelines on emergency anesthesia provide the scientific background on how to handle these situations. This case report deals with a seriously injured driver involved in a truck accident. The inaccessible patient showed a scalping injury of the facial skeleton with massive bleeding and partially blocked airway but with spontaneous breathing as well as centralized cardiovascular circulation conditions and an initial Glasgow coma scale (GCS) of 8. An attempt was made to stop the massive bleeding by using hemostyptic-coated dressings. In addition, the patient was intubated via video laryngoscopy and received a left and right thoracic drainage as well as two entry points for intraosseous infusion. In modern emergency medical services, treatment based on defined algorithms is recommended and also increasingly established in dealing with critical patients. The guideline-oriented emergency care of patients with polytrauma requires invasive measures, such as intubation and thoracic decompression in the preclinical setting. The foundation for this procedure includes training in theory and practice both of the non-medical and medical rescue service personnel.

Treatment of air leak in polytrauma patients with blunt chest injury.

Science.gov (United States)

Halat, Gabriel; Negrin, Lukas L; Chrysou, Konstantina; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

2017-09-01

Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of air leak in polytrauma patients with blunt chest trauma. The aim of this study was to evaluate the incidence, characteristics, and management of air leak following this injury pattern. Data from 110 polytrauma patients was collected retrospectively. Fifty-four patients received initial treatment by chest tube placement for pneumothorax. These patients were classified into two groups, one with severe air leak and one with minor air leak. An evaluation of injury pattern, chest wall injuries in particular, duration of air leak, reason for drainage maintenance in place, hospital length of stay, ICU stay, ventilator duration, type of treatment, and the delay to surgical intervention was performed. Whereas 4 patients showed severe air leak and were subsequently scheduled for timely surgical intervention, the remaining 50 patients only showed minor air leak. Only 7 patients with minor air leak suffered from prolonged air leak (>5days), which spontaneously resolved in all of them after a mean duration of 7.7days (range 6-12days). Absence of a prolonged air leak resulted in a shorter length of stay and a shorter duration of mechanical ventilation, although no statistical significance was observed. Early spontaneous cessation of most minor air leaks as well as early surgical intervention for severe air leak lead to very satisfactory patient outcomes with a relatively short hospital stay in our patients. We therefore advocate early surgery for lacerations of the pulmonary parenchyma resulting in severe air leak, whereas minor air leaks can usually be treated conservatively. Copyright © 2017 Elsevier Ltd. All rights reserved.

Kinked and retained nasogastric tube in polytrauma patient; a case report

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Kumar Ashok

2017-06-01

Full Text Available Enteral feeding is an important and preferred technique of feeding in head injury patient to provide nutrition. As inadequate nutrition causes decrease in physical ability, neurological impairment and takes a long time for improvement or delayed deterioratation. With our best knowledge kinked and retained nasogastric tube in stomach is a very rare complication of feeding in head injuries patients. Predisposing factors that can cause kinking is excess tube length, tube in situ for long time and small bore tube. We are reporting one such case of kinked and retained nasogastric tube in the stomach of a polytrauma patient which was retrieved by upper GI endoscope.

Juvenile Stroke: Cervical Artery Dissection in a Patient after a Polytrauma

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Nicole Marschner-Preuth

2013-01-01

Full Text Available Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (polytrauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms.We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm.To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.

Penetrating Cardiac and Hepatic Injury; Polytrauma of a Child After Bombing

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Baris Akca

2013-10-01

Full Text Available After a bombing attack, patients were brought into hospital suffering from a combination of injuries caused by the blast, penetrating injuries and burns which as a case of polytrauma. In penetrating thoracoabdominal injuries due to bombing possibility of cardiac injury should be kept in mind. Penetrating cardiac injuries in children are rare but has a high mortality and morbidity. In some cases there may be difficulty in diagnosis of penetrating cardiac injury. In this case we want to share the diagnosis, treatment and follow-up processes of penetrating cardiac and hepatic injury with burns of a politrauma child due to bombing.

A novel evaluation of microvascular damage in critically ill polytrauma patients by using circulating microRNAs

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Bedreag Ovidiu Horea

2016-03-01

Full Text Available The management of the critically ill polytrauma patient is complex due to the multiple complications and biochemical and physiopathological imbalances. This happened due to the direct traumatic injury, or due to the post-traumatic events. One of the most complex physiopathology associated to the multiple traumas is represented by microvascular damage, subsequently responsible for a series of complications induced through the imbalance of the redox status, severe molecular damage, reduction of the oxygen delivery to the cell and tissues, cell and mitochondrial dead, augmentation of the inflammatory response and finally the installation of multiple organ dysfunction syndrome in this type of patients. A gold goal in the intensive care units is represented by the evaluation and intense monitoring of the molecular and physiopathological dysfunctions of the critically ill patients. Recently, it was intensely researched the use of microRNAs as biomarkers for the specific physiopathological dysfunctions. In this paper we wish to present a series of microRNAs that can serve as biomarkers for the evaluation of microvascular damage, as well as for the evaluation of other specific physiopathology for the critically ill polytrauma patient.

Provisional reporting of polytrauma CT by on-call radiology registrars. Is it Safe?

Energy Technology Data Exchange (ETDEWEB)

Briggs, R.H., E-mail: robbriggs@hotmail.co.u [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Rowbotham, E.; Johnstone, A.L.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

2010-08-15

Aim: To assess the accuracy of provisional reporting and the impact on patient management. Materials and methods: Over a 6 month period, 137 polytrauma computed tomography (CT) examinations were performed by on-call registrar radiologists at our institution. After exclusions, 130 cases were analysed. Discrepancies between registrar and consultant reports were reviewed and classified as either major or minor dependent on potential impact on patient safety. The relationship between seniority of reporting registrar and likelihood of a missed finding was analysed using the Chi-square test. Results: Of the 130 patients, 46 (35%) had a serious injury, 36 (28%) a minor injury, and 48 (38%) no identifiable injury on CT. There were 32 (25%) patients with discrepancies of which 24 (18%) had missed or significantly under-reported findings and eight (6%) overcalled findings. There were six misses classified as major; the remaining 18 were classified as minor. No association was found between the seniority of reporting registrar and the likelihood of a miss (p = 0.96). Conclusion: The incidence of major discrepancies between the provisional and final report was low and did not lead to any significant clinical deterioration. Our study provides a reference of the commonly missed injuries. We conclude that registrar provisional reporting of polytrauma is safe; however, note that a large proportion of examinations are normal and that further work is required to produce robust criteria given the radiation risk to a young population group scanned in trauma.

Provisional reporting of polytrauma CT by on-call radiology registrars. Is it Safe?

International Nuclear Information System (INIS)

Briggs, R.H.; Rowbotham, E.; Johnstone, A.L.; Chalmers, A.G.

2010-01-01

Aim: To assess the accuracy of provisional reporting and the impact on patient management. Materials and methods: Over a 6 month period, 137 polytrauma computed tomography (CT) examinations were performed by on-call registrar radiologists at our institution. After exclusions, 130 cases were analysed. Discrepancies between registrar and consultant reports were reviewed and classified as either major or minor dependent on potential impact on patient safety. The relationship between seniority of reporting registrar and likelihood of a missed finding was analysed using the Chi-square test. Results: Of the 130 patients, 46 (35%) had a serious injury, 36 (28%) a minor injury, and 48 (38%) no identifiable injury on CT. There were 32 (25%) patients with discrepancies of which 24 (18%) had missed or significantly under-reported findings and eight (6%) overcalled findings. There were six misses classified as major; the remaining 18 were classified as minor. No association was found between the seniority of reporting registrar and the likelihood of a miss (p = 0.96). Conclusion: The incidence of major discrepancies between the provisional and final report was low and did not lead to any significant clinical deterioration. Our study provides a reference of the commonly missed injuries. We conclude that registrar provisional reporting of polytrauma is safe; however, note that a large proportion of examinations are normal and that further work is required to produce robust criteria given the radiation risk to a young population group scanned in trauma.

Interdisciplinary stratification of patients with myoma-related symptoms; Interdisziplinaere Stratifizierung von Patientinnen mit myombedingten Beschwerden

Energy Technology Data Exchange (ETDEWEB)

David, M. [Campus Virchow-Klinikum, Charite - Universitaetsmedizin Berlin, Klinik fuer Frauenheilkunde und Geburtshilfe, Berlin (Germany)

2008-07-15

With the establishment of uterine artery embolization (UAE), the individualization of treatment of the symptomatic myomatous uterus showed a general progression. The concrete therapy decision is made in an interactive process between doctor and patient. A series of factors influence the choice of a suitable, operative or non-operative, therapeutic procedure. In the weighting of therapeutic options between surgery or UAE, in addition to current results of studies which compare both techniques,recommendations made by expert committees and guidelines are helpful for a competent counseling of patients and additionally supportive in decision processes such as interdisciplinary stratification. (orig.) [German] Mit der Etablierung der Uterusarterienembolisation (UAE) wurde die Individualisierung der Behandlung beim symptomatischen Uterus myomatosus insgesamt weiter vorangetrieben. Die Therapieentscheidung wird individuell in einem interaktiven Prozess zwischen Arzt und Patientin getroffen. Eine Reihe von Faktoren beeinflusst die Auswahl eines geeigneten - operativen oder nichtoperativen - Therapieverfahrens. Bei der Abwaegung der Therapieoptionen Operation vs. UAE sind neben aktuellen Ergebnisse von Studien, die beide Verfahren vergleichen, fuer eine kompetente Beratung der Patientinnen Empfehlungen von Expertengremien bzw. Leitlinien hilfreich und in Entscheidungsprozessen wie der interdisziplinaeren Stratifizierung zusaetzlich unterstuetzend. (orig.)

Pharmacological targeting of chemokine (C-X-C motif) receptor 4 in porcine polytrauma and hemorrhage models

Science.gov (United States)

Bach, Harold H.; Wong, Yee M.; LaPorte, Heather M.; Gamelli, Richard L.; Majetschak, Matthias

2016-01-01

BACKGROUND Recent evidence suggests that chemokine receptor CXCR4 regulates vascular α1-adrenergic receptor function and that the noncognate CXCR4 agonist ubiquitin has therapeutic potential after trauma/hemorrhage. Pharmacologic properties of ubiquitin in large animal trauma models, however, are poorly characterized. Thus, the aims of the present study were to determine the effects of CXCR4 modulation on resuscitation requirements after polytrauma, to assess whether ubiquitin influences survival times after lethal polytrauma-hemorrhage, and to characterize its dose-effect profile in porcine models. METHODS Anesthetized pigs underwent polytrauma (PT, femur fractures/lung contusion) alone (Series 1) or PT/hemorrhage (PT/H) to a mean arterial blood pressure of 30 mmHg with subsequent fluid resuscitation (Series 2 and 3) or 40% blood volume hemorrhage within 15 minutes followed by 2.5% blood volume hemorrhage every 15 minutes without fluid resuscitation (Series 4). In Series 1, ubiquitin (175 and 350 nmol/kg), AMD3100 (CXCR4 antagonist, 350 nmol/kg), or vehicle treatment 60 minutes after PT was performed. In Series 2, ubiquitin (175, 875, and 1,750 nmol/kg) or vehicle treatment 60 minutes after PT/H was performed. In Series 3, ubiquitin (175 and 875 nmol/kg) or vehicle treatment at 60 and 180 minutes after PT/H was performed. In Series 4, ubiquitin (875 nmol/kg) or vehicle treatment 30 minutes after hemorrhage was performed. RESULTS In Series 1, resuscitation fluid requirements were significantly reduced by 40% with 350-nmol/kg ubiquitin and increased by 25% with AMD3100. In Series 2, median survival time was 190 minutes with vehicle, 260 minutes with 175-nmol/kg ubiquitin, and longer than 420 minutes with 875-nmol/kg and 1,750-nmol/kg ubiquitin (p 0.05). CONCLUSION These findings further suggest CXCR4 as a drug target after PT/H. Ubiquitin treatment reduces resuscitation fluid requirements and provides survival benefits after PT/H. The pharmacological effects of

Neodadjuvante und adjuvante Kurzzeit-Hormontherapie in Kombination mit konformaler HDR-Brachytherapie beim Prostatakarzinom

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Martin T

2004-01-01

Full Text Available Zielsetzung: Auswertung der Behandlungsergebnisse der neoadjuvanten und adjuvanten Kurzzeit-Hormontherapie kombiniert mit konformaler HDR-Brachytherapie und externer Radiotherapie beim Prostatakarzinom. Patienten und Methoden: Von 01/97 bis 09/99 behandelten wir 102 Patienten mit Prostatakarzinomen im Stadium T1–3 N0 M0. Im Stadium T1–2 befanden sich 71, im Stadium T3 31 Patienten. Der mediane prätherapeutische PSA-Wert betrug 15,3 ng/ml. Nach ultraschallgesteuerter transrektaler Implantation von vier Afterloadingnadeln erfolgte die CT-gestützte 3D-Brachytherapie- Planung. Alle Patienten erhielten vier HDR-Implantate mit einer Referenzdosis von 5 Gy oder 7 Gy pro Implantat. Die Zeit zwischen jedem Implantat betrug jeweils 14 Tage. Nach der Brachytherapie folgte die externe Radiotherapie bis 39,6 Gy oder 45,0 Gy. Alle Patienten erhielten eine neoadjuvante und adjuvante Kurzzeit-Hormontherapie, die 2–19 Monate vor der Brachytherapie eingeleitet und 3 Monate nach Abschluß der externen Radiotherapie abgesetzt wurde (mediane Dauer: 9 Monate. Ergebnisse: Die mediane Nachbeobachtungszeit war 2,6 Jahre (range: 2,0–4,1 Jahre. Die biochemische Kontrollrate betrug 82 % nach 3 Jahren. Bei 14/102 Patienten registrierten wir ein biochemisches Rezidiv, bei 5/102 Patienten ein klinisches Rezidiv. Das Gesamtüberleben betrug 90 %, das krankheitsspezifische Überleben 98,0 % nach 3 Jahren. Ein Patient entwickelte eine prostato-urethro-rektale Fistel als späte Grad 4-Toxizität. Akute Grad-3 Toxizitäten traten bei 4 %, späte Grad-3 Toxizitäten bei 5 % der Patienten auf. Schlußfolgerung: Die neoadjuvante und adjuvante Kurzzeit-Hormontherapie kombiniert mit konformaler HDR-Brachytherapie und externer Radiotherapie erweist sich als sichere und wirksame Behandlungsmodalität beim Prostatakarzinom mit minimalen behandlungsbedingten Toxizitäten und einer vielversprechenden biochemischen Kontrollrate nach medianer Nachbeobachtungszeit von 2,6 Jahren.

Untersuchungen zur Involution der Vagina and Zervix beim Rind post partum unter Berücksichtigung der Zervix als Geburtshindernis

OpenAIRE

Wehrend, Axel

2002-01-01

Ziel der vorliegenden Arbeit war es die physiologische Involution der Zervix im Vergleich zur Vagina beim Rind während der ersten zehn Tage post partum zu charakterisieren. Weiterhin sollte durch klinische Untersuchungen an Kühen nach Dystokie und einer retrospektiven Datenauswertung von Schwergeburten unterschiedlicher Tierarten der Anteil zervikal bedingter Geburtsstockungen im Interspeziesvergleich analysiert und Einflussfaktoren auf das Auftreten dieser Dystokieform sowie Störungen in der...

Cognitive functions in the acute period of polytrauma and correction of their disorders with thiocetam

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Krishtafor A.A.

2017-10-01

Full Text Available Aim of the work – to evaluate the effectiveness of thiocetam as a medicine that prevents cognitive impairments in patients with polytrauma, as well as to compare the scales of cognitive function assessment - MoCA and MMSE. We examined 50 victims with polytrauma without severe intracranial lesions, randomly divided into a control group (26 patients and a main (24 patients group. Patients of the control group received conventional intensive therapy for traumatic illness, patients of the main group in addition to this therapy received thiocetam. The somatic status was assessed according to the generally accepted clinical and laboratory indicators. The level of cognitive functions before the injury was assessed by the CFQ questionnaire for 2-3 days after the injury; The MoCA and MMSE scales were used on the 2nd day, when patients were transferred from the intensive care unit and before the discharge. The severity of injury was assessed by the ISS scale. The severity of the response to traumatic stress was assessed by the IES-R scale. In both groups, the baseline level of cognitive function was within the age range. On the second day after the trauma, significant inhibition of cognitive functions in both groups was noted, but in the main group this decrease was un­reliably less. At subsequent stages a gradual increase in both groups was noted, however, in the main group recovery of cognitive functions occurred more rapidly. After 3 months, decrease in cognitive functions preserved at a level when patients were discharged from the hospital. In the main group there were significantly fewer pa­tients whose posttraumatic stress after 3 months increased from minimal to low. When using the MoCA scale, there was a more pronounced decrease in cognitive functions than with the MMSE scale, but it in the less degree consider pecu­liarities of thinking. Thiocetam prevents the decrease of cognitive functions in patients with polytrauma and, due to that, also

Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture

NARCIS (Netherlands)

Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P.H.; Houwert, Roderick M.

2017-01-01

Background Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in

Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

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Andrew M. Mason

2009-01-01

Full Text Available A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

Radiotherapeutic concepts in cancer of unknown primary site; Strahlentherapeutische Konzepte beim CUP-Syndrom

Energy Technology Data Exchange (ETDEWEB)

Krug, D.; Debus, J.; Sterzing, F. [Universitaetsklinikum Heidelberg, Klinik fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany)

2014-02-15

The term cancer of unknown primary (CUP) encompasses a group of entities which differ to a great extent regarding etiology, prognosis and therapeutic management. The aim of the study was an elaboration of the role of radiotherapy in CUP syndrome. Systematic literature search and specification of the available treatment options. Radiotherapy is an integral part of interdisciplinary management approaches for patients with CUP in both curative and palliative situations. Radio-oncological techniques, such as intensity-modulated radiotherapy and stereotactic body radiotherapy increase the therapeutic window. Modern diagnostic modalities from radiology and nuclear medicine are the cornerstone of radiotherapeutic interventions, especially in terms of target volume definition and pretherapeutic staging. In the interdisciplinary setting radiation oncology offers the possibility of curative and often organ preserving approaches in patients with axillary and cervical CUP. In addition, improvement and preservation of quality of life can be achieved in patients with metastatic disease. Radiation oncology is a crucial component of the interdisciplinary management of patients with CUP. Therapeutic decisions in patients with CUP should be made in an interdisciplinary setting. (orig.) [German] Das Cancer-of-unknown-primary(CUP)-Syndrom fasst eine Gruppe von Erkrankungen zusammen, die durch eine ausgepraegte Heterogenitaet hinsichtlich Aetiologie, Therapie und Prognose gepraegt sind. Darstellung der Rolle der Strahlentherapie beim CUP-Syndrom. Systematische Literaturrecherche und Erlaeuterung der Behandlungsoptionen. Die Strahlentherapie ist beim CUP-Syndrom sowohl in adjuvanten und definitiven Therapiekonzepten wie auch in palliativer Intention etabliert. Technisch innovative Verfahren wie die intensitaetsmodulierte Radiotherapie und die stereotaktische Bestrahlung im Koerperstammbereich ermoeglichen eine Vergroesserung der therapeutischen Breite. Eine leistungsfaehige und moderne

The use of external fixators in the definitive stabilisation of the pelvis in polytrauma patients: Safety, efficacy and clinical outcomes.

Science.gov (United States)

Tosounidis, Theodoros H; Sheikh, Hassaan Qaiser; Kanakaris, Nikolaos K; Giannoudis, Peter V

2017-06-01

To analyse the complications and outcomes (functional/radiographic) of Pelvic External Fixators applied as part of the definitive fixation in polytrauma patients. A single center retrospective chart review. A level-1 trauma center. We reviewed all the polytrauma patients (ISS>16) between 2007 and 2012 that had a PEF applied more than 30days. Complications including infection, aseptic loosening, neurological injury, loss of reduction, non-union and mal-union were recorded. Pelvic asymmetry and Deformity Index (DI) were measured at the immediate postoperative radiographs and final follow-up. The functional outcome at final follow up was estimated using a scale previously reported by Chiou et al. 59 patients with mean age of 38.4 (16 - 81) years and mean ISS score 28 (16- 66) were included. The PEFs were applied for mean duration of 56 (30-104) days. The average follow-up was 403days. 22 injuries were type B and 37 type C (AO/OTA). The most common symptomatic complications were pin site infection in 11 (18.6%) and loosening in 5 (8.5%) cases. 44 (74.5%) patients had satisfactory functional outcome. The immediate post-operative and final asymmetry and DI were compared between the two pelvic injury groups (type B and C fractures). The difference in displacement progression was more for type C injuries (p=0.034) but no correlation to the functional outcome was evident. PEF can be used as definitive alternative stabilization method in specific situations at polytrauma setting. Radiological displacement occurred in both type B and C injuries but the clinical outcome was not correlated to this displacement. Complications related to PEF do not affect the final clinical outcome. Therapeutic Level III. Copyright © 2017 Elsevier Ltd. All rights reserved.

The management of musculoskeletal pain and disfunction from traffic accidents polytrauma

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Monica Adriana Farago

2018-02-01

Full Text Available After complex orthopaedic-surgical treatment of car crash polytrauma, we face multilevel patient problems, from algodisfunctional to psychological consequences, which are very difficult to manage. Aim of the study: identifying the optimal ways to approach cases of polytrauma with major functional and psychological implications. Material and Methods: We present the cases of two female patients, 19 and 18-year-old, victims of major road accidents that required car extrication. The accidents resulted in minor craniocerebral trauma, weight bearing bones and pelvis fractures, musculoskeletal and skin avulsion, and neurogenic bladder with catheterization. They underwent repeated orthopedic-surgical interventions and plastic surgery after which they were referred to functional rehabilitation. In the rehabilitation department we were confronted with anxious, uncooperative patients, with a very high level of somatic pain, incapable of actively mobilizing in the bed plan, one of them, within the limits of physical resources, presenting agitation and night aggressiveness. Results: After the complex clinical evaluation we initiated the rehabilitation treatment. The initial rehabilitation results were minimal because of the pain threshold, high levels of anxiety and fatigue due to insomnia. We asked for psychological evaluation and counseling and we organized 6 short daily exercise sessions, then four longer ones, so as not to exceed the patients' momentary resources. The level of difficulty of the kinetic training was progressively increased, being constantly adapted to the daily training gains of the patients. The aggressive outbursts in one of the patients were related to the dread of darkness and loneliness at night, as a consequence of incarceration from the night road accident. In 4 weeks we gained independence for eating, spontaneous urination, bedside independent mobilization, verticalisation and walking with a frame for short distances. Conclusions

Costs and role of ultrasound follow-up of polytrauma patients after initial computed tomography

International Nuclear Information System (INIS)

Maurer, M.H.; Winkler, A.; Powerski, M.J.; Elgeti, F.; Huppertz, A.; Roettgen, R.; Marnitz, T.; Wichlas, F.

2012-01-01

Purpose: To assess the costs and diagnostic gain of abdominal ultrasound follow-up of polytrauma patients initially examined by whole-body computed tomography (CT). Materials and Methods: A total of 176 patients with suspected multiple trauma (126 men, 50 women; age 43.5 ± 17.4 years) were retrospectively analyzed with regard to supplementary and new findings obtained by ultrasound follow-up compared with the results of exploratory FAST (focused assessment with sonography for trauma) at admission and the findings of whole-body CT. A process model was used to document the staff, materials, and total costs of the ultrasound follow-up examinations. Results: FAST yielded 26 abdominal findings (organ injury and/or free intra-abdominal fluid) in 19 patients, while the abdominal scan of whole-body CT revealed 32 findings in 25 patients. FAST had 81 % sensitivity and 100 % specificity. Follow-up ultrasound examinations revealed new findings in 2 of the 25 patients with abdominal injuries detected with initial CT. In the 151 patients without abdominal injuries in the initial CT scan, ultrasound follow-up did not yield any supplementary or new findings. The total costs of an ultrasound follow-up examination were EUR 28.93. The total costs of all follow-up ultrasound examinations performed in the study population were EUR 5658.23. Conclusion: Follow-up abdominal ultrasound yields only a low overall diagnostic gain in polytrauma patients in whom initial CT fails to detect any abdominal injuries but incurs high personnel expenses for radiological departments. (orig.)

Evaluation of the polytrauma victim by the nursing staff in an emergency service of Santa Catarina

Directory of Open Access Journals (Sweden)

Leandro Sanceverino Mattos

2012-06-01

Full Text Available Objective: To investigate the actions developed by the nursing staff of a private hospital emergency service in the southern Santa Catarina (SC, related to primary and secondary evaluation of polytrauma victims. Methods: Research of a qualitative approach, the type of case study, performed with twelve nurses. Sample has been characterized as non-probabilistic intentional. Data collection has been performed using the techniques of semi-structured interview and participant observation. Data analysis has been developed using the technique of content analysis. Results: Analysis of nurses’ testimonies and the results of observation have showed that most participants comprehend the importance of adopting the ABCDE rule in primary evaluation - A (Air Way - airway permeability with safe administration of cervical collar; B (Breathing; C (Circulation - search for bleeding and control; D (Disability - neurological evaluation; e E (Exposure - patient’s body exposition seeking missed injuries - and the need of meticulous secondary evaluation of polytrauma victim. However, due to demand of urgency and agility in emergencies of this nature, the rule is not followed in a systematic way. Conclusion: It has been demonstrated the nursing staff’s concern over the following aspects: agility of service; immediate performance of examinations; communication between emergency service professionals; adequate perception of the general condition of the victim; and the reception to victim and family.

Feinkartierung von Loss of Heterozygosity-Intervallen auf Chromosom 11p und Untersuchungen zum Expressions- und Methylierungsstatus von FANCF beim Ovarialkarzinom

OpenAIRE

Schulze, Kathrin

2011-01-01

Um Tumorsuppressorgene beim Ovarialkarzinom zu identifizieren wurde eine Kartierung von LOH-Intervallen der Region 11p15.5 - 11p11.2 mittels 11 Mikrosatellitenmarkern an 47 Ovarialtumorproben vorgenommen. Im Bereich des ST5- und AFM255/KAI1-Locus konnten potentielle Intervalle abgegrenzt werden. Das Fanconi Anämie Gen FANCF wurde für Untersuchungen zum Expressions- und Methylierungsstatus ausgewählt, da dessen Abschaltung mit einem besseren Ansprechen auf Cisplatin bei Ovarialkarzinompatienti...

Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study

NARCIS (Netherlands)

Briet, Jan Paul; Houwert, Roderick Marijn; Smeeing, Diederik P. J.; Dijkgraaf, Marcel G. W.; Verleisdonk, Egbert Jan; Leenen, Luke P. H.; Hietbrink, Falco

2017-01-01

Although fracture type and treatment options for ankle fractures are well defined, the differences between mono- and polytrauma patients and low- and high-energy trauma have not been addressed. The aim of the present study was to compare the fracture type and trauma mechanism between mono- and

Neuro-, Trauma -, or Med/Surg-ICU: Does it matter where polytrauma patients with TBI are admitted? Secondary analysis of AAST-MITC decompressive craniectomy study

Science.gov (United States)

Scalea, Tom; Sperry, Jason; Coimbra, Raul; Vercruysse, Gary; Jurkovich, Gregory J; Nirula, Ram

2016-01-01

Introduction Patients with non-traumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without TBI fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. Methods This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study. Twelve Level 1 trauma centers provided clinical data and head CT scans of patients with Glasgow Coma Scale (GCS) ≤13 and CT evidence of TBI. Non-ICU admissions were excluded. Multivariate logistic regression was performed to measure the association between ICU-type and survival and calculate the probability of death for increasing ISS. Polytrauma patients (ISS > 15) with TBI and isolated TBI patients (other AIS polytrauma patients admitted to a TICU had improved survival across increasing ISS (Fig1). Survival for isolated TBI patients was similar between TICU and NICU. Med/Surg ICU carried the greatest probability of death. Conclusion Polytrauma patients with TBI have lower mortality risk when admitted to a Trauma ICU. This survival benefit increases with increasing injury severity. Isolated TBI patients have similar mortality risk when admitted to a Neuro ICU compared to a Trauma ICU. Med/Surg ICU admission carries the highest mortality risk. PMID:28225527

Clinical importance and significance of early evaluation of therapy response in lung cancer; Klinische Notwendigkeit und Bedeutung der Frueherfassung der Therapie-Response beim Bronchialkarzinom

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Griesinger, F. [Universitaetsklinik Goettingen (Germany). Abt. Haematologie und Onkologie; Baum, R.P. [Zentralklinik Bad Berka (Germany). Klinik fuer Nuklearmedizin/PET-Zentrum

2001-04-01

In solid tumors, especially in non-small cell lung cancer (NSCLC), the TNM staging is the only well defined pretherapeutic risk factor. TNM-staging has a significant impact on prognosis and survival and is used to determine therapeutic stratification. Although numerous molecular and immunologic pretherapeutic risk factors have been described in NSCLC, none of them has been translated into therapeutic stratification. Therefore, the identification of posttherapeutic risk factors in NSCLC is essential. Locally advanced NSCLC are currently treated with preoperative (neoadjuvant) induction regimens. It has been shown that systemic tumor control and long-term disease free survival is correlated with histologic tumor regression. First results are presented in this paper that PET may be highly predictive for histologic tumor regression and long term outcome in NSCLC stage III. These results may establish PET as the first noninvasive posttherapeutic risk factor in locally advanced NSCLC. (orig.) [German] Bei soliden Tumoren, insbesondere beim nichtkleinzelligen Bronchialkarzinom (NSCLC), sind praetherapeutische Risikofaktoren im Westlichen durch das Tumorstadium (TNM-Klassifikation) definiert. Diese Tumorstadien haben eine erhebliche prognostische Relevanz und sind entscheidend fuer die Therapiestratifikation. Obwohl eine Reihe praetherapeutischer molekularer und immunologischer Risikofaktoren beim NSCLC beschrieben wurden, hat keiner von ihnen Eingang in die prospektive Risikostratifikation oder Therapieplanung gefunden. Daher ist die Identifikation posttherapeutischer Risikofaktoren zur Therapiestratifikation des NSCLC essenziell wichtig. Ein innovativer Therapieansatz bei lokal fortgeschrittenen NSCLC ist die neoadjuvante (praeoperative) Induktionstherapie. Hier konnte gezeigt werden, dass die systemische Tumorkontrolle und das Langzeitueberleben mit dem histologischen Ansprechen korrelierte. Erste Untersuchungen zeigen jetzt, dass die FDG-PET vermutlich einen hohen

The Assignment of American Society of Anesthesiologists Physical Status Classification for Adult Polytrauma Patients: Results From a Survey and Future Considerations.

Science.gov (United States)

Kuza, Catherine M; Hatzakis, George; Nahmias, Jeffry T

2017-12-01

The American Society of Anesthesiologists (ASA) physical status (PS) classification system assesses the preoperative health of patients. Previous studies demonstrated poor interrater reliability and variable ASA PS scores, especially in trauma scenarios. There are few studies that evaluated the assignment of ASA PS scores in trauma patients and no studies that evaluated ASA PS assignment in severely injured adult polytrauma patients. Our objective was to assess interrater reliability and identify sources of discrepancy among anesthesiologists and trauma surgeons in designating ASA PS scores to adult polytrauma patients. A link to an online survey containing questions assessing attitudes regarding ASA PS classification, demographic information, and 8 fictional trauma cases was e-mailed to anesthesiologists and trauma surgeons. The participants were asked to assign an ASA PS score to each scenario and explain their choice. Rater-versus-reference and interrater reliability, beyond that expected by chance, among respondents was analyzed using the Fleiss kappa analysis. A total of 349 participants completed the survey. All 8 cases had inconsistent ASA PS scores; several cases had scores ranging from I to VI and variable emergency (E) designations. Using weighted kappa (Kw) analysis for a subset of 201 respondents (101 trauma surgeons [S] and 100 anesthesiologists [A]), we found moderate (Kw = 0.63; SE = 0.024; 95% confidence interval, 0.594-0.666; P polytrauma patients. Although the ASA PS is used in some trauma risk stratification models, discrepancies of ASA PS scores assigned to trauma cases exist. Future modifications of the ASA PS guidelines should aim to improve the interrater reliability of ASA PS scores in trauma patients. Further studies are warranted to determine the value of the ASA PS score as a trauma prognostic metric.

Early predictors of health-related quality of life outcomes in polytrauma patients with spine injuries: a level 1 trauma center study.

Science.gov (United States)

Tee, J W; Chan, C H P; Gruen, R L; Fitzgerald, M C B; Liew, S M; Cameron, P A; Rosenfeld, J V

2014-02-01

Study Design Retrospective review on clinical-quality trauma registry prospective data. Objective To identify early predictors of suboptimal health status in polytrauma patients with spine injuries. Methods A retrospective review on a prospective cohort was performed on spine-injured polytrauma patients with successful discharge from May 2009 to January 2011. The Short Form 12-Questionnaire Health Survey (SF-12) was used in the health status assessment of these patients. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, blood sugar level, vital signs, brain trauma severity, comorbidities, coagulation profile, spine trauma-related neurologic status, and spine injury characteristics of the patients. Results The SF-12 had a 52.3% completion rate from 915 patients. The patients who completed the SF-12 were younger, and there were fewer patients with severe spinal cord injuries (American Spinal Injury Association classifications A, B, and C). Other comparison parameters were satisfactorily matched. Multivariate logistic regression revealed five early predictive factors with statistical significance (p ≤ 0.05). They were (1) tachycardia (odds ratio [OR] = 1.88; confidence interval [CI] = 1.11 to 3.19), (2) hyperglycemia (OR = 2.65; CI = 1.51 to 4.65), (3) multiple chronic comorbidities (OR = 2.98; CI = 1.68 to 5.26), and (4) thoracic spine injuries (OR = 1.54; CI = 1.01 to 2.37). There were no independent early predictive factors identified for suboptimal mental health-related qualify of life outcomes. Conclusion Early independent risk factors predictive of suboptimal physical health status identified in a level 1 trauma center in polytrauma patients with spine injuries were tachycardia, hyperglycemia, multiple chronic medical comorbidities, and thoracic spine injuries. Early spine trauma risk factors were shown not to predict suboptimal mental

Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture : A Retrospective Cohort Study

NARCIS (Netherlands)

Briet, Jan Paul; Houwert, Roderick Marijn; Smeeing, Diederik P J; Dijkgraaf, Marcel G. W.; Verleisdonk, Egbert Jan M M; Leenen, Luke P H; Hietbrink, Falco

2017-01-01

Although fracture type and treatment options for ankle fractures are well defined, the differences between mono- and polytrauma patients and low- and high-energy trauma have not been addressed. The aim of the present study was to compare the fracture type and trauma mechanism between mono- and

Comparison of PCT, CRP, D-Dimer, Lactate, TNF-α, IL-1β, IL-6 and lL-10 in Development of Systemic Inflammatory Response Syndrome and Sepsis on Patients with Isolated Head Trauma and Polytrauma

Directory of Open Access Journals (Sweden)

Emine Dağlı

2012-12-01

Full Text Available Objective: In this study, it was aimed to compare the relationship between Glasgow Coma Scale (GKS, ISS values, PCT, CRP, D-Dimer, laktat, TNF-α, IL-1β, IL-6, IL-10 in patients with polytrauma and isolated head trauma in conjunction with SIRS and sepsis. Material and Method: Total of 68 patients (32 polytrauma, 36 isolated head trauma aged between 18-65 years were enrolled in the study. For 7 days of follow up, the biochemical parameters were analysed on the days 0, 1, 3, 5, 7 and the ISS, GCS score and growth rates of SIRS and sepsis were recorded. Results: It was demonstrated that for patients with isolated head trauma, SIRS (80.6%, sepsis (38.9% and mortality values (71.4% were higher and there is a statistically important linear and inverse relationship between ISS and GCS values (p<0.05. During sepsis and SIRS phases, CRP elevated in both groups, whereas PCT only in the polytrauma group. D-Dimer values were investigated high in both groups, but atypically decreased on day 3 in isolated head trauma group. Lactate, TNF-α and, IL-1β were within reference values, IL-6 and IL-10 values were elevated in both groups but were higher in the polytrauma group. Conclusion: Although multiple variations were detected in serum markers of pro-inflamatory and acute phase proteins, we thought that these are inadequate in predicting mortality and complications such as SIRS and sepsis.

The effect of polytrauma as a possible confounder in the outcome of monotraumatic vs polytraumatic paraplegic patients: a clinical cohort study.

Science.gov (United States)

Putz, C; Schuld, C; Gantz, S; Grieser, T; Akbar, M; Moradi, B; Wiedenhöfer, B; Fürstenberg, C H; Gerner, H J; Rupp, R

2011-06-01

Clinical cohort study. To evaluate if the impact of the severity of the trauma as a possible confounding factor influences the neurological and functional recovery in paraplegia during the course of a 6-month follow-up period after injury. Spinal Cord Injury Center, Heidelberg University Hospital, Germany. A retrospective monocentric analysis, from 2002 to 2008, of the Heidelberg European Multicenter Study about spinal cord injury database was performed. We included 31 paraplegic patients (neurological level T1-T12) who were assigned either to a monotrauma (polytraumaschluessel (PTS) 1) or to a polytrauma (PTS≥2) group. The American Spinal Injury Association Impairment Scale, lower extremity motor score, pin prick, light touch and the spinal cord independence measure (SCIM) were obtained at five distinct time points after trauma. Data were analyzed using Mann-Whitney U-test (αpressure sores between 3 and 6 months (P=0.031). The mean length of primary rehabilitation in the polytrauma group was 5.5 vs 3.6 months in monotrauma. The prognosis of polytraumatic paraplegics in terms of neurological recovery is not inferior to those with monotrauma. Multiple-injured patients need a prolonged hospital stay to reach the functional outcome of monotraumatic patients.

Outcome after polytrauma in a certified trauma network: comparing standard vs. maximum care facilities concept of the study and study protocol (POLYQUALY).

Science.gov (United States)

Koller, Michael; Ernstberger, Antonio; Zeman, Florian; Loss, Julika; Nerlich, Michael

2016-07-11

The aim of this study is to evaluate the performance of the first certified regional trauma network in Germany, the Trauma Network Eastern Bavaria (TNO) addressing the following specific research questions: Do standard and maximum care facilities produce comparable (risk-adjusted) levels of patient outcome? Does TNO outperform reference data provided by the German Trauma Register 2008? Does TNO comply with selected benchmarks derived from the S3 practice guideline? Which barriers and facilitators can be identified in the health care delivery processes for polytrauma patients? The design is based on a prospective multicenter cohort study comparing two cohorts of polytrauma patients: those treated in maximum care facilities and those treated in standard care facilities. Patient recruitment will take place in the 25 TNO clinics. It is estimated that n = 1.100 patients will be assessed for eligibility within a two-year period and n = 800 will be included into the study and analysed. Main outcome measures include the TraumaRegisterQM form, which has been implemented in the clinical routine since 2009 and is filled in via a web-based data management system in participating hospitals on a mandatory basis. Furthermore, patient-reported outcome is assessed using the EQ-5D at 6, 12 and 24 months after trauma. Comparisons will be drawn between the two cohorts. Further standards of comparisons are secondary data derived from German Trauma Registry as well as benchmarks from German S3 guideline on polytrauma. The qualitative part of the study will be based on semi-standardized interviews and focus group discussions with health care providers within TNO. The goal of the qualitative analysis is to elucidate which facilitating and inhibiting forces influence cooperation and performance within the network. This is the first study to evaluate a certified trauma network within the German health care system using a unique combination of a quantitative (prospective cohort

Modern imaging technology for childhood urinary tract infection; Moderne Bildgebung beim Harnweginfekt im Kindesalter

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Riccabona, M.; Fotter, R. [Radiologische Universitaetsklinik Graz (Germany). Abteilung Kinderradiologie

2005-12-01

Imaging in childhood urinary tract infection (UTI) is still a matter of debate. There are established guidelines, however new knowledge and the changed medical environment have enhanced this ongoing discussion. These new insights have impacted therapy and consequently the imaging algorithm. Modern imaging methods - particularly MRI and modern ultrasound (US) - are less invasive with a lower radiation burden. Additionally, it has been shown that VUR is a poor predictor for renal scarring out, which affects long-term results. Furthermore, the majority of UT malformations is depicted by prenatal US. The most crucial aspect of improving long-term outcome appears to be the early and reliable depiction of UTI and effective treatment to prevent renal scarring. This review tries to present this new knowledge and to discuss the potential of modern imaging. Recent changes in imaging algorithms are highlighted and an outcome-oriented algorithm that addresses these recent developments is proposed, without lightly abandoning established standards. It consists of an orienting US and - for depiction of renal involvement - amplitude coded color Doppler sonography or renal static scintigraphy (considered the gold standard, particularly for evaluating scars); in future MRI may play a role. Based on this concept, only patients with renal damage as well as patients with complex urinary tract malformations or intractable recurrent UTI may have to undergo VCUG. (orig.) [German] Die bildgebende Diagnostik beim kindlichen Harnweginfekt (HWI) wird weiterhin heftig diskutiert. Zwar existieren etablierte Bildgebungsalgorithmen, insbesondere fuer das Kleinkindesalter; neue Erkenntnisse bzw. Aufgabenstellungen haben aber zu einer Aenderung des Therapiekonzepts mit Auswirkungen auf die Bildgebung gefuehrt. Zusaetzlich haben technische (Weiter)Entwicklungen das Potenzial der Bildgebung erweitert; v. a. MRT und moderne Ultraschallverfahren versprechen eine weniger invasive und strahlenfreie

Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms?

Science.gov (United States)

Falkenberg, Lisa; Zeckey, Christian; Mommsen, Philipp; Winkelmann, Marcel; Zelle, Boris A; Panzica, Martin; Pape, Hans-Christoph; Krettek, Christian; Probst, Christian

2017-10-30

Physical impairment is well-known to last for many years after a severe injury, and there is a high impact on the quality of the survivor's life. The purpose of this study was to examine if this is also true for psychological impairment with symptoms of posttraumatic stress disorder or depression after polytrauma. Retrospective cohort outcome study. Level I trauma centre. 637 polytrauma trauma patients who were treated at our Level I trauma centre between 1973 and 1990. Minimum follow-up was 10 years after the injury. Patients were asked to fill in a questionnaire, including parts of the Posttraumatic Stress Diagnostic Scale, the Impact of Event Scale-Revised and the German Hospital Anxiety and Depression Scale, to evaluate mental health. Clinical outcome was assessed before by standardised scores. Three hundred and twenty-four questionnaires were evaluated. One hundred and forty-nine (45.9%) patients presented with symptoms of mental impairment. Quality of life was significantly higher in the mentally healthy group, while the impaired group achieved a lower rehabilitation status. Mental impairment can be found in multiple trauma victims, even after 10 years or more. Treating physicians should not only focus on early physical rehabilitation but also focus on early mental rehabilitation to prevent long-term problems in both physical and mental disability.

Association between gene expression biomarkers of immunosuppression and blood transfusion in severely injured polytrauma patients.

Science.gov (United States)

Torrance, Hew Dt; Brohi, Karim; Pearse, Rupert M; Mein, Charles A; Wozniak, Eva; Prowle, John R; Hinds, Charles J; OʼDwyer, Michael J

2015-04-01

To explore the hypothesis that blood transfusion contributes to an immunosuppressed phenotype in severely injured patients. Despite trauma patients using disproportionately large quantities of blood and blood products, the immunomodulatory effects of blood transfusion in this group are inadequately described. A total of 112 ventilated polytrauma patients were recruited. Messenger RNA (mRNA) was extracted from PAXGene tubes collected within 2 hours of the trauma, at 24 hours, and at 72 hours. T-helper cell subtype specific cytokines and transcription factors were quantified using real-time polymerase chain reaction. Median injury severity score was 29. Blood transfusion was administered to 27 (24%) patients before the 2-hour sampling point. Transfusion was associated with a greater immediate rise in IL-10 (P = 0.003) and IL-27 (P = 0.04) mRNA levels. Blood products were transfused in 72 (64%) patients within the first 24 hours. There was an association between transfusion at 24 hours and higher IL-10 (P < 0.0001), lower Foxp3 (P = 0.01), GATA3 (P = 0.006), and RORγt (P = 0.05) mRNA levels at 24 hours. There were greater reductions in T-bet (P = 0.03) mRNA levels and lesser increases in TNFα (P = 0.015) and IFNγ (P = 0.035) at 24 hours in those transfused. Multiple regression models confirmed that the transfusion of blood products was independently associated with altered patterns of gene expression. Blood stream infections occur in 15 (20.8%) of those transfused in the first 24 hours, compared with 1 patient (2.5%) not transfused (OR = 10.3 [1.3-81], P = 0.008). The primarily immunosuppressive inflammatory response to polytrauma may be exacerbated by the transfusion of blood products. Furthermore, transfusion was associated with an increased susceptibility to nosocomial infections.

Inflammatory and apoptotic alterations in serum and injured tissue after experimental polytrauma in mice: distinct early response compared with single trauma or "double-hit" injury.

Science.gov (United States)

Weckbach, Sebastian; Hohmann, Christoph; Braumueller, Sonja; Denk, Stephanie; Klohs, Bettina; Stahel, Philip F; Gebhard, Florian; Huber-Lang, Markus S; Perl, Mario

2013-02-01

The exact alterations of the immune system after polytrauma leading to sepsis and multiple-organ failure are poorly understood. Thus, the early local and systemic inflammatory and apoptotic response was characterized in a new polytrauma model and compared with the alterations seen after single or combined injuries. Anesthetized C57BL/6 mice were subjected to either blunt bilateral chest trauma (Tx), closed head injury, right femur fracture including contralateral soft tissue injury, or a combination of injuries (PTx). After 2 hours or 6 hours, animals were sacrificed, and the systemic as well as the local pulmonary immune response (bronchoalveolar lavage [BAL]/plasma cytokines, lung myeloperoxidase [MPO] activity, and alveolocapillary barrier dysfunction) were evaluated along with lung/brain apoptosis (lung caspase 3 Western blotting, immunohistochemistry, and polymorphonuclear leukocytes [PMN] Annexin V). Hemoglobin, PO2 saturation, and pH did not differ between the experimental groups. Local BAL cytokines/chemokines were significantly increased in almost all groups, which included Tx. There was no further enhancement of this local inflammatory response in the lungs in case of PTx. At 2 hours, all groups except sham and closed head injury alone revealed an increased activity of lung MPO. However, 6 hours after injury, lung MPO remained increased only in the PTx group. Increased BAL protein levels were found, reflecting enhanced lung leakage in all groups with Tx 6 hours after trauma. Only after PTx was neutrophil apoptosis significantly decreased, whereas lung caspase 3 and plasma interleukin 6/keratinocyte chemoattractant (KC) were substantially increased. The combination of different injuries leads to an earlier systemic inflammatory response when compared with the single insults. Interestingly, only after PTx but not after single or double hits was lung apoptosis increased, and PMN apoptosis was decreased along with a prolonged presence of neutrophils in the

Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT

International Nuclear Information System (INIS)

Wedegaertner, U.; Lorenzen, M.; Weber, C.; Adam, G.; Nagel, H.D.

2004-01-01

Purpose: To compare the radiation dose of whole-body multislice CT (MSCT) and conventional radiography with organ-specific CT in polytrauma. Materials and Methods: The whole-body MSCT encompassing brain, neck and midface, chest, abdomen and pelvis was performed on a Somatom Volume Zoom (Siemens). Conventional radiography consisted of chest and cervical, thoracic and lumbar spine in two views as well as pelvis. Polymat, Siemens. Three combinations of organ specific CT were chosen: CT examination of (1) head and cervical spine, (2) head, cervical spine and chest, (3) head, cervical spine and abdomen. The effective doses of whole-body MSCT and conventional radiography with organ-specific CT were calculated. Results: Effective doses were 20 mSv for whole-body MSCT, 2 mSv for conventional x-ray, and 5 mSv for combination (1), 8 mSv for combination (2) and (3) 16 mSv for combination (3) of the organ-specific CT. The ratio of radiation dose between whole-body MSCT and radiography was 10: 1. This ratio was reduced to 3: 1, 2: 1 and 1: 1 when a combination of radiography and CT was performed. Conclusions: Whole-body MSCT in polytrauma compared to conventional radiography with organ-specific CT induces a threefold increased dose in unfavorable situations and no increased dose in favorable situations. Nevertheless, routine use of whole-body MSCT should be critically evaluated and should be adapted to the clinical benefit. (orig.) [de

Significance of findings of both emergency chest X-ray and thoracic computed tomography routinely performed at the emergency unit in 102 polytrauma patients. A prospective study

International Nuclear Information System (INIS)

Grieser, T.; Buehne, K.H.; Haeuser, H.; Bohndorf, K.

2001-01-01

Purpose: To evaluate prospectively whether and to what extent both thoracic computed tomography (Tx-CT) and supine X-ray of the chest (Rx-Tx) are able to show additional findings that are therapeutically relevant. Patients and Methods: According to a fixed study protocol, we performed Rx-Tx and Tx-CT in 102 consecutive, haemodynamically stable polytrauma patients (mean age, 41.2 yrs; age range, 12-93 yrs). Findings of therapeutical relevance drawn from both Tx-CT and Rx-Tx, and urgent interventions indicated by an attending trauma team were documented on a standardized evaluation sheet immediately. Any change in the patient's management that is different from routine life-saving procedures, and any therapeutical intervention done in the emergency room or elsewhere (operating theatre, angiographic facility) were considered therapeutically relevant. Results: Of 102 patients, 43 (42.2%) had a total of 51 therapeutically relevant findings. Rx-Tx alone yielded 23 relevant findings (45.1%) in 23 patients (22.5%). Of them, Tx-CT has shown additional important findings in 7 patients (30.4%). When Tx-CT alone is considered, it revealed 22 new findings of therapeutical relevance (43.2%) in 20 patients (46.5%). Altogether, Tx-CT was able to show 30 relevant findings in 27 patients, i.e., there was a therapeutical benefit for 26.5% of all polytrauma patients included. Most frequently, there was a need for chest-tube insertion (n=29). Conclusions: Polytrauma patients if haemodynamically stable may profit from computed tomography of the chest when therapeutically relevant thoracic injuries are looked for or early therapeutical interventions are to be checked. However, chest X-ray should stay as a 'front-line' screening method because of its superbly quick feasibility and availability. (orig.) [de

Fair in the face: modern diagnostics of midfacial trauma; Mitten ins Gesicht: Moderne bildgebende Diagnostik beim Gesichtsschaedeltrauma

Energy Technology Data Exchange (ETDEWEB)

Zajaczek, J.E.W. [Abt. Neuroradiologie (OE 8210), Zentrum Radiologie, Medizinische Hochschule Hannover (Germany); Abt. Diagnostische Radiologie, Medizinische Hochschule Hannover (Germany); Rodt, T.; Keberle, M. [Abt. Diagnostische Radiologie, Medizinische Hochschule Hannover (Germany)

2007-07-15

Modern diagnostics of midfacial trauma are embedded in a diagnostic concept that is oriented to the therapeutic relevance for the individual. Critical analysis of the indicated and efficient radiological method in the acute phase shows that MSCT is currently the method of choice in the diagnosis of midfacial trauma. Besides extensive acquisition of data in the shortest time the possibilities of modern post-processing provide a three-dimensional picture of the often complex injuries in real time. Other perilous injuries are often more important especially for the polytrauma patient. With modern scan protocols intracranial injuries as well as injuries of bone and soft tissue of the head and neck region can be diagnosed during a single examination. Radiology plays a key role for the economically oriented strategy of patient care. (orig.)

Differential effects of fresh frozen plasma and normal saline on secondary brain damage in a large animal model of polytrauma, hemorrhage and traumatic brain injury

DEFF Research Database (Denmark)

Hwabejire, John O; Imam, Ayesha M; Jin, Guang

2013-01-01

We have previously shown that the extent of traumatic brain injury (TBI) in large animal models can be reduced with early infusion of fresh frozen plasma (FFP), but the precise mechanisms remain unclear. In this study, we investigated whether resuscitation with FFP or normal saline differed in th...... in their effects on cerebral metabolism and excitotoxic secondary brain injury in a model of polytrauma, TBI, and hemorrhagic shock....

Injuries to the upper extremities in polytrauma: limited effect on outcome more than ten years after injury - a cohort study in 629 patients.

Science.gov (United States)

Macke, C; Winkelmann, M; Mommsen, P; Probst, C; Zelle, B; Krettek, C; Zeckey, C

2017-02-01

To analyse the influence of upper extremity trauma on the long-term outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up study at least ten years after injury (mean age 26.5 years, standard deviation 12.4). The extent of the patients' injury was classified using the Injury Severity Score. Outcome was measured using the Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation duration, and employment status. Outcomes for patients with and without a fracture of the upper extremity were compared and analysed with regard to specific fracture regions and any additional brachial plexus lesion. In all, 307 multiply-injured patients with and 322 without upper extremity injuries were included in the study. The groups with and without upper limb injuries were similar with respect to demographic data and injury pattern, except for midface trauma. There were no significant differences in the long-term outcome. In patients with brachial plexus lesions there were significantly more who were unemployed, required greater retraining and a worse HASPOC. Injuries to the upper extremities seem to have limited effect on long-term outcome in patients with polytrauma, as long as no injury was caused to the brachial plexus. Cite this article: Bone Joint J 2017;99-B:255-60. ©2017 The British Editorial Society of Bone & Joint Surgery.

[Myocardial infarction as cause of an accident. The role of multislice CT in polytrauma management, differential diagnosis and insurance aspects].

Science.gov (United States)

Kleber, C; Oswald, B; Bail, H J; Haas, N P; Kandziora, F

2008-12-01

We present for the first time the use of contrast-enhanced multislice computed tomography in trauma care to detect acute myocardial infarction and verify it as the cause of a traffic accident. In addition to the case report, cardiac contusion, coronary dissection, and facets of insurance law are discussed. The determination of acute myocardial infarction, cardiac contusion, and coronary dissection can be challenging, but answers can be found in the medical history and accident details. The trauma surgeon in the emergency department must always be interested in clarifying the cause of trauma and keeping a secondary diagnosis in mind to strive for the goal of optimal and complete polytrauma care.

The role of whole body spiral CT in the primary work-up of polytrauma patients - comparison with conventional radiography and abdominal sonography

International Nuclear Information System (INIS)

Albrecht, T.; Schlippenbach, J. von; Wolf, K.J.; Stahel, P.F.; Ertel, W.

2004-01-01

Purpose: To evaluate the role of routine 'whole body spiral CT' in the primary work-up of polytrauma patients for injuries of the thorax, abdomen and spine, and to compare the results with those of conventional radiography of the chest and spine and abdominal ultrasound. Materials and Methods: Fifty consecutive polytrauma patients underwent contrast-enhanced single slice spiral CT (5 mm collimation) from the vertex to the floor of the pelvis as part of the primary work-up after emergency room admission. Overlapping high resolution sections and sagittal reformations of the spine were obtained. Reports of additional chest radiographs (n=43), abdominal ultrasound examinations (n=47) and spine radiographs (n=36) performed in the emergency room were available for retrospective comparison. The 'final diagnoses', which served as the standard of reference, were taken from the patients' records using all information that became available until discharge or death, such as findings from further imaging, surgery and autopsy. Results: CT showed 109 (97%) of 112 thoracic and abdominal soft-tissue injuries. Relevant injuries missed were an early splenic laceration and an early pelvic hematoma, both of which became clinically apparent several hours later. There were 4 false positive CT findings. Conventional chest radiography demonstrated only 20% of thoracic and sonography 22% of abdominal injuries. Chest radiography and sonography produced 2 false-positive findings each. CT showed 66 (87%) of 76 vertebral fractures including all 19 unstable ones. CT missed 5 anterior vertebral body and 5 spinous/transverse process fractures. Conventional radiography found 71% of vertebral fractures including only 50% of the unstable one. (orig.)

Hilfe oder Hindernis? Meinungen finnischer Sprachstudierender über Mehrsprachigkeit als Ressource beim Deutschlernen

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Sabine Grasz

2017-10-01

Full Text Available Der Fremdsprachenunterricht in Finnland befindet sich gerade in einer Umbruchphase, denn mit der Einführung neuer Lehrpläne im Jahr 2016 werden Verfahren der Mehrsprachigkeitsdidaktik in Zukunft eine zentrale Rolle spielen. In diesem Beitrag wird untersucht, ob und wie finnische Universitätsstudierende, die selbst von einer eher monolingual ausgerichteten Lerntradition geprägt sind, ihr mehrsprachiges Repertoire als Ressource beim Lernen weiterer Fremdsprachen sehen. Zu diesem Zweck wurde eine Befragung unter Lehramtsstudierenden der Fächer Anglistik und Skandinavistik, die Germanistik als Nebenfach studieren möchten, durchgeführt. Die Analyse zeigt, dass die Studierenden zwar mehrheitlich positive Einstellungen gegenüber Mehrsprachigkeit aufweisen, dass es aber Entwicklungsbedarf im Hinblick auf Sprachbewusstheit, multilinguale Fähigkeiten und bei den Einstellungen gegenüber Sprachmischungen gibt. Foreign language education in Finland is currently undergoing a period of change, as the introduction of new curricula in 2016 will lead to a central role of multilingualism in teaching. This article examines whether and how Finnish university students, who themselves were influenced by a more monolingual learning tradition, consider their multilingual repertoire as a resource for learning other foreign languages. For this purpose, a survey was conducted among teacher students of English and Swedish, who would like to study German as a minor. The analysis shows that while the majority of students have positive attitudes towards multilingualism, there is a need for development in terms of language awareness, multilingual skills, and attitudes towards language mixes.

Aktuelle Technik der Bruststraffung beim Mann nach Gewichtsverlust [Modern technique in male breast contouring after weight loss

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Stoff, Alexander

2013-08-01

Full Text Available [english] The morbid adiposity and its medical consequences demonstrates a growing problem of our current prosperous society. Due to a significant improvement of bariatric techniques and a reduplication of adipose patients during the 20 century, the number of patients, who present to plastic surgeons with a new degree of suffering, has been growing steadily. Initially, the female patients were in the majority, which has been more balanced nowadays.The male breast is a body region that primarily symbolizes masculinity and strenght. In male patients after massive weight loss, this body region remains as an extremly deflated breast envelope without any sign of possible retraction. The plastic surgeon may choose from different single or combinated ltechniques, which are indicated depending on the local and adjacent tissue characteristics.We are presenting our modified technique of male breast reshaping, referring to the technique of Aly, except for a NAC transposition on a central pedicle. The central pedicle is hereby preserved from resection after tremendous liposuction. This central pedicle technique allows a safe and uncomplicated NAC transposition with significant advantages compared to free NAC-Transposition techniques in terms of aesthetical and functional outcome. [german] Die morbide Adipositas mit ihren Langzeitfolgen ist ein zunehmendes Problem unserer heutigen Wohlstandsgesellschaft. Mit einer Verdoppelung der betroffenen Patienten im Laufe des 20. Jahrhunderts ist gleichzeitig durch rasante Verbesserung der bariatrischen Eingriffe auch die Zahl der Patienten signifikant und stetig gestiegen, die sich nach massiver Gewichtsreduktion nun mit neuem Leidensdruck beim Plastischen Chirurgen vorstellen. Hierbei ist die anfängliche Überzahl der weiblichen Patienten in ein ausgewogenes Verhältnis der betroffenen Geschlechter übergegangen. Die männliche Brust, eine Körperregion, die in erster Linie Männlichkeit und Stärke symbolisiert und

Costs and role of ultrasound follow-up of polytrauma patients after initial computed tomography; Kosten und Stellenwert von Ultraschallverlaufskontrollen bei polytraumatisierten Patienten nach initialer Computertomografie

Energy Technology Data Exchange (ETDEWEB)

Maurer, M.H.; Winkler, A.; Powerski, M.J.; Elgeti, F.; Huppertz, A.; Roettgen, R.; Marnitz, T. [Charite - Universitaetsmedizin Berlin (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Wichlas, F. [Charite - Universitaetsmedizin Berlin (Germany). Centrum fuer Muskuloskeletale Chirurgie

2012-01-15

Purpose: To assess the costs and diagnostic gain of abdominal ultrasound follow-up of polytrauma patients initially examined by whole-body computed tomography (CT). Materials and Methods: A total of 176 patients with suspected multiple trauma (126 men, 50 women; age 43.5 {+-} 17.4 years) were retrospectively analyzed with regard to supplementary and new findings obtained by ultrasound follow-up compared with the results of exploratory FAST (focused assessment with sonography for trauma) at admission and the findings of whole-body CT. A process model was used to document the staff, materials, and total costs of the ultrasound follow-up examinations. Results: FAST yielded 26 abdominal findings (organ injury and/or free intra-abdominal fluid) in 19 patients, while the abdominal scan of whole-body CT revealed 32 findings in 25 patients. FAST had 81 % sensitivity and 100 % specificity. Follow-up ultrasound examinations revealed new findings in 2 of the 25 patients with abdominal injuries detected with initial CT. In the 151 patients without abdominal injuries in the initial CT scan, ultrasound follow-up did not yield any supplementary or new findings. The total costs of an ultrasound follow-up examination were EUR 28.93. The total costs of all follow-up ultrasound examinations performed in the study population were EUR 5658.23. Conclusion: Follow-up abdominal ultrasound yields only a low overall diagnostic gain in polytrauma patients in whom initial CT fails to detect any abdominal injuries but incurs high personnel expenses for radiological departments. (orig.)

C-Reactive Protein and Cytokines in Polytrauma

Directory of Open Access Journals (Sweden)

E. K Gumanenko

2007-01-01

Full Text Available Objective: to study the association of C-reactive protein (CRP with cytokines in polytrauma.Subjects and methods. Eighty-four victims with severe concomitant injury were examined. Twenty-five (29.7% patients developed sepsis, death being observed in 83.3%. CRP was daily determined in the sera of the victims, by using CRP latex test kits (HUMATEX, Germany. On days 1, 3, 7, 10, and 15 after injury, serum and lymphocytic culture IL-2, IL-4, TNF-a, IFN-y, and HLA-DR were studied on an automatic Elx 800 Universal Microplate Reader enzyme immunoassay analyzer (BIO-TEK INSTRUMENTS, Inc., USA, by applying enzyme immunoassay systems (OOO «Cytokine», Saint Petersburg, Russia.Results. No complications were observed with a CRP level of 40 mg/l on day 1 and its further reduction. The CRP level of 40 mg/l on day 1 (without use of glucocorticoids and its prolonged increase were determined in visceral inflammatory and infectious complications. The CRP level of 120 mg/l within the first 7 days was noted in subsequently developed sepsis. Glucocorticoids and specific immune drugs resulted in a reduction or complete disappearance of CRP. When the latter were discontinued, CRP appeared in the quantity reflecting the effect of treatment. In the absence of multiple organ dysfunctions, the level of CRP decreased as the infectious process diminished. The low level of CRP and the activation of an infectious process suggest the areactivity of an organism. With the CRP level of 40 mg/l, the spontaneous production and level of blood IL-4 increased less significantly, whereas those of IFN-y rose more substantially; the induced activity of TNF-a also more drastically decreased (by 10 times versus 2.2 with a CRP level of 40 mg/l. Irrespective of the level of CRP, the induced activity of IL-4 decreased by 59%, suggesting immunosuppression. There was no association of CRP with IL-2 and HLA-DR.Conclusion. Daily blood CRP analysis in injury makes it possible to predict visceral

A state-of-the-art review of built environment information modelling (BeIM

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Tah J.H.M.

2017-12-01

Full Text Available Elements that constitute the built environment are vast and so are the independent systems developed to model its various aspects. Many of these systems have been developed under various assumptions and approaches to execute functions that are distinct, complementary or sometimes similar. Furthermore, these systems are ever increasing in number and often assume similar nomenclatures and acronyms, thereby exacerbating the challenges of understanding their peculiar functions, definitions and differences. The current societal demand to improve sustainability per­formance through collaboration as well as whole-system and through-life thinking is driving the need to integrate independent systems associated with different aspects and scales of the built environment to deliver smart solutions and services that improve the well-being of citizens. The contemporary object-oriented digitization of real-world elements appears to provide a leeway for amalgamating the modelling systems of various domains in the built environment which we termed as built environment information modelling (BeIM. These domains include architecture, engineering, construction as well as urban planning and design. Applications such as building information modelling, geographic information systems and 3D city modelling systems are now being integrated for city modelling purposes. The various works directed at integrating these systems are examined, revealing that current research efforts on integration fall into three categories: (1 data/file conversion systems, (2 semantic mapping systems and (3 the hybrid of both. The review outcome suggests that good knowledge of these domains and how their respective systems operate is vital to pursuing holistic systems integration in the built environment.

Βιβλιοκρισία:P. SCHREINER-E. VOGT(eds., Karl Krumbacher. Leben und Werk, München, Verlag der Bayerischen Akademie der Wissenschaften in Kommission beim Verlag C. H. Beck, München 2011

Directory of Open Access Journals (Sweden)

Walter PUCHNER

2013-04-01

Full Text Available Βιβλιοκρισία: P. Schreiner-E. Vogt (eds., Karl Krumbacher. Leben und Werk, München, Verlag der Bayerischen Akademie der Wissenschaften in Kommission beim Verlag C. H. Beck, München 2011 (Bayerische Akademie der Wissenschaften, Philosophisch-historische Klasse, Sitzungsberichte, Jahrgang 2011, Heft 4, σελ. 147, 5 εικ., ΙSBN 978 3 7696 1569 0.

Magnetic resonance imaging of complex congenital heart disease in aduits; Magnetresonanztomographie komplexer kongenitaler Herzerkrankungen beim Erwachsenen

Energy Technology Data Exchange (ETDEWEB)

Bremerich, J. [San Francisco Univ, CA (United States). Dept. of Radiology]|[Universitaetsklinik Basel (Switzerland). Abt. fuer Medizinische Radiologie; Wyttenbach, R.; Higgins, C.B. [San Francisco Univ, CA (United States). Dept. of Radiology; Buser, P. [Universitaetsklinik Basel (Switzerland). Abt. fuer Kardiologie; Steinbrich, W. [Universitaetsklinik Basel (Switzerland). Abt. fuer Medizinische Radiologie

1999-04-01

An increasing number of patients with complex congenital heart disease reaches adulthood, because treatment and patient outcome have improved considerably in recent years. Monitoring of these patients requires both definition of cardiac anatomy and assessment of function with good reproducibility. Complications after surgical repair such as restenoses of pulmonary arteries after surgical repair of Tetralogy of Fallot, ventricular hypertrophy, stenoses or leakage of baffles, or stenosis and aneurysms of anastomoses have to be detected at an early stage. Magnetic Resonance Imaging (MRI) is an excellent tool to monitor these patients because of its noninvasive nature, its good interstudy and interobserver reproducibility, and because it allows assessment of both cardiac anatomy and function. This paper reviews the current applications of MRI in complex congenital heart disease in adults. (orig.) [Deutsch] Durch Verbesserungen in der Diagnose und Therapie komplexer kongenitaler Herzerkrankungen kann eine zunehmende Anzahl von betroffenen Patienten das Erwachsenenalter erreichen. Diese Patienten benoetigen regelmaessige postoperative Verlaufskontrollen, um Komplikationen wie z.B. Restenosen der grossen Arterien, Stenosen, Lecks und Aneurysmata von Anastomosen, Ventrikelhypertrophie und -dilatation oder Klappendysfunktionen fruehzeitig zu erkennen und zu behandeln. Fuer nichtinvasive regelmaessige Verlaufskontrollen bietet sich die Magnetresonanztomographie (MRT) des Herzens an, da sie eine umfassende Untersuchung sowohl der Morphologie als auch der Funktion des Herzens mit guter Reproduzierbarkeit erlaubt. Die gegenwaertigen klinischen Anwendungen der MRT bei komplexen kongenitalen Herzerkrankungen beim Erwachsenen werden in dieser Uebersicht beschrieben. (orig.)

Cerebral MR imaging of malignant melanoma; Zerebrale MR-Bildgebung beim malignen Melanom

Energy Technology Data Exchange (ETDEWEB)

Breckwoldt, M.; Bendszus, M. [Universitaetsklinikum Heidelberg, Abteilung Neuroradiologie, Neurologische Klinik, Heidelberg (Germany)

2015-01-16

Suszeptibilitaetssignale (ITSS), was sie von anderen Metastasen unterscheidet (Spezifitaet ca. 81-96 %). Die Diffusionsbildgebung spielt beim MM nur eine untergeordnete Rolle. Die suszeptibilitaetsgewichtete Bildgebung verbessert die Sensitivitaet der Metastasendetektion bei eingeschraenkter Spezifitaet. Eine Unterscheidung von Mikroblutungen oder Verkalkungen kann im Einzelfall unmoeglich sein. Kontrovers ist zudem, wie SWI-Signalausloeschungen zu werten sind, fuer die sich kein Korrelat in den anderen Sequenzen findet (Differenzialdiagnose: Metastase, Mikroblutung, Verkalkung). Der beim MM haeufig vorkommende ZNS-Befall ist ab Stadium IIc auch bei neurologisch asymptomatischen Patienten auszuschliessen. Ebenso sind im Stadium IV alle 3 Monate kraniale MRT-Untersuchungen indiziert. Die Unterscheidung von Metastasen und intrazerebralen Einblutungen ist nicht immer moeglich und muss im Einzelfall durch eine Verlaufsuntersuchung geklaert werden. Zusaetzliche diagnostische Sensitivitaet bei eingeschraenkter Spezifitaet bringt die SWI. (orig.)

Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

Science.gov (United States)

V, Dei Giudici; N, Giampaolini; A, Panfighi; M, Marinelli; R, Procaccini; A, Gigante

2015-01-01

The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards “where” and “when” to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient’s outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113

49. and 50. annual meeting of the Civil Defence Commission of the Federal Ministry of the Interior. Proceedings; 49. und 50. Jahrestagung der Schutzkommission beim Bundesminister des Innern. Vortraege

Energy Technology Data Exchange (ETDEWEB)

NONE

2003-07-01

The publication contains the proceedings of the 2000 and 2001 annual meetings. Subjects were: Disaster medicine, public alarm, proliferation of weapons of mass destruction, epidemic hygiene and control, therapy of organophosphate poisoning, airborne energy and dose equivalent profiles by microdosimetry, zoning system for floods, backwater, heavy rains, health services, information security in transition, heavy-duty concretes, building and infrastructure protection. [German] Der Band umfasst die Vortraege der Jahrestagungen 2000 und 2001 der Schutzkommission beim Bundesminister des Innern. Die Vortraege beschaeftigten sich mit folgenden Themen: Katastrophenmedizin, Warnung der Bevoelkerung, Proliferation von Massenvernichtungswaffen, Seuchenhygiene und Seuchenbekaempfung, Therapie von Organophosphatvergiftung, Energie- und Aequivalentdosisleistungsprofile mittels Microdosimetrie in Flugzeugen, Zonierungssystem Ueberschwemmung Rueckstau Starkregen, Gesundheitsdienst, Informationssicherheit im Wandel, Hochleistungsbetone, Baulicher Schutz und Schutz von Infrastruktur. (uke)

Early decreased TLR2 expression on monocytes is associated with their reduced phagocytic activity and impaired maturation in a porcine polytrauma model

Science.gov (United States)

Schimunek, Lukas; Serve, Rafael; Teuben, Michel P. J.; Störmann, Philipp; Auner, Birgit; Woschek, Mathias; Pfeifer, Roman; Horst, Klemens; Simon, Tim-P.; Kalbitz, Miriam; Sturm, Ramona; Pape, Hans-C.; Hildebrand, Frank; Marzi, Ingo

2017-01-01

In their post-traumatic course, trauma patients suffering from multiple injuries have a high risk for immune dysregulation, which may contribute to post-injury complications and late mortality. Monocytes as specific effector cells of the innate immunity play a crucial role in inflammation. Using their Pattern Recognition Receptors (PRRs), notably Toll-Like Receptors (TLR), the monocytes recognize pathogens and/or pathogen-associated molecular patterns (PAMPs) and organize their clearance. TLR2 is the major receptor for particles of gram-positive bacteria, and initiates their phagocytosis. Here, we investigated the phagocytizing capability of monocytes in a long-term porcine severe trauma model (polytrauma, PT) with regard to their TLR2 expression. Polytrauma consisted of femur fracture, unilateral lung contusion, liver laceration, hemorrhagic shock with subsequent resuscitation and surgical fracture fixation. After induction of PT, peripheral blood was withdrawn before (-1 h) and directly after trauma (0 h), as well as 3.5 h, 5.5 h, 24 h and 72 h later. CD14+ monocytes were identified and the expression levels of H(S)LA-DR and TLR2 were investigated by flow cytometry. Additionally, the phagocytizing activity of monocytes by applying S. aureus particles labelled with pHrodo fluorescent reagent was also assessed by flow cytometry. Furthermore, blood samples from 10 healthy pigs were exposed to a TLR2-neutralizing antibody and subsequently to S. aureus particles. Using flow cytometry, phagocytizing activity was determined. P below 0.05 was considered significant. The number of CD14+ monocytes of all circulating leukocytes remained constant during the observational time period, while the percentage of CD14+H(S)LA-DR+ monocytes significantly decreased directly, 3.5 h and 5.5 h after trauma. The percentage of TLR2+ expressing cells out of all monocytes significantly decreased directly, 3.5 h and 5.5 h after trauma. The percentage of phagocytizing monocytes decreased

Radioimmunoassay of pancreatic glucagon. Improvement of method and application in order to determine the role of glucagon in the polytrauma

International Nuclear Information System (INIS)

Schrezenmeir, J.

1980-01-01

Radio-iodizing of glucagon under the application of chloralamine-T was examined and optimized with respect to its dependency on the concentration of the reacting agents, on the duration of reaction and on the pH value. The methods of other authors to purify labeled glucagon were put in contrast with the considerably faster and less complicated batch-procedure, in which Ouso G32 is applied. In order to improve the immunogenity of the weak antigen glucagon, different immunogenic preparations were produced and compared with each other. By the glucagon polymerisation with carbodiimid in guadinin HCl-solution, antibodies of excellent quality were obtained. With the glucagon polymers for the first time an immunogen was found, which produced exclusively so-called specific anti-glucagon sera. The influence of the albumine concentration and of the charcoal quantity on the separation of free and antibody-bound glucagon by means of dextran-covered charcoal was investigated. The early beginning of the investigations, the observation of the course, the temporal correlation of numerous other parameters and the fast application of shock-measures led to new knowledge about glucagon in the polytrauma. (orig./MG) [de

Interdisciplinary interventional therapy for tracheobronchial stenosis with modern metal net stents; Interdisziplinaere interventionelle Therapie tracheobronchialer Stenosen mit modernen Metallmaschenstents

Energy Technology Data Exchange (ETDEWEB)

Rieger, J.; Linsenmaier, U.; Fedorowski, A.; Pfeifer, K.J. [Ludwig-Maximilians-Universitaet Muenchen (Germany). Inst. fuer Klinische Radiologie; Hautmann, H.; Huber, R.M. [Klinikum Innenstadt der Ludwig-Maximilians-Universitaet Muenchen (Germany). Abteilung Pulmonologie, Medizinische Klinik

2002-08-01

, ein Rueschstent und ein Palmazstent) wurde in einer unifizierten Datenbank erfasst. Die Patienten wurden hinsichtlich der klinischen Wirkung der Endoprothesen einschliesslich Lungenfunktionsparameter, relevanter Komplikationen, Implantationsmethodik und radiologischer Verlaufsparameter untersucht. Die Verweil-, Dislokations- und Kompressionswahrscheinlichkeit wurde nach Kaplan-Meier berechnet und dargestellt. Ergebnisse: Bei 86% der Patienten stellte die Stentimplantation eine effektive Behandlungsmethode dar. Der Atemwegswiderstand normalisierte sich bei 9/9 Patienten. Die Analyse nach Kaplan-Meier ergab fuer den Wall- und den Nitinolstent eine deutlich hoehere Wahrscheinlichkeit, im Tracheobronchialsystem zu verweilen und nicht komprimiert zu werden. Eine Dislokation war ebenfalls seltener. Die Explantation eines Wallstents ist jedoch im Vergleich zum Streckerstent erheblich schwieriger. Auch kam es beim Wallstent gelegentlich zur interventionspflichtigen Bildung von Granulationsgewebe am proximalen Stentende. (orig.)

Monitoring lung contusion in a porcine polytrauma model using EIT: an application study.

Science.gov (United States)

Santos, Susana Aguiar; Wembers, Carlos Castelar; Horst, Klemens; Pfeifer, Roman; Simon, Tim-Philipp; Pape, Hans-Christoph; Hildebrand, Frank; Czaplik, Michael; Leonhardt, Steffen; Teichmann, Daniel

2017-07-26

Lung contusion is the most common lung injury following blunt chest trauma which, in turn, is associated with high mortality rates (Gavelli et al 2002 Eur. Radiol. 12 1273-94). Lung contusion is characterized by hemorrhage and edema with consecutively reduced compliance. Objective and Approach: In this study, unilateral lung contusion and other traumata were induced in 12 pigs by using a bolt gun machine. To investigate the pathophysiological consequences of lung contusion, information on clinical parameters was collected and monitored regularly while animals were additionally monitored with electrical impedance tomography (EIT) before trauma, and at 4, 24, 48 and 72 h after polytrauma. Statistical analyses showed significant differences between the measurement time points in terms of lung compliance ([Formula: see text]) and in global EIT parameters, such as absolute global impedance (aGlobImp) ([Formula: see text]), tidal impedance variation (TIV) ([Formula: see text]) and the center of ventilation (CoV) ([Formula: see text]). Additionally, distinct analyses for the left (non-injured) and right (injured) lung were also performed. In this context, during the progress of lung contusion, significant changes were found for the injured lung in TIV ([Formula: see text]), global inhomogeneity ([Formula: see text]), regional ventilation delay ([Formula: see text]), CoV ([Formula: see text]) and in regions of non-ventilation (rNoVent) ([Formula: see text]). Furthermore, TIV and rNoVent were capable to differentiate the injured and the contralateral healthy lung at 4 and 24 h after injury (TIV: [Formula: see text] and [Formula: see text]; rNoVent: [Formula: see text] and [Formula: see text]). TIV reached a sensitivity of 82% (specificity of 100%) at 4 h and sensitivity of 82% (specificity of 82%) at 24 h after injury, in detecting lung contusion specific consequences. The results indicate that EIT might be a valuable tool to detect and to monitor lung injuries

Radiography of the equine thorax and its differential diagnosis relevance; Die differenzialdiagnostische Bedeutung der röntgenologischen Thoraxuntersuchung beim Pferd

Energy Technology Data Exchange (ETDEWEB)

Klein, H. J. [Klinik fuer Pferde, Tieraerztliche Hochschule Hannover (Germany); Offeney, F.

1990-07-01

Commonly chronic obstructive pulmonary disease (COPD) is the cause of dyspnoe or loss of performance in the horse. Tracheobronchoscopy, cytology of tracheobronchial aspirates, interpleural pressure measurement, and arterial blood gas analysis improved diagnosis of equine respiratory disorders. Yet some intrathoraeie diseases, especially chronic pneumonia, are differential diagnosis problems. Radiography of the thorax improves the diagnosis of pneumonia and some other intrathoraeie diseases. The technique of the radiography of the thorax is described and radiographic findings in 166 horses suffering from respiratory diseases are evaluated. Theses horses showed pathologic radiographic findings caused by COPD (n =61), pneumonia (67), pleuritis (12), exercise-induced pulmonary haemorrhage (8), aspiration pneumonia (7), hydrothorax (6), pneumothorax (2), lung abseess (1); mediastinal tumor (1), and diaphragmatie hernia (1) [German] Die chronisch obstruktive Bronchitis (COB) ist die häufigste Ursache von Atembeschwerden oder Leistungsmangel beim Pferd. Tracheobronchoskopie, Tracheobronchialsekretzytologie, interpleurale Druckmessung und arterielle Blutgasanalyse verbesserten die Diagnostik respiratorischer Erkrankungen. Dennoch bestehen Probleme hinsichtlich der Differentialdiagnose zur COB, und zwar insbesondere bei chronischen Pneumonien. Die röntgenologische Thoraxuntersuchung verbessert die Diagnose von Pneumonien und einigen anderen intrathorakalen Erkrankungen. Die Technik der röntgenologischen Thoraxuntersuchung wird beschrieben, und die Befunde von 166 Pferden mit Erkrankungen der Atemorgane werden ausgewertet. Diese Pferde zeigten pathologische Röntgenbefunde als Folge einer COB (n =61), einer Pneumonie (67), einer Pleuritis (12), eines belastungsinduzierten Lungenblutens (8), einer Aspirationspneumonie (7), eines Hydrothorax (6), eines Pneumothorax (2), eines Lungenabszesses (1), eines mediastinalen Tumors (1) und einer Zwerchfellhernie (1)

Systemic Inflammatory Effects of Traumatic Brain Injury, Femur Fracture, and Shock: An Experimental Murine Polytrauma Model

Directory of Open Access Journals (Sweden)

C. Probst

2012-01-01

Full Text Available Objective. Despite broad research in neurotrauma and shock, little is known on systemic inflammatory effects of the clinically most relevant combined polytrauma. Experimental investigation in an animal model may provide relevant insight for therapeutic strategies. We describe the effects of a combined injury with respect to lymphocyte population and cytokine activation. Methods. 45 male C57BL/6J mice (mean weight 27 g were anesthetized with ketamine/xylazine. Animals were subjected to a weight drop closed traumatic brain injury (WD-TBI, a femoral fracture and hemorrhagic shock (FX-SH. Animals were subdivided into WD-TBI, FX-SH and combined trauma (CO-TX groups. Subjects were sacrificed at 96 h. Blood was analysed for cytokines and by flow cytometry for lymphocyte populations. Results. Mortality was 8%, 13% and 47% for FX-SH, WD-TBI and CO-TX groups (P<0.05. TNFα (11/13/139 for FX-SH/WD-TBI/CO-TX; P<0.05, CCL2 (78/96/227; P<0.05 and IL-6 (16/48/281; P=0.05 showed significant increases in the CO-TX group. Lymphocyte populations results for FX-SH, WD-TBI and CO-TX were: CD-4 (31/21/22; P= n.s., CD-8 (7/28/34, P<0.05, CD-4-CD-8 (11/12/18; P= n.s., CD-56 (36/7/8; P<0.05. Conclusion. This study shows that a combination of closed TBI and femur-fracture/ shock results in an increase of the humoral inflammation. More attention to combined injury models in inflammation research is indicated.

Politik der Mikroentscheidungen: Edward Snowden, Netzneutralität und die Architekturen des Internets

OpenAIRE

Sprenger, Florian

2015-01-01

Ob beim Aufrufen einer Webseite, beim Versenden einer E-Mail oder beim Hochfrequenzhandel an der Börse: Auf ihrem Weg durch die Weiten digitaler Netze durchqueren Bits zahlreiche Knoten, an denen eine Reihe von Mikroentscheidungen getroffen werden. Diese Entscheidungen betreffen den besten Pfad zum Ziel, die Verarbeitungsgeschwindigkeit oder die Priorität zwischen den ankommenden Paketen. In ihrer vielschichtigen Gestalt bilden solche Mikroentscheidungen eine bislang nur marginal beachtete Di...

Value of radiographic examination of the knee joint for the orthopedic surgeon; Wertigkeit der radiologischen Bildgebung beim Kniegelenk fuer den Orthopaeden

Energy Technology Data Exchange (ETDEWEB)

Pietsch, M.; Hofmann, S. [Allgemeines und Orthopaedisches LKH Stolzalpe (Austria). Abteilung fuer Orthopaedie und orthopaedische Chirurgie

2006-01-01

Extended radiographic examinations offer excellent options for diagnosis and strategy for treatment of the knee joint. The whole-leg radiograph is indispensable in measuring alignment for osteotomy or total knee arthroplasty (TKA). Fluoroscopically assisted varus-valgus stress radiographs provide the possibility for verifying mechanical function of the implanted knee prosthesis. Ultrasound examinations have been widely replaced by magnetic resonance imaging (MRI). MRI is the golden standard to examine intra-articular structures of the knee (meniscus, ligaments, cartilage) and surrounding soft tissue. For evaluating femoral and tibial torsion and determining axial rotation of TKA, computed tomography (CT) is best qualified. Imaging of the patellofemoral joint (patella instability) is difficult; CT scans in combination with true lateral radiographs seem to be helpful. (orig.) [German] Die erweiterte Roentgendiagnostik bietet gute Moeglichkeiten der Diagnose und Therapieplanung beim Kniegelenk. Das Ganzbeinroentgen ist unabdingbar zur Achsvermessung bei der Planung einer Umstellungsosteotomie oder der Implantation einer Knietotalendoprothese (KTEP). Varus-/Valgusaufnahmen unter Bildwandler gestatten die Ueberpruefung der Mechanik einer liegenden KTEP. Sonographische Untersuchungen des Kniegelenks sind weitgehend durch die Magnetresonanztomographie (MRT) ersetzt. Die MRT ist die Methode der Wahl zur Beurteilung der Kniebinnenstrukturen (Meniskus, Baender, Knorpel) und der umgebenden Weichteile. Zur Bestimmung der Torsion von Femur und Tibia sowie der Rotation der Komponenten einer KTEP ist die Computertomographie (CT) am besten geeignet. Die Beurteilung des Femorpatellargelenks (Patellainstabilitaet) ist schwierig, am vielversprechendsten erscheint die CT in Kombination mit streng seitlichen Roentgenbildern. (orig.)

Computed tomography in multiple trauma patients. Technical aspects, work flow, and dose reduction; Polytrauma-Computertomographie. Technische Grundlagen, Workflow und Dosisreduktion

Energy Technology Data Exchange (ETDEWEB)

Fellner, F.A. [AKH Linz - Kepler Universitaetsklinikum/JKU, Zentrales Radiologie Institut, Linz (Austria); Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen (Germany); Krieger, J.; Floery, D. [AKH Linz - Kepler Universitaetsklinikum/JKU, Zentrales Radiologie Institut, Linz (Austria); Lechner, N. [AKH Linz - Kepler Universitaetsklinikum/JKU, Abteilung fuer Medizintechnik, Linz (Austria)

2014-09-15

radiologischen Managements sowie auf den verschiedenen Moeglichkeiten der Untersuchungsdurchfuehrung im Routineeinsatz und in Spezialsituationen liegt. Ein weiterer Schwerpunkt sind Moeglichkeiten und Strategien zur Dosisreduktion der Schockraum-CT sowie der Untersuchung polytraumatisierter Kinder. Zahlreiche Studien haben gezeigt, dass eine fruehe Ganzkoerper-CT-Untersuchung positiv mit einer niedrigen Mortalitaet und Morbiditaet korreliert und anderen Bildgebungsverfahren deutlich ueberlegen ist. Die optimale Schockraumversorgung erfordert eine interdisziplinaere Zusammenarbeit von Unfallchirurgen, Anaesthesisten und Radiologen, wobei die Radiologie fuer einen raschen und adaequaten Einsatz der bildgebenden Verfahren und die zeitnahe Kommunikation relevanter Befunde verantwortlich ist. Daneben sollte auch im Rahmen der Schockraum-CT die Patientenstrahlendosis im Hauptaugenmerk des Radiologen stehen. (orig.)

The role of whole body spiral CT in the primary work-up of polytrauma patients - comparison with conventional radiography and abdominal sonography; Die Rolle der Ganzkoerper-Spiral-CT bei der Primaerdiagnostik polytraumatisierter Patienten - Vergleich mit konventioneller Radiographie und Abdomensonographie

Energy Technology Data Exchange (ETDEWEB)

Albrecht, T.; Schlippenbach, J. von; Wolf, K.J. [Klinik und Poliklinik fuer Radiologie und Nuklearmedizin, Charite - Campus Benjamin Franklin (Germany); Stahel, P.F.; Ertel, W. [Klinik fuer Unfall- und Wiederherstellungschirurgie, Charite - Campus Benjamin Franklin (Germany)

2004-08-01

Purpose: To evaluate the role of routine 'whole body spiral CT' in the primary work-up of polytrauma patients for injuries of the thorax, abdomen and spine, and to compare the results with those of conventional radiography of the chest and spine and abdominal ultrasound. Materials and Methods: Fifty consecutive polytrauma patients underwent contrast-enhanced single slice spiral CT (5 mm collimation) from the vertex to the floor of the pelvis as part of the primary work-up after emergency room admission. Overlapping high resolution sections and sagittal reformations of the spine were obtained. Reports of additional chest radiographs (n=43), abdominal ultrasound examinations (n=47) and spine radiographs (n=36) performed in the emergency room were available for retrospective comparison. The 'final diagnoses', which served as the standard of reference, were taken from the patients' records using all information that became available until discharge or death, such as findings from further imaging, surgery and autopsy. Results: CT showed 109 (97%) of 112 thoracic and abdominal soft-tissue injuries. Relevant injuries missed were an early splenic laceration and an early pelvic hematoma, both of which became clinically apparent several hours later. There were 4 false positive CT findings. Conventional chest radiography demonstrated only 20% of thoracic and sonography 22% of abdominal injuries. Chest radiography and sonography produced 2 false-positive findings each. CT showed 66 (87%) of 76 vertebral fractures including all 19 unstable ones. CT missed 5 anterior vertebral body and 5 spinous/transverse process fractures. Conventional radiography found 71% of vertebral fractures including only 50% of the unstable one. (orig.)

Quality of life after multiple trauma: validation and population norm of the Polytrauma Outcome (POLO) chart.

Science.gov (United States)

Lefering, R; Tecic, T; Schmidt, Y; Pirente, N; Bouillon, B; Neugebauer, E

2012-08-01

Due to an increasing number of survivors after multiple injuries in Western countries, the health-related quality of life (QoL) is considered to be an important outcome parameter. Up to now, measuring instruments used in this field lacked validity and comparability. Within 6 years, our working group developed a new modular instrument, called the Polytrauma Outcome (POLO) chart. This study documents the validation of the trauma-specific module specifically designed for trauma patients, the Trauma Outcome Profile (TOP). A total of 172 multiply injured patients (mean Injury Severity Score [ISS] 26.7) recruited from eight trauma centres participating in the German Trauma Registry were compared with 166 marginally injured patients (mean ISS 3.9). The mean follow-up was 24.2 and 26.4 months, respectively. The validation questionnaires used were the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R), Social Support Questionnaire (F-SOZU-K-22), Barthel Index of Activities of Daily Living (ADL) and the Short Form Health Survey (SF-36). The internal consistency of the different dimensions of QoL assessed with the TOP was good. Factor analysis provides evidence of the construct validity of the questionnaire. Correlation with external measures gives evidence of criterion validity for the various dimensions of QoL and similar exceedance of proposed cut-off points within TOP and external measures is verified. The TOP module is a reliable and valid instrument to assess health-related QoL in patients with multiple injuries. It can be used stand-alone or as part of the POLO chart together with the Glasgow Outcome Scale (GOS), the EuroQoL and the SF-36 as a regular systematic follow-up instrument.

A SOF Damage Control Resuscitation Cocktail

Science.gov (United States)

2015-05-01

resuscitation (DCR) cocktail for use by SOF’s that is capable of improving survival from polytrauma in austere settings. The cocktail components...components are tested in a combat-relevant swine polytrauma model of hemorrhagic shock with traumatic brain injury, free internal bleeding from an aortic...from polytrauma in austere settings. The cocktail components include Hextend for volume resuscitation and tissue perfusion, fibrinogen concentrate

Volumetry of metastases from renal cell carcinoma. Comparison with the RECIST criteria; Volumetrie von Metastasen beim Nierenzellkarzinom. Vergleich mit den RECIST-Kriterien

Energy Technology Data Exchange (ETDEWEB)

Graser, A.; Becker, C.R.; Reiser, M.F. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany); Stief, C.; Staehler, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Klinik und Poliklinik fuer Urologie, Muenchen (Germany)

2008-09-15

For patients with metastasized renal cell carcinoma (RCC), imaging techniques are of great importance. Currently, therapy widely relies on antiangiogenic factors, which frequently lead to relatively subtle changes in the size of lesions. From this aspect the commonly used RECIST criteria (response evaluation criteria in solid tumors) must be considered as imprecise for the evaluation of the response to therapy. This article gives a review on new software-based volumetric methods, which allow therapy-induced changes in the size of metastases from RCC to be detected with higher sensitivity and reproducibility. A comparison of RECIST and volumetry was carried out with data from patients with metastasized RCC to demonstrate the higher sensitivity of the 3D volumetric procedure. (orig.) [German] Bei Patienten mit metastasiertem Nierenzellkarzinom werden an die Bildgebung besondere Anforderungen gestellt. Die Therapie beruht heute in den meisten Faellen auf antiangiogenetischen Wirkstoffen, die im Verlauf teils zu relativ geringen Groessenaenderungen von Laesionen fuehren. Daher sind die oftmals verwendeten RECIST-Kriterien (''response evaluation criteria in solid tumors'') bei der Beurteilung des Therapieansprechens als ungenau anzusehen. In diesem Artikel wird ein Ueberblick ueber neue, softwarebasierte volumetrische Methoden gegeben, die es ermoeglichen, therapieinduzierte Groessenaenderungen von Metastasen beim Nierenzellkarzinom mit hoeherer Sensitivitaet und Reproduzierbarkeit zu detektieren. Anhand eigener Daten wird ein Vergleich von RECIST und Volumetrie bei Patienten mit metastasiertem Nierenzellkarzinom durchgefuehrt und die hoehere Sensitivitaet des automatisierten Verfahrens gezeigt. (orig.)

Biomarkers Prognostic for Elevated Intracranial Pressure

Science.gov (United States)

2016-03-01

Orthopedic injury (n=20) iii) Exclusion of patients with polytrauma . It has been reported that serum ceruloplasmin (as well as copper) levels...inclusion of polytrauma patients in our results. We therefore identified the TBI patients with isolated head trauma, and compared the recorded...ceruloplasmin values between those with elevated ICP and those without. Figure 13 shows that when the patients with polytrauma were excluded from the

The value of radiotherapy in comparison with extracorporeal shockwave therapy for supraspinatus tendinitis; Die Wertigkeit der Strahlenbehandlung im Vergleich zur extrakorporalen Stosswellentherapie (ESWT) beim Supraspinatussehnensyndrom

Energy Technology Data Exchange (ETDEWEB)

Gross, M.W.; Engenhart-Cabillic, R. [Klinik fuer Strahlentherapie und Radioonkologie der Philipps-Univ. Marburg (Germany); Sattler, A.; Haake, M.; Schmitt, J.; Hildebrandt, R. [Orthopaedische Klinik der Philipps-Univ. Marburg (Germany); Mueller, H.H. [Inst. fuer Medizinische Biometrie und Epidemiologie, Philipps-Univ. Marburg (Germany)

2002-06-01

Background and Aim: Supraspinatus tendinitis is usually treated by antiinflammatoric drugs, local injections, physiotherapy or low-dose irradiation. A novel approach is the use of extracorporeal shock wave therapy (ESWT) if conservative therapies have failed. So far there has been no controlled study comparing the effectiveness of ESWT with an established conservative method of therapy such as X-ray stimulation radiotherapy. Patients and Methods: 30 patients with chronic supraspinatus tendinitis were admitted into the prospective randomized study. After randomization the patients were treated either with X-ray stimulation radiotherapy with 6 x 0.5 Gy on the ICRU reference point (1 fraction/day) with cobalt 60 gamma rays or three times with 2000 pulses (energy flux density ED+ 0.1 mJ/mm{sup 2}) in 1 week intervals using a Storz Minilith SL1. Primary endpoint was the age-corrected constant score 3 months after intervention. Results: Acute side effects caused by the irradiation were not observed, as expected. One patient described pain and one patient showed a moderate skin irritation after ESWT. In the radiotherapy group average the age-corrected constant score improved from 47.6 through 79.5 points to 87.4 points. In the ESWT group it rose from 50.1 points before ESWT to 91.4 points after 12 weeks and 97.8 after 52 weeks. Conclusion: No statistically significant differences were proven between ESWT and radiotherapy. ESWT appears to be equivalent but not superior to radiotherapy in treating chronic supraspinatus tendinitis syndrome. A comprehensive randomized study is, however, necessary to ensure the equivalence of ESWT. (orig.) [German] Hintergrund und Studienziel: Neben den medikamentoesen Therapieverfahren stehen beim Supraspinatussehnensyndrom die niedrig dosierte Strahlentherapie und, als neuere Methode, die extrakorporale Stosswellentherapie (ESWT) zur Verfuegung. Bislang fehlt jedoch eine kontrollierte Studie, die die Wirksamkeit der ESWT im Vergleich zur

Pacientes vítimas de politrauma com insuficiência renal aguda na unidade de terapia intensiva Pacientes víctimas de politrauma con insuficiência renal aguda en la unidad de cuidados intensivos Patient victim of polytrauma with acute renal failure in the intensive care unit

Directory of Open Access Journals (Sweden)

Rita de Cássia Helú Mendonça Ribeiro

2008-01-01

evitar las complicaciones de la IRA y la respectiva mortalidad.OBJECTIVE: To identify the characteristics of patients with acute renal failure (ARF, polytrauma victims hospitalized in an Intensive Care Unit (ICU. METHODS: A retrospective analysis was performed on 357 records of patients with ARF in the period of 2002 to 2003. These patients presented a creatinine index of 1.8 to 4 mg/dl. Of these patients, 10.6% in the ICU were polytrauma victims. RESULTS: Of the 38 (10.6% patients with ARF and polytrauma victims, 78.9% of were males; 47.3% were aged between 16 and 45 years; 84.3% presented oliguria; 92.1% received no treatment for ARF during hospitalization; 50% remained from one to five days in the ICU; 47.3% had not presented any underlying disease and mortality occurred in 50%. CONCLUSION: Daily control of the renal function in polytrauma victims is important to prevent ARF complications and consequent mortality.

Preclinical Evaluation of the Effects of Aeromedical Evacuation on Military-Relevant Casualties

Science.gov (United States)

2017-10-01

Evaluation of the timing of aeromedical evacuation in rat and swine models of TBI and polytrauma ” will investigate whether early vs delayed aeromedical...injury. Instrumented swine with polytrauma [TBI, hemorrhagic shock (HS), and acute respiratory distress syndrome (ARDS)] will be resuscitated and...2). WRAIR/NMRC IACUC protocol 17-OUMD-29LS “Evaluation of the Timing of Aeromedical Evacuation in Rat and Swine Models of TBI and Polytrauma

A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India.

Science.gov (United States)

Kumar, Parmeshwar; Jithesh, V; Gupta, Shakti Kumar

2016-07-01

Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical analysis was performed by Fisher's two tailed t-test. Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

Clostridium perfringens challenge and dietary fat type modifies performance, microbiota composition and histomorphology of the broiler chicken gastrointestinal tract

DEFF Research Database (Denmark)

Josefiak, Damian; Swiatkiewicz, S; Kieronczyk, B

2016-01-01

Belastung mit Clostridium perfringens und Futterfettquelle modifizieren die Leistung, die Zusammensetzung der Microbiota und die Histomorphologie des Verdauungstraktes beim Broiler......Belastung mit Clostridium perfringens und Futterfettquelle modifizieren die Leistung, die Zusammensetzung der Microbiota und die Histomorphologie des Verdauungstraktes beim Broiler...

Characterization and Comparison of Combat Related Injuries in Women During OIF and OEF

Science.gov (United States)

2016-01-05

military women have sustained in recent conflicts, with specific attention to polytrauma incidence in this population. In addition to studying physical...multi- ple body regions because of polytrauma . *p ≤ 0.05; **p < 0.01; ***p < 0.001. TABLE I. Demographic and Injury Characteristics by Mission 2003...that were involved in explosive events.18 Polytrauma was evident in the majority of women injured in these conflicts; findings showed that almost 65

Evaluation of SOCOM Wireless Monitor in Trauma Patients

Science.gov (United States)

2016-02-01

justified in polytrauma patients? Presented at 2014 American College of Surgeons Florida Committee on Trauma Paper Competition Jacksonville, FL Oct...Model of Polytrauma , Hemorrhage and Traumatic Brain Injury” J Trauma Acute Care Surg 2013 Dec 75(6):974-975 4) Thorson CM, Dubose JJ, Rhee P, Knuth TE...injury increase the risk for venous thromboembolism in polytrauma patients? J Trauma Acute Care Surg 2014 Aug;77(2):243-50. 26) Ryan ML, Van Haren RM

77 FR 27863 - Privacy Act of 1974; System of Records

Science.gov (United States)

2012-05-11

... from each facility within the Polytrauma System of Care and the Physical Medicine and Rehabilitation..., Dallas, TX 75216. VA Polytrauma Rehabilitation Center/ Craig Hospital, 3425 S. Traumatic Brain Injury...

Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries--analysis of 1,867 cases.

Science.gov (United States)

Odell, David D; Peleg, Kobi; Givon, Adi; Radomislensky, Irina; Makey, Ian; Decamp, Malcolm M; Whyte, Richard; Gangadharan, Sidhu P; Berger, Robert L

2013-09-01

Sternal fractures fall into two distinct categories as follows: (1) isolated sternal fracture (ISF) without associated injury and (2) polytrauma sternal fracture (PSF) with associated extrasternal injury. PSF can be sufficiently severe to require hospitalization, while ISF is usually a mild insult manageable in an ambulatory setting. Nonetheless, most patients with ISF are hospitalized. The disconnect between treatment based on existing evidence and actual clinical practice may be caused in large part by the small patient cohorts in published studies conducive to inaccurate conclusions. This article addresses the issue by analyzing prospectively collected data on a far larger population than hitherto available. The Israeli National Trauma Registry (INTR) collects data prospectively on patients admitted to trauma centers in Israel. We analyzed the INTR database on sternal fractures for demographics, mechanisms and severity of injury, diagnostic evaluation, treatment, and outcomes. Between 1997 and 2008, the INTR received data on 1,867 consecutive patients hospitalized with sternal fractures. The injury was sustained most often during motor vehicle accidents (84.1%), followed by falls (10.3%) and other blunt or penetrating mechanisms (5.6%). ISF was sustained in 26.4%, and PSF was sustained in 73.6%. Associated injuries involved most parts of the body. Cardiac contusions or lacerations were diagnosed in 1.8% of the 1,867 patients. ISF was associated with a lower incidence of cardiorespiratory compromise, more favorable trauma scores (Glasgow Coma Scale [GCS] score > 14, Revised Trauma Score > 11), and use of fewer intensive care facilities or operations compared with PSF. Endotracheal intubation, chest tube insertion, or thoracotomy was not performed in any ISF patient but was performed in 16.9% of the PSF cohort. The differences between ISF and PSF were statistically significant in all analyzed indices of injury severity. This study produced compelling evidence that

Rehabilitation and Prosthetic Services

Science.gov (United States)

... Review Resources AT Education Blind Rehab Chiropractic Service Polytrauma/TBI Prosthetics & Sensory Aids Recreation Therapy More Health ... Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues ...

Dimensioning of activation systems using submerged membranes at municipal sewage treatment plants; Bemessung von Membranbelebungsanlagen beim Einsatz zur Reinigung kommunaler Abwaesser

Energy Technology Data Exchange (ETDEWEB)

Ohle, P.; Dorgeloh, E. [Technische Hochschule Aachen (DE). Inst. fuer Siedlungswasserwirtschaft (ISA)

1999-07-01

Dimensioning of conventional activation systems in Germany as a rule relies on instruction sheet A131 of the Abwassertechnische Vereinigung or follows the Hochschulgruppen approach (HSG). They contain recommendations as to the size of the nitrification and denitrification zones, the amount of oxygen supplied and sludge production, and the size of the final sedimentation tank. For the use of sludge activation techniques by means of submerged membranes at municipal sewage treatment plant there so far do not exist any clues to dimensioning that make allowance for the modified boundary conditions. The present paper analyses instruction sheet A131 for its suitability as a basis in the dimensioning of sludge activation systems with submerged membranes at municipal sewage treatment plant. Then the dimensioning instructions are modified to suit the changed boundary conditions, and recommendations for the dimensioning of activation systems with submerged membranes on the basis of extensive studies carried out at the Institut fuer Siedlungswasserwirtschaft ISA of Aachen Technical University RWTH are given. (orig.) [German] Die Bemessung konventioneller Belebungsverfahren erfolgt in Deutschland i.d.R. auf der Grundlage des Arbeitsblatts A 131 der Abwassertechnischen Vereinigung bzw. nach dem Hochschulgruppenansatz (HSG). Sie enthalten Empfehlungen bezueglich der Dimensionierung von Nitrifikations- und Denitrifikationszone, Sauerstoffversorgung, Schlammproduktion und Nachklaerbecken. Fuer den Einsatz von Membranbelebungsanlagen in kommunalen Klaeranlagen existieren bislang keine Bemessungshinweise, die den veraenderten Randbedingungen Rechnung tragen. Der vorliegende Beitrag analysiert das Arbeitsblatt A 131 in Hinsicht auf die Moeglichkeit zur Anwendung fuer die Bemessung von Membranbelebungsanlagen beim Einsatz zur kommunalen Abwasserreinigung. Im Weiteren erfolgt die Modifikation der Bemessungshinweise hinsichtlich der geaenderten Randbedingungen und die Angabe von

Verletzungsschwere und -lokalisationen polytraumatisierter Kinder im Vergleich zu Erwachsenen und deren Bedeutung für das Schockraummanagement

DEFF Research Database (Denmark)

Zwingmann, J; Schmal, H; Südkamp, N P

2008-01-01

PURPOSE: The treatment of paediatric polytrauma patients in the emergency room is not common. The knowledge of specific injuries in consideration of the age-specific characteristics is of particular importance for precise diagnostics and therapy. The goal of this study is the aquisition of the fr......PURPOSE: The treatment of paediatric polytrauma patients in the emergency room is not common. The knowledge of specific injuries in consideration of the age-specific characteristics is of particular importance for precise diagnostics and therapy. The goal of this study is the aquisition...... of the frequency, the localisation and the severity of paediatric polytrauma (age: 0-16 years) in comparison with adults. PATIENTS AND METHODS: In the period 7 / 01 to 5 / 04 the localisation and injury severity of 23 paediatric polytrauma patients (age: 2-16 years) were compared retrospectivly with those of 324...

Harnessing Neuroplasticity to Promote Rehabilitation: CI Therapy for TBI

Science.gov (United States)

2015-10-01

the Tampa VAMC and San Antonio VAMC, which both host Polytrauma Rehabilitation Centers. In addition, we plan to work with the Alabama Brain Injury...sites with those funds, e.g., the Tampa VAMC and San Antonio VAMC, which both host Polytrauma Rehabilitation Centers. In addition, we are seeking

Medical Surveillance Monthly Report (MSMR). Volume 22, Number 12, December 2015

Science.gov (United States)

2015-12-01

injury. In fact, PTSD, chronic pain, and persis- tent post-concussive symptoms have been termed the “ polytrauma clinical triad.”7–10 However, whether...SK, Clark ME, Morasco BJ, Freeman M, Campbell R, Helfand M. Systematic review of the literature on pain in patients with polytrauma including

Gender-Pay-Gap

OpenAIRE

Eicker, Jannis

2017-01-01

Der Gender-Pay-Gap ist eine statistische Kennzahl zur Messung der Ungleichheit zwischen Männern* und Frauen* beim Verdienst. Es gibt zwei Versionen: einen "unbereinigten" und einen "bereinigten". Der "unbereinigte" Gender-Pay-Gap berechnet den geschlechtsspezifischen Verdienstunterschied auf Basis der Bruttostundenlöhne aller Männer* und Frauen* der Grundgesamtheit. Beim "bereinigten" Wert hingegen werden je nach Studie verschiedene Faktoren wie Branche, Position und Berufserfahrung herausger...

Importance of multidetector CT imaging in multiple trauma; Stellenwert der Multidetektor-CT bei Polytrauma

Energy Technology Data Exchange (ETDEWEB)

Linsenmaier, U. [HELIOS Kliniken Muenchen West, HELIOS Klinik Muenchen Perlach, Institut fuer Diagnostische und Interventionelle Radiologie, Muenchen (Germany); Geyer, L.L.; Reiser, M.; Wirth, S. [Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer Klinische Radiologie, Muenchen (Germany); Koerner, M. [Radiologie Muehleninsel, Landshut (Germany)

2014-09-15

zeitnahe Therapie mit dem Ziel, potenziell lebensbedrohliche Verletzungen fruehzeitig zu erkennen und adaequat zu behandeln. Die Basisdiagnostik triagiert zur Sofortoperation und besteht unveraendert aus einer fokussierten Ultraschalluntersuchung (Focused Assessment with Sonography for Trauma, FAST) und Projektionsradiographie (CR), meist limitiert auf eine einzelne Thoraxaufnahme. Die Multidetektor-CT (MDCT) hat sich als standardisierte fruehe Ganzkoerper-CT (''whole-body'', WBCT) etabliert; die Detektionsrate von Verletzungen ist herausragend und die Ueberlebenswahrscheinlichkeit verbessert sich um 20-25 %. Die raeumliche und zeitliche Aufloesung wurde verbessert und die Untersuchungszeit erheblich verkuerzt. Die Dosisexposition ist auch bei einmaliger Akutanwendung nicht unerheblich, durch moderne Scannertechnologie und Dosisreduktion, einschliesslich der iterativen Bildrekonstruktion, konnte eine Dosisreduktion von bis zu 40 % erreicht werden. Die zahlreichen Bilder der WBCT muessen prioritaetenorientiert hergestellt, befundet und archiviert werden, zur schnellen Diagnostik bietet sich das ''volume image reading'' (VIR) an. Die moderne WBCT wir bei Polytrauma frueh, umfassend und individuell adaptiert durchgefuehrt, dabei verbessert die WBCT die Ueberlebenswahrscheinlichkeit um 20-25 %. (orig.)

About the effect of melted zinc mass additives on the formation on layers during hot galvanizing; Zur Wirkung von Zusaetzen zur Zinkschmelze auf die Schichtbildung beim Feuerverzinken

Energy Technology Data Exchange (ETDEWEB)

Schubert, P.; Schulz, W.D. [Institut fuer Korrosionsschutz Dresden GmbH, Gostritzer Str. 61-63, D-01217 Dresden (Germany)

2002-09-01

The influence of various melted zinc mass additives on the galvanizing behaviour of steels is examined by way of comparison. The mechanisms influencing the formation of layers are very different. In case tin is added, a material barrier of enriched tin develops in the zinc coating, which inhibits the iron transport. The mechanisms of Ni, Ti and Al in the melted zinc mass are explained by means of a new theory on the formation of layers, which is based on the influence of the growth of layers via hydrogen escaping from the steel surface during hot galvanizing. This behaviour makes it clear why the single melted mass additives only have a layer-thickness reducing effect on steels with very definite Si contents. The different inhibitions of the growth of the layer during hot galvanizing are discussed. (Abstract Copyright[2002], Wiley Periodicals, Inc.) [German] Der Einfluss unterschiedlicher Zinkschmelzezusaetze auf das Verzinkungsverhalten der Staehle wird vergleichend untersucht. Die Mechanismen der Einflussnahme auf die Schichtbildung sind sehr unterschiedlich. Bei Zusatz von Zinn entsteht im Zinkueberzug eine Materialbarriere aus angereichertem Zinn, die den Eisentransport hemmt. Die Wirkungsweise von Ni, Ti und Al in der Zinkschmelze wird mit Hilfe einer neuen Theorie der Schichtbildung erklaert. Diese beruht auf der Beeinflussung des Schichtwachstums durch Wasserstoff, der waehrend des Feuerverzinkens aus der Stahloberflaeche austritt. Diese Erklaerung macht verstaendlich, warum die einzelnen Schmelzezusaetze nur bei Staehlen mit ganz bestimmten Si-Gehalten schichtdickenreduzierend wirken. Die unterschiedlichen Hemmungen des Schichtwachstums beim Feuerverzinken werden diskutiert. (Abstract Copyright[2002], Wiley Periodicals, Inc.)

Phylogenetische und funktionelle Analysen zur Kapsel O-Acetyltransferase NeuO von Escherichia coli K1

OpenAIRE

Mordhorst, Ines Louise

2010-01-01

Escherichia coli ist ein Kommensale des menschlichen und tierischen Gastrointestinaltraktes. Einige E. coli-Stämme sind in der Lage, extraintestinale Erkrankungen beim Menschen wie Harnwegsinfekte, Neugeborenen-Meningitis und Sepsis, sowie beim Tier aviäre Coliseptikämien, hervorzurufen. Ein wichtiger Virulenzfaktor des Bakteriums ist dabei die aus α-2,8-verknüpften Sialinsäuremonomeren aufgebaute K1-Kapsel, die phasenvariabel mit einer hohen Frequenz O-acetyliert werden kann. Im Jahr 20...

Investigations on avoidance of hot cracks during laser welding of austenitic Cr-Ni steels and nickel-based alloys using temperature field tailoring. Final report; Untersuchungen zur Vermeidung von Heissrissen beim Laserstrahlschweissen von austenitischen Cr-Ni-Staehlen und Nickelbasislegierungen mittels Temperaturfeld-Tailoring. Schlussbericht

Energy Technology Data Exchange (ETDEWEB)

NONE

2013-08-08

. Zweitens wird bei rotationssymmetrischen Bauteilen, die mittels einer Axial-Rundnaht zu verschweissen sind, mit einem relativ einfachen Temperaturfeld, das durch Erwaermung des innen liegenden Fuegepartners vor und waehrend des Schweissens aufgebaut wird, ein Spannungsfeld erzeugt, das die Bildung von Heissrissen verhindert. Schliesslich konnte drittens ein heissrissfreies Laserstrahlschweissen des Stahls 1.4305 und der Nickelbasislegierung Udimet 720 bereits ohne den Einsatz zusaetzlicher Temperaturfelder erreicht werden. Die Grenzen der Einsetzbarkeit des Verfahrens bei Cr-Ni-Staehlen werden dann erreicht, wenn Quer-Heissrisse oder parallel zur Blechoberflaeche liegende Heissrisse entstehen. Die zur Vermeidung dieser Risse noetigen Druckspannungen in den Richtungen parallel zur Schweissnaht bzw. senkrecht zur Blechoberflaeche koennen mittels induktiver Erwaermung von der Blechoberseite aus nicht in der erforderlichen Groesse erzeugt werden. Ebenso stoesst das Verfahren an seine Grenzen, wenn Wiederaufschmelzungsrisse auftreten, was beim hier verwendeten Stahl 1.4435 der Fall war. Die Spannungen, die zur Verhinderung einer Rissoeffnung an den Korngrenzen der Waermeeinflusszone erforderlich waeren, konnten durch Temperaturfeld-Tailoring nicht erreicht werden. Die Moeglichkeit des heissrissfreien Schweissens des Stahls 1.4305 auch ohne Temperaturfeld-Tailoring ergibt sich hauptsaechlich aus dem primaer ferritischen Erstarrungsmodus des Stahls in der vorliegenden Legierungszusammensetzung. Ein industrieller Einsatz des Laserstrahlschweissens fuer diesen oft als nicht schweissbar klassifizierten Stahl erscheint moeglich, wenn bei der Legierungszusammensetzung auf niedrige Anteile der Austenitbildner Nickel, Kohlenstoff und Stickstoff Wert gelegt wird und damit eine stabil primaer ferritische Erstarrung erreicht wird. Fuer diesen Fall kommt es nicht zur Schwefelanreicherung an den Korngrenzen, wodurch die Bildung niedrigschmelzender Phasen und damit die Heissrissentstehung

Der Preis als Kaufbarriere?

DEFF Research Database (Denmark)

Mueller Loose, Simone

2012-01-01

Konsumenten im benachbarten europäischen Ausland (vgl. BVE 2011). Auch der im europäischen Vergleich hohe Marktanteil von Discountern ist ein Indi-kator dafür, dass die Deutschen beim Einkauf von Lebensmitteln weniger qualitäts- und stärker preisorientiert sind (vgl. Zühlsdorf/Spiller 2012). Nicht nur durch......-braucher beim Einkauf von Lebensmitteln hat und gibt einen Überblick über vorhandene empirische Ergebnisse zur Preisbereitschaft für gesunde Lebensmittel....

Ungleiche Ungleichheiten:Zu den Gemeinsamkeiten und Unterschieden von Sexismus und Rassismus

OpenAIRE

Späte, K. (Katrin)

2011-01-01

Sexismus durchzieht fast alle gesellschaftlichen Teilbereiche und deren Grundlagen, im Kern ging es schon Jahrtausende lang um die Rechtfertigung der Herrschaft von Männern über Frauen. Die Minderwertigkeit „der Frau“ wurde unter Rückgriff auf natürliche Begebenheiten bewiesen. Die Grundlage sowohl von Sexismus als auch von Rassismus ist eine Konstruktion: Beim Sexismus die des „weiblichen Geschlechts“, beim Rassismus die der „Rasse“. Während sich die Benennung des Objekts von Rassismus im...

Gruppenleistungen beim Review von Multiple-Choice-Fragen - Ein Vergleich von face-to-face und virtuellen Gruppen mit und ohne Moderation [Review of multiple-choice-questions and group performance - A comparison of face-to-face and virtual groups with and without facilitation

Directory of Open Access Journals (Sweden)

Schüttpelz-Brauns, Katrin

2010-11-01

Full Text Available [english] Background: Multiple choice questions (MCQs are often used in exams of medical education and need careful quality management for example by the application of review committees. This study investigates whether groups communicating virtually by email are similar to face-to-face groups concerning their review process performance and whether a facilitator has positive effects.Methods: 16 small groups of students were examined, which had to evaluate and correct MCQs under four different conditions. In the second part of the investigation the changed questions were given to a new random sample for the judgement of the item quality.Results: There was no significant influence of the variables “form of review committee” and “facilitation”. However, face-to-face and virtual groups clearly differed in the required treatment times. The test condition “face to face without facilitation” was generally valued most positively concerning taking over responsibility, approach to work, sense of well-being, motivation and concentration on the task.Discussion: Face-to-face and virtual groups are equally effective in the review of MCQs but differ concerning their efficiency. The application of electronic review seems to be possible but is hardly recommendable because of the long process time and technical problems.[german] Einleitung: Multiple-Choice-Fragen (MCF werden in vielen Prüfungen der medizinischen Ausbildung verwendet und bedürfen aus diesem Grund einer sorgfältigen Qualitätssicherung, beispielsweise durch den Einsatz von Review-Komitees. Anhand der vorliegenden empirischen Studie soll erforscht werden, ob virtuell per E-Mail kommunizierende Review-Komitees vergleichbar sind mit face-to-face Review-Komitees hinsichtlich ihrer Leistung beim Review-Prozess und ob sich Moderation positiv auswirkt.Methodik: 16 Kleingruppen von Psychologie-Studenten hatten die Aufgabe unter vier verschiedenen Versuchsbedingungen MCF zu bewerten und zu

Significance of findings of both emergency chest X-ray and thoracic computed tomography routinely performed at the emergency unit in 102 polytrauma patients. A prospective study; Relevanz der Befunde von Thoraxroentgen und Thorax-CT im routinemaessigen Schockraumeinsatz bei 102 polytraumatisierten Patienten. Eine prospektive Studie

Energy Technology Data Exchange (ETDEWEB)

Grieser, T.; Buehne, K.H.; Haeuser, H.; Bohndorf, K. [Zentralklinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie

2001-01-01

Purpose: To evaluate prospectively whether and to what extent both thoracic computed tomography (Tx-CT) and supine X-ray of the chest (Rx-Tx) are able to show additional findings that are therapeutically relevant. Patients and Methods: According to a fixed study protocol, we performed Rx-Tx and Tx-CT in 102 consecutive, haemodynamically stable polytrauma patients (mean age, 41.2 yrs; age range, 12-93 yrs). Findings of therapeutical relevance drawn from both Tx-CT and Rx-Tx, and urgent interventions indicated by an attending trauma team were documented on a standardized evaluation sheet immediately. Any change in the patient's management that is different from routine life-saving procedures, and any therapeutical intervention done in the emergency room or elsewhere (operating theatre, angiographic facility) were considered therapeutically relevant. Results: Of 102 patients, 43 (42.2%) had a total of 51 therapeutically relevant findings. Rx-Tx alone yielded 23 relevant findings (45.1%) in 23 patients (22.5%). Of them, Tx-CT has shown additional important findings in 7 patients (30.4%). When Tx-CT alone is considered, it revealed 22 new findings of therapeutical relevance (43.2%) in 20 patients (46.5%). Altogether, Tx-CT was able to show 30 relevant findings in 27 patients, i.e., there was a therapeutical benefit for 26.5% of all polytrauma patients included. Most frequently, there was a need for chest-tube insertion (n=29). Conclusions: Polytrauma patients if haemodynamically stable may profit from computed tomography of the chest when therapeutically relevant thoracic injuries are looked for or early therapeutical interventions are to be checked. However, chest X-ray should stay as a 'front-line' screening method because of its superbly quick feasibility and availability. (orig.) [German] Ziel: Die prospektive Studie soll klaeren, ob und inwieweit eine Thoraxcomputertomographie (Tx-CT) unter Schockraumbedingungen gegenueber der Roentgen

Percutaneous pedicle screw for unstable spine fractures in polytraumatized patients: A report of two cases

Directory of Open Access Journals (Sweden)

Boon Beng Tan

2012-01-01

Full Text Available Unstable spine fractures commonly occur in the setting of a polytraumatized patient. The aim of management is to balance the need for early operative stabilization and prevent additional trauma due to the surgery. Recent published literature has demonstrated the benefits of early stabilization of an unstable spine fracture particularly in patients with higher injury severity score (ISS. We report two cases of polytrauma with unstable spine fractures stabilized with a minimally invasive percutaneous pedicle screw instrumentation system as a form of damage control surgery. The patients had good recovery from the polytrauma injuries. These two cases illustrate the role of minimally invasive stabilization, its limitations and technical pitfalls in the management of unstable spine fractures in the polytrauma setting as a form of damage control surgery.

Cycles of selected trace elements in the South Atlantic: Vertical transport and interactions between particulates and solution; Zum Kreislauf ausgewaehlter Spurenmetalle im Suedatlantik: Vertikaltransport und Wechselwirkung zwischen Partikeln und Loesung

Energy Technology Data Exchange (ETDEWEB)

Dierssen, H

1999-07-01

Subjects: Concentrations, vertical and regional distributions of dissolved and suspended particulate trace elements; Trace element fluxes - vertical, regional, seasonal; The role of particulate organic carbon and atmospheric dust in vertical transport; Fractionation of trace elements in particulate material during transport. [German] Themen dieser Arbeit sind: Konzentrationen, vertikale und regionale Verteilungen von geloesten und suspendierten partikulaeren Spurenelementem (SE); SE-Fluesse vertikal, regional und saisonal; die Rolle des partikulaeren organischen Kohlenstoffs und des atmosphaerischen Staubeintrags beim Vertikaltransport; Fraktionierung von SE im partikulaeren Material beim Transport. (orig./SR)

Evaluating the Joint Theater Trauma Registry as a data source to benchmark casualty care.

Science.gov (United States)

O'Connell, Karen M; Littleton-Kearney, Marguerite T; Bridges, Elizabeth; Bibb, Sandra C

2012-05-01

Just as data from civilian trauma registries have been used to benchmark and evaluate civilian trauma care, data contained within the Joint Theater Trauma Registry (JTTR) present a unique opportunity to benchmark combat care. Using the iterative steps of the benchmarking process, we evaluated data in the JTTR for suitability and established benchmarks for 24-hour mortality in casualties with polytrauma and a moderate or severe blunt traumatic brain injury (TBI). Mortality at 24 hours was greatest in those with polytrauma and a severe blunt TBI. No mortality was seen in casualties with polytrauma and a moderate blunt TBI. Secondary insults after TBI, especially hypothermia and hypoxemia, increased the odds of 24-hour mortality. Data contained in the JTTR were found to be suitable for establishing benchmarks. JTTR data may be useful in establishing benchmarks for other outcomes and types of combat injuries.

Clinical value of FDG hybrid-PET in staging and restaging of malignant lymphoma. Compared with conventional diagnostic methods; Klinische Wertigkeit der Befunde von FDG-PET mittels Koinzidenz-Gammakamera beim Staging und Restaging maligner Lymphome. Ein Vergleich zu konventioneller Diagnostik

Energy Technology Data Exchange (ETDEWEB)

Pichler, R.; Maschek, W.; Hatzl-Griesenhofer, M.; Huber, H. [Allgemeines Krankenhaus Linz (Austria). Inst. fuer Nuklearmedizin; Wimmer, G.; Wahl, G.; Fridrik, M. [Allgemeines Krankenhaus Linz (Austria). I. Medizinische Abt.

2000-09-01

Therapieplan. Insgesamt wurden 29 Personen zwecks posttherapeutischem Restaging untersucht. Bei allen wurden Computertomographie- und Lymphknoten-Ultraschalluntersuchungen angewendet. Die Ergebnisse wurden durch den klinischen Verlauf validiert, in drei Faellen wurde ein Rezidiv durch Biopsie bestaetigt. Ergebnisse: CT und US zeigten beim praetherapeutischen Staging 77 Herde verglichen mit 100 durch Doppelkopf-(DK-)PET dargestellten, dieser Unterschied war im Fisher-T-Test jedoch nicht signifikant (p>0,05). Bei der Erkennung residualer Erkrankungsaktivitaet erzielte DK-Koinzidenz-PET eine Sensitivitaet von 93%, eine Spezifitaet von 79%, einen positiven von 82% und einen negativen praediktiven Wert von 92%. Fuer CT+US ergaben sich entsprechend 87%, 64%, 72% und 88%. Schlussfolgerung: FDG-DK-PET erzielt beim Prestaging maligner Lymphome mindestens so genaue Ergebnisse wie ueblicherweise eingesetzte morphologische Diagnoseverfahren. Zusaetzlich ergibt sich ein erkennbarer Vorteil im therapeutischen Monitoring residualer Lymphome durch den Einsatz von Positronen-Koinzidenz-Detektion mittels einer 3/4-Zoll-Kristall-Gammakamera. (orig.)

Theory of rubber friction and traction properties of car tyres; Theorie der Gummireibung und Traktionseigenschaften von Reifen

Energy Technology Data Exchange (ETDEWEB)

Klueppel, M.; Alshuth, T.; Schuster, R.H. [Deutsches Inst. fuer Kautschuktechnologie e.V., Hannover (Germany)

1998-12-31

ABS braking on dry and wet roads involves different mechanisms of rubber friction on rough surfaces. This improves car safety in terms of higher manoeuvrability and shorter braking lengths especially on wet roads. Current research focuses on optimisation of tyrecontact surface materials with better traction characteristics and lower rolling resistance. Laboratory predictions of the traction properties of tyre faces must be based on fundamental knowledge of the local sliding phenomena in the tyre contact surface and the resulting energy dissipation during ABS braking. This contribution therefore attempts to relate the elementary mechanisms of tyre mechanics in ABS braking processes to theoretical concepts of rubber friction on rough surfaces. [Deutsch] Beim ABS-Bremsen auf trockenen und nassen Strassen werden unterschiedliche Mechanismen der Gummireibung auf rauhen Oberflaechen wirksam. In der Summe bewirkt dies eine hoehere Fahrsicherheit, da neben der Manoevrierfaehigkeit des Autos auch der Bremsweg, vor allem auf nassen Strassen, verkuerzt sein kann. In diesem Zusammenhang wird zur Zeit verstaerkt an einer Optimierung von Laufflaechenmaterialien durch den Einsatz von massgeschneiderten Loesungs-SBR-Typen in Verbindung mit gefaellten Kieselsaeuren gearbeitet, wodurch neben einer Verbesserung der Traktionseigenschaften beim ABS-Bremsen auch eine Verringerung des Rollwiderstandes erreicht wird. Fuer Laborvorhersagen der Traktionseigenschaften von Reifenlaufflaechen ist ein grundlegendes Verstaendnis der lokalen Gleitphaenomene in der Reifenaufstandsflaeche und der damit verbundenen Energiedissipation beim ABS-Bremsen erforderlich. In dieser Arbeit wird deshalb angestrebt, die elementaren Mechanismen der Reifenmechanik beim ABS-Bremsen mit theoretischen Konzepten der Gummireibung auf rauhen Oberflaechen in Verbindung zu bringen. (orig.)

Infektion beim Menschen und beim Hund mit der Milbe Cheyletiella yasguri Smiley

DEFF Research Database (Denmark)

Brandrup, F; Andersen, Klaus Ejner; Kristensen, S

1979-01-01

The infection with the mite Cheyletiella yasguri Smiley in 3 dogs and 5 out of 6 persons exposed to infestation is reported. Two of the dogs appeared to have been infected during a stay in a kennel. The dogs presented with moderate itching and slight to massive floury squamation on the back. In t...

Evaluation of multiple trauma victims with 16-row multidetector CT (MDCT): a time analysis; Anwendung der 16-Zeilen-Mehrdetektor-CT in der Initialdiagnostik beim Polytrauma: Eine Zeitanalyse

Energy Technology Data Exchange (ETDEWEB)

Heyer, C.M.; Nicolas, V. [Bochum Univ. (Germany). Inst. fuer Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin; Rduch, G.J. [Bochum Univ. (Germany). Klinik fuer Chirurgie; Wick, M.; Muhr, G. [Bochum Univ. (Germany). Medizinische Klinik III, Pneumologie, Allergologie und Schlafmedizin; Bauer, T.T. [Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Univ. Bochum (Germany)

2005-12-15

Purpose: Description and time analysis of a 16-row MDCT protocol in the evaluation of multiple trauma patients considering transport, time of scanning, patient positioning, image reconstruction, and image interpretation. Materials and methods: Between May and December 2004, 60 multiple trauma patients underwent 16-row MDCT (Sensation, Siemens, Erlangen, Germany). The protocol included serial scanning of the head, spiral scanning of the cervical spine and contrast-enhanced spiral scanning of the thorax/abdomen with multiplanar reformations (MPR) of the thoracic/lumbar spine and the pelvis. All time intervals including transport, patient positioning, scanning, duration of MPR, total time in the examination room, and time to first and final image interpretation were prospectively evaluated. Furthermore, patient characteristics, trauma profiles, and mortality rates were recorded. Results: 46 male and 14 female patients (mean age 43.6 years) were enrolled in the study. Time analysis of 16-row MDCT revealed the following results (mean time standard deviation): Emergency room treatment and transport 19.2{+-}6.7 min, patient positioning 16.5{+-}6.5 min, scan duration 8.0{+-}3.3 min, total time in examination room 24.5{+-}7.2 min, image reconstruction including MPR 32.0{+-}16.4 min, and time of first (16.4{+-}4.7 min) and final image interpretation (82.5{+-}30.4 min). Trauma profiles revealed thoracic injuries in 35/60 patients (58.3%), head injuries in 23/60 patients (38.3%), abdominal injuries in 15/60 patients (25.0%), injuries of the cervical (9/60 patients, 15.0%), thoracic (12/60 patients, 20.0%), and lumbar spine (19/60 patients, 31.7%), pelvic injuries in 13/60 patients (21.7%), and injuries of extremities in 39/60 patients (65.0%). The mortality rate was 21.7%. (orig.)

Driving systems: trends - innovations - mechatronics; Antriebssysteme: Trends - Innovationen - Mechatronik

Energy Technology Data Exchange (ETDEWEB)

Binder, A. [Technische Univ. Darmstadt (Germany). Inst. fuer Elektrische Energiewandlung; Wick, A. [Siemens A und D (Germany); Gold, P.W. [RWTH Aachen (Germany)

2005-04-01

Short overview on this special meeting with interdisciplinary topics of connection between mechanical and electrical engineering: mechatronics. The main topics are covered by the fields motion control, simulation of drives, monitoring, gears, motors engineering/-design, converter systems, industrial applications and drives for wind turbines. (GL) [German] Zeitgemaesse Planung und Entwicklung von Antriebssystemen bedarf eines interdisziplinaeren Vorgehens zwischen Elektrotechnik und Maschinenbau. Die erstmalig von VDE und VDI gemeinsam abgehaltene Tagung mit ca. 70 Fachbeitraegen ist folglich bewusst als interdisziplinaere Konferenz an der Nahtstelle von Maschinenbau und Eletrotechnik konzipiert worden. Die Schwerpunktthemen decken dabei die Bereiche Motion Control, Antriebsstrangmodellierung, Monitoring, Getriebetechnik, Motorentechnik/-bemessung, Umrichtertechnik, industrielle Antriebsapplikationen und Antriebe in der Windenergie ab. (orig.)

Germany's first CO{sub 2} skating rink. Axima Kaeltetechnik builds new skating rink at Ravensburg; Die erste CO{sub 2}-Kunsteisbahn Deutschlands. Axima Kaeltetechnik baut in Ravensburg

Energy Technology Data Exchange (ETDEWEB)

Anon.

2004-04-01

Natural refrigerants are frequently used in skating rinks. Increasingly, CO2 is preferred to brine, as in the new Ravensburg skating rink. It is the first time this technology is applied in Germany, but more systems of this kind are sure to come. [German] Beim Bau von Kunsteisbahnen sind natuerliche Kaeltemittel kein Novum. Immer haeufiger erhaelt allerdings der Kaeltetraeger CO{sub 2} den Vorzug vor einer Sole, so auch beim Bau der neuen Kunsteisbahn in Ravensburg. Damit wurde erstmals in Deutschland in diesem Bereich der Schritt hin zu einer Systemtechnologie gemacht, die aller Voraussicht nach noch zahlreiche weitere Anwendungen nach sich ziehen wird. (orig.)

Results from the first year as a major trauma radiology unit in the UK

International Nuclear Information System (INIS)

Adiotomre, A.; Chopra, A.; Kirwadi, A.; Kotnis, N.

2014-01-01

Aim: To record and analyse data from all facets of practice in the first year as a newly set-up major trauma centre radiology department. Materials and methods: Retrospective analysis of all patients who underwent whole-body computed tomography (WBCT) for suspected polytrauma over a 1 year period was performed. The mechanism, the time of day, the number of body parts injured, the type of injuries, and resulting surgical or radiological interventions were recorded. Also recorded was the time from the CT examination to the formal report. Where applicable, the consultant-verified reports were cross-referenced with the out-of-hours registrar reports to assess for discrepancies. Results: Two hundred and one patients underwent WBCT for suspected polytrauma. Sixty-four percent (128/201) of WBCT examinations were performed “out-of-hours”. Fifty-seven percent (115/201) were road traffic accidents (RTAs), 33% (66/201) were falls, and 6% (12/201) were assaults. At WBCT, 31% (63/201) had no injuries; 27% (54/201) had injury to one body area; 21% (43/201) had injury to two areas; and 20% (41/201) had injury to three or more areas. Nineteen percent (39/201) required urgent radiological or surgical intervention. The mean time from end-of-CT to a formal report was 27 min. There were discrepancies between consultant reports and registrar reports in 22% (31/142) of cases; 1% (2/142) led to a change in acute management. Conclusion: Based on our early experiences, nearly one-third of patients who undergo a WBCT scan for suspected polytrauma, will have no acute injury at WBCT. One-fifth of patients in our study required emergency surgical or radiological intervention for acute injuries found on WBCT. A low discrepancy rate was found between on-call registrar reports and the consultant-verified reports. - Highlights: • Almost one-third of patients with clinically suspected polytrauma had no acute injury at whole body CT. • One-fifth of clinically suspected polytrauma patients

The role of multislice spiral computed tomography in the diagnosis and management of acute facial trauma in patients with multiple injuries.

Science.gov (United States)

Nemsadze, G; Urushadze, O

2011-11-01

Using of mutislice spiral CT as first line examination for the diagnosis of Acute Facial trauma in the setting of Polytrauma reduces both: valuable time and cost of patient treatment. After a brief clinical examination, MDCT was performed depending on the area of injury, using a slice thickness of 0.65 mm. The obtained data were analyzed using 3D, MIP and Standard axial with Bone reconstruction protocols. 64 polytrauma patients were evaluated with both Anterior and Lateral craniography (plain skull X ray: AP and Lateral) and Multi Slice CT. Craniography detected only 18 cases of traumatic injuries of facial bones, but exact range of dislocation and accurate management plan could not be established. In the same 64 cases, Multislice CT revealed localization of all existed fractures, range of fragment dislocation, soft tissue damage and status of Paranasal sinus in 62 cases (96.8%). In two cases MS CT missed the facial fracture, in one case the examination was complicated because of bone thinness and numerous fracture fragments, in another multiple foreign body artifacts complicated the investigation. The study results show that, CT investigation based on our MDCT polytrauma protocol, detects all more or less serious facial bone injuries.

PTSD: National Center for PTSD

Medline Plus

Full Text Available ... Military Exposures Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations ...

Fat embolism syndrome in femoral shaft fractures: does the initial treatment make a difference?

Directory of Open Access Journals (Sweden)

Janio Jose Alves Bezerra Silva

Full Text Available ABSTRACT Objective: To identify the risk factors correlated with the initial treatment performed. Methods: This is a retrospective study involving a total of 272 patients diagnosed with femoral shaft fractures. Of the patients, 14% were kept at rest until the surgical treatment, 52% underwent external fixation, 10% received immediate definitive treatment, and 23% remained in skeletal traction (23% until definitive treatment., Results: There were six cases of fat embolism syndrome (FES, which showed that , polytrauma is the main risk factor for its development and that initial therapy was not important. Conclusion: Polytrauma patients have a greater chance of developing FES and there was no influence from the initial treatment.

PTSD: National Center for PTSD

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Full Text Available ... Treatments (A-Z) Hepatitis HIV Mental Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation ...

A latent profile analysis of childhood trauma in women with bulimia nervosa: Associations with borderline personality disorder psychopathology.

Science.gov (United States)

Utzinger, Linsey M; Haukebo, Justine E; Simonich, Heather; Wonderlich, Stephen A; Cao, Li; Lavender, Jason M; Mitchell, James E; Engel, Scott G; Crosby, Ross D

2016-07-01

The aim of this study was to empirically examine naturally occurring groups of individuals with bulimia nervosa (BN) based on their childhood trauma (CT) histories and to compare these groups on a clinically relevant external validator, borderline personality disorder (BPD) psychopathology. This study examined the relationship between CT and BPD psychopathology among 133 women with BN using latent profile analysis (LPA) to classify participants based on histories of CT. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P), the Diagnostic Interview for Borderlines-Revised (DIB-R), and the Childhood Trauma Questionnaire (CTQ). The LPA revealed four trauma profiles: low/no trauma, emotional trauma, sexual trauma, and polytrauma. Results indicated that the sexual and polytrauma profiles displayed significantly elevated scores on the DIB-R and that the low/no and emotional trauma profiles did not differ significantly on the DIB-R. Secondary analyses revealed elevated levels of a composite CT score among those with both BN and BPD psychopathology compared to those with BN only. These findings suggest that both childhood sexual abuse and the additive effects of childhood polytrauma may be linked to BPD psychopathology in BN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:689-694). © 2016 Wiley Periodicals, Inc.

Das biochemische Rezidiv beim Prostatakarzinom

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Rauchenwald M

2010-01-01

Full Text Available Als biochemisches Rezidiv (BCR wird der Wiederanstieg des nach kurativer Therapie des Prostatakarzinoms (PCa abgefallenen PSA-Werts bezeichnet. Der PSA-Verlauf nach kurativer Therapie ist von der primären Behandlungsmethode abhängig, weshalb auch unterschiedliche Definitionen dafür vorliegen. Der Verlauf selbst scheint prognostische Bedeutung zu haben. Ein Wiederanstieg des PSA-Werts geht der klinischen Progression voraus, wodurch frühzeitig eine Therapie eingeleitet werden kann. Der ideale Zeitpunkt für eine Sekundärbehandlung ist allerdings noch ungenügend definiert. Fast die Hälfte der BCR treten innerhalb der ersten 2 Jahre, ¾ innerhalb der ersten 5 Jahre nach Primärtherapie auf. Als Risikofaktoren für einen BCR werden ein primäres Tumorstadium ≥ T2c, PSA 15, Samenblaseninvasion, Lymphknotenbefall sowie Gleason-Score ≥ 8 angesehen. Von klinischer Bedeutung ist vor allem die Unterscheidung zwischen lokoregionärem und systemischem Rezidiv. Hierzu werden als Parameter neben dem primären Tumorstadium und Gleason-Score das posttherapeutische Intervall und die PSA-Dynamik empfohlen. Als diagnostische Maßnahmen erscheinen nur die Skelettszintigraphie und die Positronenemissionstomographie mit Acetat- oder Cholintracern und diese ebenfalls nur bei entsprechend hohen PSA-Werten sinnvoll. Therapeutisch kommt nach primärer Radikaloperation und Verdacht auf einen lokalen Progress in erster Linie die Salvagebestrahlung zur Anwendung, nach primärer Radiatio wird allerdings vorwiegend die hormonelle Manipulation einer Salvageoperation oder alter“nativen lokaltherapeutischen Maßnahmen vorgezogen.

Netzformen und VDE-Bestimmungen

Science.gov (United States)

Bernstein, Herbert

Der Verband Deutscher Elektrotechniker (VDE) hat eine Reihe von Vorschriften ausgearbeitet, die dem Schutz von Leben und Sachen beim Umgang mit elektrischer Energie dienen. Besonders wichtig sind die in den VDE-Bestimmungen 0100 und 0411 festgelegten Vorschriften.

Vom Terrorismus zum Wandel durch Annäherung: Houellebecqs ‚Soumission‘

Directory of Open Access Journals (Sweden)

Wolfgang Asholt

2016-03-01

Full Text Available Es handelt sich um den Text eines Vortrags beim von Ursula Hennigfeld und Elmar Schafroth organisierten Workshop „Zensur, Political Correctness und Terrorismus“  (Universität Düsseldorf, 30.6. – 2.7. 2015.

Temporal bone trauma and complications: computed tomography findings

Energy Technology Data Exchange (ETDEWEB)

Costa, Ana Maria Doffemond; Gaiotti, Juliana Oggioni; Couto, Caroline Laurita Batista; Gomes, Natalia Delage; Diniz, Renata Lopes Furletti Caldeira; Motta, Emilia Guerra Pinto Coelho, E-mail: anadoffemond@yahoo.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil). Unit of Radiology and Imaging Diagnosis

2013-03-15

Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others. (author)

Temporal bone trauma and complications: computed tomography findings

International Nuclear Information System (INIS)

Costa, Ana Maria Doffemond; Gaiotti, Juliana Oggioni; Couto, Caroline Laurita Batista; Gomes, Natalia Delage; Diniz, Renata Lopes Furletti Caldeira; Motta, Emilia Guerra Pinto Coelho

2013-01-01

Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others. (author)

Real-time detection of root zone-CO2 and its potential for irrigation scheduling

Directory of Open Access Journals (Sweden)

Klaus Spohrer

2015-08-01

Full Text Available Als Basis für die Bewässerungsplanung wurde die Eignung von CO2-Messungen im Wurzelraum (WR-CO2 untersucht und evaluiert. Die grundlegende Annahme war, dass Pflanzen als Reaktion auf eine defizitäre Wasserversorgung die Wurzelatmung reduzieren. Die Untersuchungen an Apfelbäumen konnten zeigen, dass das WR-CO2 zu großen Teilen (56–72 % seinen Ursprung in der pflanzenspezifischen CO2-Produktion (v. a. Wurzelatmung hat. Darüber hinaus reagierte das WR-CO2 deutlich auf Bewässerung und korrelierte bei der Austrocknung mit dem Bodenwassergehalt. Da Veränderungen beim WR-CO2 sich auch in Veränderungen beim Pflanzenwasserstatus widerspiegelten, besitzt das WR-CO2 Potenzial zur Ermittlung des Bewässerungsbedarfs der untersuchten Apfelbäume. Die Übertragbarkeit auf weitere Nutzpflanzen wird untersucht.

Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers

International Nuclear Information System (INIS)

Hinzpeter, R.; Alkadhi, Hatem; Boehm, T.; Boll, D.; Constantin, C.; Del Grande, F.; Fretz, V.; Leschka, S.; Ohletz, T.; Broennimann, M.; Schmidt, S.; Treumann, T.; Poletti, P.A.

2017-01-01

To identify imaging algorithms and indications, CT protocols, and radiation doses in polytrauma patients in Swiss trauma centres. An online survey with multiple choice questions and free-text responses was sent to authorized level-I trauma centres in Switzerland. All centres responded and indicated that they have internal standardized imaging algorithms for polytrauma patients. Nine of 12 centres (75 %) perform whole-body CT (WBCT) after focused assessment with sonography for trauma (FAST) and conventional radiography; 3/12 (25 %) use WBCT for initial imaging. Indications for WBCT were similar across centres being based on trauma mechanisms, vital signs, and presence of multiple injuries. Seven of 12 centres (58 %) perform an arterial and venous phase of the abdomen in split-bolus technique. Six of 12 centres (50 %) use multiphase protocols of the head (n = 3) and abdomen (n = 4), whereas 6/12 (50 %) use single-phase protocols for WBCT. Arm position was on the patient's body during scanning (3/12, 25 %), alongside the body (2/12, 17 %), above the head (2/12, 17 %), or was changed during scanning (5/12, 42 %). Radiation doses showed large variations across centres ranging from 1268-3988 mGy*cm (DLP) per WBCT. Imaging algorithms in polytrauma patients are standardized within, but vary across Swiss trauma centres, similar to the individual WBCT protocols, resulting in large variations in associated radiation doses. (orig.)

Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers

Energy Technology Data Exchange (ETDEWEB)

Hinzpeter, R.; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Boehm, T. [Kantonsspital Graubuenden, Department of Radiology, Chur (Switzerland); Boll, D. [University Hospital Basel, Department of Radiology and Nuclear Medicine, Basel (Switzerland); Constantin, C. [Spital Wallis, Department of Radiology, Visp (Switzerland); Del Grande, F. [Ospedale Regionale di Lugano, Department of Radiology, Lugano (Switzerland); Fretz, V. [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine, Winterthur (Switzerland); Leschka, S. [Kantonsspital St Gallen, Division of Radiology and Nuclear Medicine, Gallen (Switzerland); Ohletz, T. [Kantonsspital Aarau, Department of Radiology, Aarau (Switzerland); Broennimann, M. [University Hospital Bern, Department of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Schmidt, S. [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Treumann, T. [Luzerner Kantonsspital, Institute of Radiology, Luzern 16 (Switzerland); Poletti, P.A. [Geneva University Hospital, Department of Radiology, Geneve (Switzerland)

2017-05-15

To identify imaging algorithms and indications, CT protocols, and radiation doses in polytrauma patients in Swiss trauma centres. An online survey with multiple choice questions and free-text responses was sent to authorized level-I trauma centres in Switzerland. All centres responded and indicated that they have internal standardized imaging algorithms for polytrauma patients. Nine of 12 centres (75 %) perform whole-body CT (WBCT) after focused assessment with sonography for trauma (FAST) and conventional radiography; 3/12 (25 %) use WBCT for initial imaging. Indications for WBCT were similar across centres being based on trauma mechanisms, vital signs, and presence of multiple injuries. Seven of 12 centres (58 %) perform an arterial and venous phase of the abdomen in split-bolus technique. Six of 12 centres (50 %) use multiphase protocols of the head (n = 3) and abdomen (n = 4), whereas 6/12 (50 %) use single-phase protocols for WBCT. Arm position was on the patient's body during scanning (3/12, 25 %), alongside the body (2/12, 17 %), above the head (2/12, 17 %), or was changed during scanning (5/12, 42 %). Radiation doses showed large variations across centres ranging from 1268-3988 mGy*cm (DLP) per WBCT. Imaging algorithms in polytrauma patients are standardized within, but vary across Swiss trauma centres, similar to the individual WBCT protocols, resulting in large variations in associated radiation doses. (orig.)

Is Whole-Body Computed Tomography the Standard Work-up for Severely-Injured Children? Results of a Survey among German Trauma Centers.

Science.gov (United States)

Bayer, J; Reising, K; Kuminack, K; Südkamp, N P; Strohm, P C

2015-01-01

Whole-body computed tomography is accepted as the standard procedure in the primary diagnostic of polytraumatised adults in the emergency room. Up to now there is still controversial discussion about the same algorithm in the primary diagnostic of children. The aim of this study was to survey the participation of German trauma-centres in the care of polytraumatised children and the hospital dependant use of whole-body computed tomography for initial patient work-up. A questionnaire was mailed to every Department of Traumatology registered in the DGU (German Trauma Society) databank. We received 60,32% of the initially sent questionnaires and after applying exclusion criteria 269 (53,91%) were applicable to statistical analysis. In the three-tiered German hospital system no statistical difference was seen in the general participation of children polytrauma care between hospitals of different tiers (p = 0.315). Even at the lowest hospital level 69,47% of hospitals stated to participate in polytrauma care for children, at the intermediate and highest level hospitals 91,89% and 95,24% stated to be involved in children polytrauma care, respectively. Children suspicious of multiple injuries or polytrauma received significantly fewer primary whole-body CTs in lowest level compared to intermediate level hospitals (36,07% vs. 56,57%; p = 0.015) and lowest level compared to highest level hospitals (36,07% vs. 68,42%; p = 0.001). Comparing the use of whole-body CT in intermediate to highest level hospitals a not significant increase in its use could be seen in highest level hospitals (56,57% vs. 68,42%; p = 0.174). According to our survey, taking care of polytraumatised children in Germany is not limited to specialised hospitals or a defined hospital level-of-care. Additionally, there is no established radiologic standard in work-up of the polytraumatised child. However, in higher hospital care -levels a higher percentage of hospitals employs whole-body CTs for primary

Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer. Literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Panje, Cedric; Andratschke, Nikolaus; Guckenberger, Matthias [Zurich University Hospital, Department of Radiation Oncology, Zurich (Switzerland); Brunner, Thomas B. [Freiburg University Hospital, Department of Radiation Oncology, Freiburg (Germany); Niyazi, Maximilian [University of Munich, Department of Radiation Oncology, Munich (Germany)

2016-12-15

This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a literature review and practice recommendations for stereotactic body radiotherapy (SBRT) of primary renal cell cancer and primary pancreatic cancer. A literature search on SBRT for both renal cancer and pancreatic cancer was performed with focus on prospective trials and technical aspects for clinical implementation. Data on renal and pancreatic SBRT are limited, but show promising rates of local control for both treatment sites. For pancreatic cancer, fractionated SBRT should be preferred to single-dose treatment to reduce the risk of gastrointestinal toxicity. Motion-compensation strategies and image guidance are paramount for safe SBRT delivery in both tumor entities. SBRT for renal cancer and pancreatic cancer have been successfully evaluated in phase I and phase II trials. Pancreatic SBRT should be practiced carefully and only within prospective protocols due to the risk of severe gastrointestinal toxicity. SBRT for primary renal cell cancer appears a viable option for medically inoperable patients but future research needs to better define patient selection criteria and the detailed practice of SBRT. (orig.) [German] Die Arbeitsgruppe ''Stereotaktische Radiotherapie'' der Deutschen Gesellschaft fuer Radioonkologie (DEGRO) legt eine Zusammenfassung der aktuellen Literatur und daraus resultierende Empfehlungen zur Durchfuehrung der stereotaktischen Strahlentherapie (SBRT) beim Nierenzellkarzinom und beim Pankreaskarzinom vor. Es erfolgte eine Literaturrecherche zur Evidenz der SBRT beim Nierenzell- und Pankreaskarzinom, wobei der Schwerpunkt auf prospektive Studien und technische Aspekte fuer die klinische Umsetzung gelegt wurde. Fuer die SBRT beim Pankreaskarzinom und Nierenzellkarzinom sind bisher nur wenige Studien veroeffentlicht worden, die jedoch konsistent eine hohe Rate an lokaler Tumorkontrolle

Dynamics of biochemical parameters of blood serum in kidney injuries

Directory of Open Access Journals (Sweden)

Y. L. Podgainiy

2014-12-01

Full Text Available Aim. Annually injuries of varying severity are registered in more than 4,5 million people (up to 10% of the population in Ukraine; renal injury in polytrauma is detected in 26,4% of cases and takes 2 – 3 place of injury of the abdominal cavity and retroperitoneal space. In order to study the kidney function and other vital organs systems 108 patients were examined. Methods and results. Laboratory methods (clinical and biochemical parameters of blood and urine tests, ultrasound and CT scans of the kidneys and abdominal organs were used. Conclusion. It was established that polytrauma often occurs in males (73,5% of middle-age. 42% of patients presented renal function violation - nitrogen excretion and 84% of patients had activated blood coagulation in the first 7 – 10 days of injury.

Fourth report by the Federal German Government to the Bundestag on measures for the protection of the ozone layer; 4. Bericht der Bundesregierung an den Deutschen Bundestag ueber Massnahmen zum Schutz der Ozonschicht

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-07-01

This report, which relates the situation as of July 1997, again confirms the internationally leading role of the Federal German Republic in the phase-out of CFCs. No country has realised a more comprehensive concept for the phase-out of substances that deplete the ozone layer. Combining statutory and voluntary measures has proved a path-breaking approach. One of the most important driving forces in the CFC phase-out were the restrictions of use imposed by the Ordinance on the Prohibition of CFCs and Halon. (orig./SR) [Deutsch] Dieser Bericht - mit Stand vom Juli 1997 - bestaetigt erneut die internationale Fuehrungsrolle der Bundesrepublik Deutschland beim FCKW-Ausstieg. In keinem anderen Staaat wurde ein umfassenderes Konzept zum Ausstieg aus den ozonabbauenden Stoffen realisiert. Als wegweisend hat sich dabei die Verknuepfung ordnungsrechtlicher und freiwilliger Massnahem erwiesen. Insbesondere von den Verwendungsbeschraenkungen der FCKW-Halon-Verbots-Verordnung gingen wichtige Impulse beim FCKW-Ausstieg aus. (orig./SR)

PTSD: National Center for PTSD

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Full Text Available ... a VA Appointment Conditions & Treatments See All Conditions & Treatments (A-Z) Hepatitis HIV Mental Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation ...

Influence of antithyroid medication on effective half-life and uptake of {sup 131}I following radioiodine therapy; Einfluss thyreostatischer Medikation beim Morbus Basedow auf die Kinetik von 131-Iod waehrend einer Radiotherapie

Energy Technology Data Exchange (ETDEWEB)

Moka, D.; Voth, E.; Schicha, H. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

1997-12-01

Aim of this study was to assess the influence of antithyroid drugs (ADT) on the kinetics of {sup 131}I. Therefore, 56 patients with Graves` disease and with shortened effective half-life of {sup 131}I were examined under stationary conditionary conditions. In 38 patients ATD was stopped three days after radioiodine therapy (RIT). The progress of the first RIT and of a second RIT, which still was necessary in 12 patients, was compared to 18 patients receiving ATD continuously. Values of effective half-life for {sup 131}I rose significantly from 3.4 to 5.7 days 2-3 days after stopping ATD. There was an increase of the {sup 131}I-uptake of a second RIT after stopping ATD from 29.0 to 38.4%. In contrast, {sup 131}I-uptake of a second RIT decreased significantly in patients receiving ATD continuously. Effective half-life and uptake of {sup 131}I were affected significantly by ATD. Interrupting ATD after RIT is useful to improve an apparantly insufficient RIT in thyrotoxic patients receiving ATD. (orig.) [Deutsch] Ziel dieser Studie war es, beim M. Basedow die Kinetik von {sup 131}I unter dem Einfluss thyreostatischer Medikation (tM) zu untersuchen. Dazu wurden die 56 Patienten mit immunogener Hyperthyreose M. Basedow (MB) und mit einem erhoehten `turn over` von {sup 131}I unter tM untersucht. Bei 38 Patienten wurde die tM am 3. Tag nach RITh abgesetzt. Der Verlauf der 1. RITh bzw. einer Nachtherapie wurde mit 18 Patienten unter fortlaufender tM verglichen. 2-3 Tage nach Absetzen der tM stieg die effektive Halbwertzeit (HWZ{sub eff.}) von {sup 131}I signifikant von 3,4 auf 5,7 Tage und der {sup 131}I-Uptake bei der Nachtherapie von 29,0 auf 38,4% an, waehrend er unter fortlaufender tM signifikant abfiel. Beide Effekte zeigen, dass tM die {sup 131}I-Kinetik der Schilddruese sehr schnell beeinflussen kann. Gezieltes Absetzen der tM eignet sich deshalb, um bei ausgewaehlten Patienten eine primaer unzureichende RITh noch waehrend des stationaeren Aufenthaltes zu steuern und

PTSD: National Center for PTSD

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Full Text Available ... Home Apply for VA Care Apply Online Application Process Veteran Eligibility Active Duty Families of Veterans Women ... Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation Spinal Cord Injury ...

PTSD: National Center for PTSD

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Full Text Available ... Types of Trauma Trauma Basics Disaster and Terrorism Military Trauma Violence & other Trauma Assessment Assessment Overview Adult ... Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma ...

PTSD: National Center for PTSD

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Full Text Available ... Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen ...

Praxis des Klebens

CERN Document Server

Theuerkauff, Petra

1989-01-01

Bei diesem Buch handelt es sich um einen Leitfaden fur Klebepraktiker. Es werden die verschiedenen Einzelschritte beim kleben beschrieben, als auch die vorbereitenden Massnahmen und anschliessenden Prufverfahren auf Festigkeit behandelt. Das Buch sollte an keinem Arbeitsplatz fehlen, wo man sich mit Problemen der Fugetechnik des Klebens beschaftigt.

Temporomandibular Joint: MRT Diagnostics; Temporomandibulargelenk: MRT-Diagnostik

Energy Technology Data Exchange (ETDEWEB)

Kress, B. [Universitaetsklinikum Heidelberg (Germany). Abteilung Neuroradiologie; Universitaetsklinikum Heidelberg (Germany). Neurologische Klinik; Schmitter, M. [Universitaetsklinikum Heidelberg (Germany). Poliklinik fuer zahnaerztliche Prothetik; Universitaetsklinikum Heidelberg (Germany). Abteilung Neuroradiologie

2005-09-01

MRI of the temporomandibular joint (TMJ) requires 1.5 T. The radiologist must be familiar with the anatomy and pathology of the TMJ. This review gives a description of MRI protocols for the TMJ, and MRI anatomy and pathology of the TMJ (open and closed mouth) by means of MR images and drawings. Diagnosing of the TMJ related diseases depends on standardized clinical and MR examinations. Therefore close interdisciplinary cooperation between dentist and radiologist is necessary. (orig.) [German] Magnetresonanztomographie bei Kiefergelenkbeschwerden erfordert neben guter technischer Ausstattung Kenntnisse der Anatomie und Pathologie des Kiefergelenks. Diese Uebersicht stellt neben MRT-Protokollen die Anatomie und die pathologischen Befunde des Kiefergelenks bei geoeffnetem und geschlossenem Mund anhand von Abbildungen und Graphiken systematisch dar. Bildgebende Diagnostik des Kiefergelenks gruendet sich auf eine standardisierte klinische und magnetresonanztomographische Untersuchung und erfordert eine enge interdisziplinaere Kooperation zwischen Zahnmedizin und Radiologie. (orig.)

LIFE JOURNEY: MEDICAL AND SCIENTIFIC WORK OF PROFESSOR V.A. SOKOLOV

Directory of Open Access Journals (Sweden)

P. A. Ivanov

2017-01-01

Full Text Available The article is dedicated to doctor of medicine, professor V.A. Sokolov. In 2017 he celebrates his eightieth birthday. Professor V.A. .Sokolov is one of the founders of polytrauma treatment in USSR and Russia. For a long time he had been heading polytrauma department at the N.V. Sklifosovsky Research Institute for Emergency Medicine. Due to his work, algorithms of life sustaining and recovery of serious patients were developed. Professor V.A. Sokolov is the author of 6 monographies and about 300 periodical papers. Besides, he is the holder of 32 patents. Some of his inventions were popularized and manufactured. He had been leading active scientific work, which resulted in 6 doctoral dissertations and 15 candidate theses. The staff of N.V. Sklifosovsky Research Institute for Emergency Medicine congratulates on the anniversary.

Multiple floating metatarsals: a unique injury

Directory of Open Access Journals (Sweden)

Trikha Vivek

2013-04-01

Full Text Available 【Abstract】Concomitant dislocation of the tar-sometatarsal and metatarsophalangeal joints of foot is an extremely rare injury. Such injuries presenting in a single or adjacent dual rays have been described in few cases previously. We describe such an injury in adjacent three metatarsals of a polytrauma patient. These injuries are likely to be missed in the initial assessment of a polytrauma patient. These patients are at risk of an overlooked diagnosis but the consequences of missing this type of injury may be Vivek Trikha*, Tarun Goyal, Amit K Agarwal quite severe. This case is presented in view of its unique-ness along with possible mechanism of injury, the sequence of reduction and follow-up. Knowledge of such injury and its proper management may be useful to the trauma surgeons. Key words: Metatarsal bones; Metatarsophalangeal joint; Wounds and injuries

New findings for the use of NMR- and computer tomography for gauging the potential of drilling fluids to cause damage to rocks; Neue Erkenntnisse bei der Anwendung von NMR- und Computertomografie-Methoden im Rahmen der Bewertung des Traegerschaedigungspotentiales von Bohrfluessigkeiten

Energy Technology Data Exchange (ETDEWEB)

Zwaag, C. van der [Reservoir Labs. AS, Trondheim (Norway); Stallmach, F. [Univ. Leipzig (Germany). Fakultaet fuer Physik und Geowissenschaften; Hanssen, J.E. [MI/Anchor Drilling Fluids AS, Stavanger (Norway); Soergaard, E. [Norsk Hydro AS, Bergen (Norway); Toennesen, R. [Saga Petroleum ASA, Stavanger (Norway)

1998-12-31

Polyanionic cellulose, xanthane and ppolyglycole are standard additives for water-based drilling fluids. These are added to drilling liquids to control water loss, provide viscosity and inhibit slating. Filtration losses, which are unavoidable when drilling, cause scavenging polymers to penetrate the area around the drilled hole. This causes a number of different reactions with the surrounding rocks and may ultimately have a permanent influence on the flow conditions of hydrocarbons. The study mentioned above aimed at determining the damage potential of these additives. [Deutsch] Polyanionische Cellulose, Xanthan und Polyglykol sind uebliche Zusatzstoffe von wasserbasischen Bohrspuelungen. Diese werden Bohrfluessigkeiten zur Wasserverlustkontrolle, zur Viskositaetsbildung und zur Schieferinhibierung zugesetzt. Die beim Bohrprozess unvermeidlichen Filtrationsverluste fuehren dazu, dass Spuelungspolymere beim Bohren in den Bohrlochnahbereich eindringen. Die Beschaffenheit dieser Stoffe fuehrt nach dem Eindringen zu unterschiedlichen Reaktionen mit dem Traegergestein. Diese koennen letzten Endes einen dauerhaften Einfluss auf die Zuflussbedingungen von Kohlenwasserstoffen haben. Das Ziel der vorliegenden Studie war es, das Traegerschaedigungspotential der obengenannten Spuelungszusaetze zu charakterisieren. (orig.)

Structural cladding /clad structures

DEFF Research Database (Denmark)

Beim, Anne

2012-01-01

Structural Cladding /Clad Structures: Studies in Tectonic Building Practice A. Beim CINARK – Centre for Industrialized Architecture, Institute of Architectural Technology, The Royal Danish Academy of Fine Arts School of Architecture, Copenhagen, Denmark ABSTRACT: With point of departure in the pr......Structural Cladding /Clad Structures: Studies in Tectonic Building Practice A. Beim CINARK – Centre for Industrialized Architecture, Institute of Architectural Technology, The Royal Danish Academy of Fine Arts School of Architecture, Copenhagen, Denmark ABSTRACT: With point of departure...... to analyze, compare, and discuss how these various construction solutions point out strategies for development based on fundamentally different mindsets. The research questions address the following issues: How to learn from traditional construction principles: When do we see limitations of tectonic maneuver......, to ask for more restrictive building codes. As an example, in Denmark there are series of increasing demands in the current building legislations that are focused at enhancing the energy performance of buildings, which consequently foster rigid insulation standards and ask for improvement of air...

Kognitive Prozesse der Adressatenantizipation beim Schreiben

OpenAIRE

Linnemann, Markus

2014-01-01

Im Fokus dieser Untersuchung stand die Textproduktion aus kognitiver Sicht. Diese umfasst im Wesentlichen vier Wissensbereiche. Neben dem thematischen und linguistischen Wissen, widmete sich die Arbeit vor allem dem pragmatischen, insbesondere dem Adressatenwissen und den dazugehörenden Prozessen. Es wurde dargestellt, dass der Adressat aufgrund seiner räumlichen und zeitlichen Distanz vom Schreiber antizipiert werden muss, wenn er erfolgreich kommunizieren will. Adressatenantizipation wurde ...

Körperliche Fitness beim alternden Mann

Directory of Open Access Journals (Sweden)

Rauchenwald M

2001-01-01

Full Text Available Die derzeitige Diskussion um die Substitution von Hormonen zur Therapie altersbedingter Leistungseinbußen und Befindlichkeitsstörungen führte zu der Frage, ob diese Veränderungen bzw. die entsprechenden Hormonspiegel nicht auch durch körperliches Training günstig beeinflußt werden können. Altern ist mit einem kontinuierlichen Abfall der körperlichen Fitness und der Erektionsfähigkeit verbunden. Die Risikofaktoren für Erektionsstörungen, wie z. B. Übergewicht, sind sehr ähnlich jenen von Herz-Kreislauf-Erkrankungen. Mehrere Studien konnten eine positive Korrelation von körperlicher Aktivität und Erektionsfähigkeit nachweisen. Regelmäßige Bewegung führt zu einer Gewichtsreduktion und zu einem Stressabbau. Die mit dem Alterungsprozeß assoziierten Hormone stehen untereinander als auch mit dem körperlichen Fitnesszustand in Zusammenhang. Ausdauertraining erhöht den Testosteronspiegel stärker als Krafttraining, zu hohe Belastungen führen zu einem Abfall desselben, v.a. in der Erholungsphase, und es besteht eine positive Korrelation von körperlicher Aktivität mit Testosteron und mit Wachstumshormon. Ältere Männer haben allerdings einen schlechteren Response als Jüngere (z. T. kein Effekt bei Krafttraining. Auch für Untrainierte scheint eine mäßige Kreislaufbelastung günstig zu sein und zumindest vorübergehend eine geringe Testosteron-Erhöhung zu bewirken. Ein Zusammenhang zwischen Fitness bzw. Lipidprofil einerseits und dem DHEAS-Spiegel andererseits ist in der Literatur bekannt. Körperliches Training führt auf physiologischem Wege zu Müdigkeit, besserem Schlaf und folglich zu höheren Wachstumshormonspiegeln. Weiters werden das Selbstbewußtsein, die Erektionsfähigkeit, die Muskelmasse und das Gefäßsystem günstig beeinflußt und Stress abgebaut. Regelmäßiges Training 3-5 x pro Woche für 30-60 Minuten mit einer Intensität von 60-80% des Maximalpulses wird als Ausdauertraining empfohlen. Regelmäßige körperliche Aktivität ist ein wichtiger Bestandteil erfolgreichen Alterns.

Defining Platelet Function During Polytrauma

Science.gov (United States)

2014-04-01

scaffold of the clot after its thrombin-induced polymerization to fibrin fibers. Formation of a stiff fibrin fiber network and its contraction by platelet...In another study (PROTEC T) Refused Participat ion (Yes=Y, No=N, W=Unqua lified , Refused further draws (agreed to keep previous data

PTSD: National Center for PTSD

Medline Plus

Full Text Available ... Website Site Map Content Inventory Accessibility Privacy and Security Updating of Web Site Web Site Policies Important ... Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations ...

Radiation therapy for Morbus Ledderhose - indication and clinical results; Strahlentherapie beim Morbus Ledderhose - Indikation und klinische Ergebnisse

Energy Technology Data Exchange (ETDEWEB)

Seegenschmiedt, M.H.; Attassi, M. [Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus, Essen (Germany)

2003-12-01

were minimal: during and within 3 months of the RT course only a slight erythema (CTC 1 ) was seen in five treated lesions, while dry skin changes within the RT portal were observed in three cases (11%) in long term FU (> 12 months). Conclusions: radiotherapy is effective in treating ML and may prevent otherwise necessary surgical interventions. Nodules, cords and symptoms regress, but long-term outcome of at least 5 years has to be awaited. Prospective phase III studies should confirm these results. (orig.) [German] Hintergrund: Der morbus ledderhose (ML) ist eine hyperproliferative Erkrankung der Plantaraponeurose, die dem morbus dupuytren (MD) sehr aehnlich ist. Wir prueften, ob eine Bestrahlung die Symptome lindern und die Progression der Erkrankung aufhalten kann. Patienten und Methoden: Von Juni 1996 bis Dezember 2002 wurden zwoelf Frauen und 13 Maenner im Alter von 9-76 (median 56) Jahren mit symptomatischem ML bestrahlt und mindestens 1 Jahr kontrolliert. Insgesamt wurden 36 Fuesse (16 rechts, 20 links) bestrahlt, da elf Patienten beidseits einen Befall hatten. Zwoelf (48%) Patienten hatten auch einen MD. An 36 Fuessen lagen 63 Knoten (mit 0,5-6,5 cm Groesse) und an 13 (52%) Fuessen 20 Straenge (mit 1-4 cm Laenge) vor. Zusaetzlich bestanden 14-mai (56%) starke Fussschmerzen, achtmal (32%) Probleme beim Laufen, zwoelfmal (48%) andere Symptome (Druck, Schwellung, Spannung). Die Orthovolt-Radiotherapie erfasste alle tastbaren Knoten und Straenge. Es wurden zwei Serien zu je 5 x 3 Gy pro Woche (gesamt: 30 Gy) im Abstand von 8-12 Wochen gegeben. Die Auswertung erfolgte am Ende der RT, nach 3 und 12 Monaten und zuletzt im Dezember 2002. Primaerer Endpunkt war die Vermeidung einer Progression bzw. Operation; sekundaere Endpunkte waren mehrere objektive morphologisch-funktionelle sowie subjektive Parameter (visuelle analogskala (VAS)). Ergebnisse: Nach 38 (12-67) Monaten medianem FU war kein Fuss progredient oder musste operiert werden. Bei 11 von 36 (44%) Fuessen nahm

Primary fixation and delayed nailing of long bone fractures in severe trauma

DEFF Research Database (Denmark)

Friedl, H.P.; Stoker, R.; Czermak, B.

1996-01-01

skeletal conditions (particularly of the lower extremities) impede optimal intensive care of these patients. Therefore in a polytrauma setup, primary operative stabilization of the femur is mandatory and generally accepted, whereas the optimal fixation procedure is still a source of controversies...

Mortality in patients with pelvic fractures

DEFF Research Database (Denmark)

Hauschild, Oliver; Strohm, Peter C; Culemann, Ulf

2008-01-01

hospitals were evaluated for age, gender, Injury Severity Score (ISS), Hannover Polytrauma Score (PTS), fracture type (using Tile's classification), peripelvic soft tissue injury, need for emergency measures, mortality, cause of death, and need for operative stabilization. We compared the patients...

The ethical and medico-legal issues of trauma care

African Journals Online (AJOL)

the case of polytrauma, the patient's autonomy is further reduced. In addition, the risk .... Rational resource use in these circumstances has been an ac- cepted part of ... The high prevalence of HIV among the trauma population is well known in ...

[Multidisciplinary approach of facial injuries

NARCIS (Netherlands)

Dubois, L.; Schreurs, R.; Lapid, O.; Saeed, P.; Adriaensen, G.F.; Hoefnagels, F.M.; Jong, V.M. de

2017-01-01

BACKGROUND: Approximately one quarter of polytrauma patients has facial injuries, which usually lead to loss of form and function. Several specialties are involved in the acute and reconstructive phases of facial injuries, such as oral and maxillofacial surgery, otorhinolaryngology, plastic surgery,

Multidisciplinaire aanpak bij aangezichtsletsel

NARCIS (Netherlands)

Dubois, L.; Schreurs, R.; Lapid, O.; Saeed, P.; Adriaensen, G. F.; Hoefnagels, F. M.; de Jong, V. M.

2017-01-01

Approximately one quarter of polytrauma patients has facial injuries, which usually lead to loss of form and function. Several specialties are involved in the acute and reconstructive phases of facial injuries, such as oral and maxillofacial surgery, otorhinolaryngology, plastic surgery,

Die Brustflosse des Grönlandswales (Balaena mysticetus L.)

NARCIS (Netherlands)

Kükenthal, W.

1922-01-01

Das Studium der Brustflosse des Grönlandswales hat zu Fragen von allgemeinerem Interesse geführt. Ihre kurze und breite Form sowie ihre anscheinende Fünffingerigkeit, die ausserdem nur noch beim südlichen Glattwal (Balaena australis) vorkommt, liess sie ursprünglicher erscheinen als die schlankere

Verwendung von Polypropylen/Polyglactin 910- (PP910- und Polypropylen/Polyglecapron 25 (PP25- Netzen bei Beckenbodenprolaps - eine retrospektive Analyse

Directory of Open Access Journals (Sweden)

Schwegler Ch

2009-01-01

Full Text Available Die Entwicklung von Polypropylen- Implantaten zur Behandlung von Bauchwandhernien stellt einen Meilenstein in der Geschichte der Chirurgie dar. Mit einigen Jahren Verzug folgten die Urogynäkologen den Chirurgen und begannen, Polypropylen-Netze zur Behebung von Beckenbodenvorfällen einzusetzen. PP910-Netze (Vypro II®, Ethicon und PP25-Netze (Ultrapro®, Ethicon werden seit Langem mit gutem Erfolg bei Hernien-Operationen eingesetzt. Das Ziel dieser Studie war herauszufinden, inwieweit sich diese beiden Netze auch für den Einsatz beim Beckenbodenprolaps eignen. Hierzu wurden Fragebögen an Patientinnen versandt, denen in den Jahren 2003 und 2004 diese Netze im Beckenboden implantiert wurden. Die Hauptfragestellungen waren hierbei, inwiefern sich die Symptome des Vorfalles nach der Behandlung verändert hatten und welche Komplikationen nach der Operation aufgetreten waren. Beide Gruppen zeigten nach dem Netzeinsatz deutliche Verbesserungen der Symptomatik bei einer geringen Komplikationsquote. Beim Einsatz von PP910 zeigten sich in 6 % der Fälle Komplikationen, die auf die Implantation des Netzes zurückgeführt werden konnten. Beim Einsatz von PP25 zeigten sogar nur 1,5 % der operierten Frauen netzbedingte Komplikationen. Somit hat sich gezeigt, dass beide Netze gut für die Verwendung im Beckenboden geeignet sind. Vergleicht man die beiden Netze mit anderen Produkten, die derzeit als Implantate im Beckenboden genutzt werden, so zeigt sich ein sehr positives Ergebnis mit signifikant weniger postoperativen Komplikationen unter der Verwendung von PP25-Netzen. Im Rahmen dieser Analyse konnte festgestellt werden, dass PP25 ein sehr sicheres Netz mit ausgesprochen guten Ergebnissen für die Therapie des Beckenbodenprolaps ist.

Influence of experience and qualification on PET-based target volume delineation. When there is no expert - ask your colleague

Energy Technology Data Exchange (ETDEWEB)

Doll, C.; Grosu, A.L.; Nestle, U. [University Medical Center Freiburg, Radiation Oncology Department, Freiburg/Breisgau (Germany); Duncker-Rohr, V. [University Medical Center Freiburg, Radiation Oncology Department, Freiburg/Breisgau (Germany); Ortenau Clinical Center Offenburg, Radiation Oncology Department, Offenburg (Germany); Ruecker, G. [University of Freiburg, Institute of Medical Biometry und Medical Informatics, Freiburg (Germany); Mix, M. [University Medical Center Freiburg, Nuclear Medicine Department, Freiburg (Germany); MacManus, M. [University of Melbourne, The Sir Peter MacCallum Department of Oncology, Melbourne (Australia); Ruysscher, D. de [University Hospital Leuven/KU Leuven, Department of Radiation Oncology, Leuven (Belgium); Vogel, W. [Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam (Netherlands); Eriksen, J.G. [Odense University Hospital, Department of Oncology, Odense (Denmark); Oyen, W. [Radboud University Nijmegen Medical Center, Department of Nuclear Medicine, Nijmegen (Netherlands); Weber, W. [University Medical Center Freiburg, Nuclear Medicine Department, Freiburg (Germany); Memorial Sloan-Kettering Cancer Center, Department of Radiology/Molecular Imaging and Therapy Service, New York (United States)

2014-06-15

Zielvolumendefinition bei der Bestrahlungsplanung verwendet. Im Gegensatz zur automatischen Konturierung wird die visuell-manuellen Konturierung nur unzureichend beforscht. Die vorliegende Studie untersucht den Einfluss von Erfahrung und Qualifikation auf die manuelle Konturierung. Insgesamt 44 internationale interdisziplinaere Untersucher konturierten jeweils ein [{sup 18}F]Fluordesoxyglukose(FDG)-PET-basiertes makroskopisches Tumorvolumen (''gross tumor volume'', GTV) anhand desselben PET-/CT-Scans eines Patienten mit Lungenkarzinom. Die Untersucher waren sog. Experten (E; n = 3), erfahrene interdisziplinaere Zweierteams aus Strahlentherapeut und Nuklearmediziner(EP; n = 9), einzelne Fachaerzte des Behandlungsfelds (SFS; n = 13) und Studenten (S; n = 10). Ferner wurden 5 automatische Konturierungsmethoden (AM) ebenfalls angewendet. Die Groesse der Volumina und die Konkordanzindizes innerhalb der Gruppen (pCI) und relativ zu den Experten (eCI) wurden berechnet. E (pCI = 0,67) und EP (pCI = 0,53) zeigten eine signifikant hoehere Uebereinstimmung innerhalb der Gruppen im Vergleich zu SFS (pCI = 0,43, p = 0,03 und p = 0,006). Relativ zu E zeigte EP (eCI = 0,55) eine bessere Uebereinstimmung verglichen mit SFS (eCI = 0,49) oder S (eCI = 0,47). Die Intermethodenvariabilitaet von AM (pCI = 0,44) war aehnlich der von SFS und S, zeigte aber eine geringere Uebereinstimmung mit E (eCI = 0,35). Die Ergebnisse legen nahe, dass interdisziplinaere Kooperation fuer konsistentes Konturieren vorteilhaft sein kann. Eine gemeinsame Konturierung durch einen Strahlentherapeuten und einen Nuklearmediziner zeigte einen beachtlichen Konsens und eine bessere Uebereinstimmung mit den Experten im Vergleich zu anderen Fachaerzten. Eine relevante Intermethodenvariabilitaet der automatischen Algorithmen verdeutlicht die Notwendigkeit weiterer Standardisierung und Optimierung auch auf diesem Gebiet. (orig.)

Arbitration in environmental matters. An interdisciplinary introduction; Studienbrief Umweltmediation. Eine interdisziplinaere Einfuehrung

Energy Technology Data Exchange (ETDEWEB)

Claus, F; Fietkau, H J; Fuchs, G [and others

2000-07-01

This textbook provides a comprehensive and systematic introduction to the process of arbitration in environmental matters, both for self-studies and for participants in the seminars on which it is based. The interdisciplinary readership is reflected in the interdisciplinary group of authors. The publication can be used as a training programme. [German] Mit Vorliegen dieses Studienbriefs wird erstmals eine Moeglichkeit geboten, sich umfassend und systematisch, im Eigenstudium oder im Rahmen des dazugehoerigen Seminarprogramms, mit dem Verfahren der Umweltmediation vertraut zu machen. Der Vielfalt der angesprochenen Zielgruppen (Politik, Verwaltung, Wirtschaft, Rechtswesen usw.) wurde in der interdisziplinaeren Zusammensetzung des Autorenkreises Rechnung getragen. Das Layout wurde so gestaltet, dass es die inhaltliche Orientierung erleichert. Zusaetzlich kann der Studienbrief auch als Bauelement fuer eine umfassendere Wissensaneignung dienen: Erstens ist es moeglich, sich ueber das oben genannte Ausbildungsprogramm fuer Praktiker zum Mediator fortzubilden. Zweitens besteht die Chance, das erworbene Wissen durch einen Lehrgang zur Agenda-Moderation des Wissenschaftsladen Bonn e.V. um weitere konsens- und handlungsorientierte Verfahren zu erweitern. Informationen koennen ueber den Foerderverein Umweltmediation e.V., Matthias-Gruenewald-Str. 1-3, 53175 Bonn, Tel. 0228/3 72 99 27, eingeholt werden. (orig.)

Mechatronic Carlab - Eine System-Entwicklungsumgebung mit realen und virtuellen mechatronischen Fahrzeug-Komponenten

OpenAIRE

Bünte, Tilman

2004-01-01

Bei der Entwicklung mechatronischer Komponenten sind verschiedene Ingenieurdisziplinen beteiligt: Das Fachwissen auf dem Gebiet Mechanik, Elektronik und Informatik ist gefragt, wenn auf kleinem Raum die unterschiedlichsten Funktionen zu einem Produkt integriert werden. Beim DLR in Oberpfaffenhofen hat diese Technologie schon Tradition - ein großes Anwendungsfeld ist inzwischen die Fahrzeugtechnik

ISSN 2073-9990 East Cent. Afr. J. 0 East Cent. Afr. J. 0 East Cent ...

African Journals Online (AJOL)

dell

2014-04-01

Apr 1, 2014 ... averaged 23.6 weeks and average time to fracture union was 17.8±1.0 ... may be complicated by knee stiffness, malunion and nonunion. .... These included 2 polytrauma (one patient with fractures of the left femur, right ankle, ...

Centralization of politrauma. Study of Ferrara’s reality and simulation of an agreed-upon protocol

Directory of Open Access Journals (Sweden)

Luigi Melcarne

2011-09-01

Full Text Available In a time in which everybody’s asked a big effort to use hospitals, resources and emergency departments in a rational way, the Centralization – that is sending the right patient to the right hospital at the right time – allows an optimization of the resources and a better management of medical patients. In this study we examined the actual state of Centralization in the city of Ferrara where an experimental protocol of “centralization” has been introduced. This study has the purpose of simulating reality if the protocol had been introduced in the years 2008/2009. The results confirm not only that an important number of patients that were meant to be sent to the CTZ of Ferrara where instead sent to the PST but also that, on the contrary, patients from the suburbs that didn’t require advanced treatments were sent to the Sant’Anna hospital of Ferrara. So if medical literature already points out the advantages of a correct Centralization for patients with polytraumas; the study, based on the reality in Ferrara , shows how the creation of an agreed protocol with the goal to guide health workers at sending polytrauma patients to the right destination , instead of creating an excessive flow th the main hub, can improve the overall organization of health services, with an equal distribution between hub and spoke. When considering First Aid not always speed and rapidity guarantee survival; this is so much more real in the case of patients with polytrauma, where quality of cures assumes more importance than time.

Mind the gap: 11 years of train-related injuries at the Royal London Hospital Major Trauma Centre.

Science.gov (United States)

Virdee, J; Pafitanis, G; Alamouti, R; Brohi, K; Patel, H

2018-06-18

Introduction This study presents an extensive retrospective database of patients with polytrauma following train-related injuries and highlights the key lessons learnt in this rare clinical presentation. Materials and methods We retrospectively collected data from 127 patients who presented to Royal London Hospital after sustaining train related trauma. We analysed demographics, accident report data, aetiologies and clinical management interventions. All data were screened and injuries were mapped to various anatomical regions. The revised trauma score, injury severity score and new injury severity scores were used to quantify injury extent. Results Mean patient age was 41 years (range 16-81 years) with a 73% to 27% male to female ratio. Deliberate injuries occurred in 71% of patients, with accidental injury accounting for 29%. The mean new injury severity score was 26.48 (range 1-75), with the most common injuries sustained to the chest and the extremities. Pneumothorax, haemothorax or tension pneumothorax occurred in 44% of patients, with 11% suffering a flail chest injury. Traumatic amputations occurred in 33% of patients and 56% of patients required admission to intensive care. Total mortality rates were 19%, with 12% of patients dying at day 0 and 18% at day 7, respectively. Conclusions This study demonstrated the significant impact of train-related polytrauma and provided a comprehensive injury patterns. It was observed that deliberate polytrauma is related to psychiatric deliberate harm but there is no significant difference in the patterns of injuries between accidental and deliberately caused injuries. Overall injuries to the thorax and extremities were the most severe, demonstrating the highest mean injury scores.

Mehrkörpersimulation eines ebenen Koppelgetriebes mittels Matlab / ADAMS -Co-Simulation

OpenAIRE

Gollee, Christian; Troll, Clemens

2017-01-01

Mit Hilfe der Matlab/ADAMS-Co-Simulation wird ein ebenes Koppelgetriebe (5- Gelenk) untersucht und anschließend die Wirkpaarung mit einem Stückgut betrachtet. Dabei werden verschiedene Modellierungsstufen angewendet und die Simulationsergebnisse Messergebnissen vom Versuchsstand gegenübergestellt. Daneben wird die grundlegende Herangehensweise beim Einsatz dieser Simulationswerkzeuge erläutert.

Resonance – Journal of Science Education | Indian Academy of ...

Indian Academy of Sciences (India)

Jürgen Drissner1 Hans-Martin Haase2 Mara Nikolajek1 Katrin Hille3. Botanical Garden, University of Ulm, D–89081 ULM, Germany. University of Education, Oberbettringer Str. 200, D–73525 Schwäbisch Gmünd, Germany. Transfercenter for Neuroscience and Learning, University of Ulm, Beim Alten Fritz 2 D–89075 ULM, ...

Selection of paediatric patients for intensive care

African Journals Online (AJOL)

illness, particularly near-drowning, cardiomyopathy, gastro- enteritis and complicated infectious illness (Table Ill). Cardiorespiratory resuscitation prior to ICU admission was associated with increased mortality (7/11 v. 27/106,. P < 0,05, two-tailed Fisher's exact test). There were no deaths in patients with polytrauma without ...

Crash tests with Smartcrash barriers, a technology with a future; Zukunftssichere Crashtests mit Smartcrash-Barrieren

Energy Technology Data Exchange (ETDEWEB)

Barz, D.; Evers, W. [Kistler Instrumente AG (Switzerland). Geschaeftsbereich Fahrzeugmesstechnik

2005-02-01

The Smartcrash barrier by Kistler is a completely new technology. State-of-the-art data processing with Microdau modules is combined with a singular mechanical modularity which meets all requirements of present and future crash standards. Together with a piezo measuring system perfectly tuned to the highly dynamic processes during crash tests, this provides a basis for making crash laboratories economically efficient, with safe and accurate data, and compatible with other measuring systems. The system is a 'must' for every modern crash laboratory. (orig.) [German] Die Smartcrash-Barriere von Kistler setzt in jeder Hinsicht Massstaebe. Neueste Technologie der Datenverarbeitung beim Crash mit Microdau-Modulen, wie sie auch in Dummys eingesetzt werden, wird mit einer einzigartigen mechanischen Modularitaet kombiniert, die alle erforderlichen Voraussetzungen fuer bestehende und zukuenftige Crash-Standards bietet. In Verbindung mit der fuer die Messung von hochdynamischen Kraftverlaeufen beim Crash praedestinierte Piezo-Messtechnik ist hiermit die Basis geschaffen, Crash-Laboratorien wirtschaftlich und hinsichtlich des Datenakquisition sicher und kompatibel mit anderen Messgroessen im Labor auszuruesten. Ein 'Muss' fuer jedes moderne Crash-Labor. (orig.)

High-resolution gamma spectroscopy with whole-body and partial-body counters. Experience, recommendations. Report; Hochaufloesende Gamma-Spektrometrie an Ganz- und Teilkoerperzaehlern. Erfahrungen, Empfehlungen. Bericht

Energy Technology Data Exchange (ETDEWEB)

Sahre, P. [comp.

1997-12-01

The application of high-resolution gamma spectroscopy with whole-body and partial-body counters shows a steadily rising upward trend over the last few years. This induced the ``Arbeitskreis Inkorporationsueberwachung`` of the association ``Fachverband fuer Strahlenschutz e.V.`` to organise a meeting for joint elaboration of a guide on recommended applications of this measuring technique, based on a review of existing experience and results. A key item on the agenda of the meeting was the comparative evaluation of the Ge semiconductor detector and the NaI solid scintillation detector. (orig./CB) [Deutsch] Der Einsatz der hochaufloesenden Gammaspektroskopie in Ganz- und Teilkoerperzaehlern hat in den letzten Jahren stetig zugenommen. Der ``Arbeitskreis Inkorporationsueberwachung`` des Fachverbandes fuer Strahlenschutz e.V. hat darum bisherige Erfahrungen zusammengetragen und Empfehlungen fuer den Einsatz dieser Messtechnik erarbeitet. Der Schwerpunkt der Tagung lag beim Vergleich von Germaniumhalbleiter- mit Natriumjodid-Festszintillationsdetektoren.Tl-Detektoren eignen sich v.a. beim Vorhandensein bekannter und zeitlich konstanter Nuklidvektoren (Kernkraftwerke, Nuklearmedizin). Bei unbekanntem bzw. variablem Nuklidvektor (Stoerfall, Unfall, Forschung) sollen Ge-Detektoren benutzt werden (orig./ABI)

Fresh-air cooling ceilings in an administration building; Frischluft-Kuehldecken in einem Verwaltungsgebaeude

Energy Technology Data Exchange (ETDEWEB)

Radtke, W

1995-06-01

In the construction of the new building of the Deutsche Innenbau GmbH in Muelheim much importance was attached to aesthetics and functionality. If the employees are enthusiastic after one year of operation this is mainly due to the ideal climatic conditions: Glazings with insulating glass (k=1,4 W/m{sup 2}k), high-quality thermal insulation of the breasts shading system with motor-driven screen at the outside, radiators with thermostatic valves and a fresh air cooling ceiling. The article describes the course of construction of the total air-conditioning and ventilation technique. (orig.) [Deutsch] Beim Neubau der DIG Deutsche Innenbau GmbH in Muelheim an der Ruhr legte man grossen Wert auf Aesthetik und Funktionalitaet. Wenn die Mitarbeiter nach einem Jahr Betrieb begeistert sind, so liegt dies grossenteils an idealen klimatechnischen Voraussetzungen: Verglasung mit Waermeschutzglas (K=1,4 W/m{sup 2}K), hochwertige Waermedaemmung der Bruestungen, aussenliegender Sonnenschutz mit motorbetaetigten Raffstoren, Radiatoren mit Thermostatventilen und einem Frischluft-Kuehldecken-System. Dieser Beitrag beschreibt die Vorgehensweise beim Bau der gesamten Klima- und Lueftungstechnik. (orig.)

How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center.

Science.gov (United States)

Bellanova, Giovanni; Buccelletti, Francesco; Berletti, Riccardo; Cavana, Marco; Folgheraiter, Giorgio; Groppo, Francesca; Marchetti, Chiara; Marzano, Amelia; Massè, Alessandro; Musetti, Antonio; Pelanda, Tina; Ricci, Nicola; Tugnoli, Gregorio; Papadia, Damiano; Ramponi, Claudio

2016-01-01

Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013. We divided the patients between two groups: before November 2013 (pre-TC group) and after November 2013 (post-TC group). MTG's courses (EMC accredited), CCD and MP courses started in November 2013. The target of these courses was the multidisciplinary management of polytrauma patient; the courses were addressed to general surgeons, anaesthesiologists, radiologists, orthopaedics and emergency physicians. Respectively 110 and 78 doctors were formed in CCD's and MP's courses. Patients directly transported to our trauma centre rose from 67.5% to 83% (pOperative Management, Trauma Course, Trauma Team, Trauma Center.

Successful use of intrapelvic Quikclot in life-threatening blast injury

Directory of Open Access Journals (Sweden)

Naveen Virin Goddard

2017-12-01

Full Text Available Patients that suffer multiple traumatic injuries often present with uncontrollable haemorrhage and rapidly descend into a viscous death triad consisting of hypothermia, coagulopathy and acidosis. Initial surgical intervention does not aim to provide conclusive repair, but instead strives to stop blood loss while priority is given to correct the patient's metabolic state (Duchesne et al., 2010. However in some cases of massive polytrauma, gaining surgical control of bleeding can be incredibly difficult. As a result a number of topical haemostatic agents were developed for use in military and civilian settings. This case details a successful intracavity use of the granular haemostatic agent, Quikclot™ (Z-Medica, in halting massive haemorrhage in a patient who sustained major blast injuries. Although not officially recommended, intracorporeal uses of Quikclot™ can be effective as a last resort in preventing loss of life in cases of severe polytrauma. However, users need to remain wary of complications which may arise due to its application.

Visuelles in der wissenschaftlichen Kommunikation - z.B. Betrug und Fälschung

OpenAIRE

Fröhlich, Gerhard

2003-01-01

Visuelle Phänomene sind oft beim Aufdecken wissenschaftlichen Betrugs involviert. Wissenschaftliche und Massenmedien berichten von "vierdimensionalen" (Flusser) Manipulationen in Laboratorien (Moewus, Parapsychologie, Beneviste), "dreidimensionalen" Artefakten in Archäologie bzw. Geologie ("Lügensteine", Piltdown, Fujimura) und Biologie bzw. Medizin (Kammerers getuschte Geburtshelferkröte, Summerlins bemalte Mäuse, Illmensees Bluff-Klone). Inkriminierte zweidimensionale Repräsentationen (Bild...

Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia

Directory of Open Access Journals (Sweden)

Maja Stachura

2017-09-01

Discussion: In this urban, low-resource, academic EC in Ethiopia, POCUS provided clinically relevant information for patient management, particularly for polytrauma, undifferentiated shock and undifferentiated dyspnea. Results have subsequently been used to develop a locally relevant emergency department ultrasound curriculum for Ethiopia’s first emergency medicine residency program.

Brain tumors in children; Hirntumoren beim Kind

Energy Technology Data Exchange (ETDEWEB)

Harting, I.; Seitz, A. [Universitaetsklinikum Heidelberg (Germany). Abt. Neuroradiologie

2009-06-15

Brain tumors are common in children; in Germany approximately 400 children are diagnosed every year. In the posterior fossa, cerebellar neoplasms outnumber brainstem gliomas. In contrast to their rarity in adults, brainstem gliomas are not uncommon in children. Supratentorial tumors can be subdivided by location into neoplasms of the cerebral hemispheres, suprasellar and pineal tumors. Astrocytoma is the most common pediatric brain tumor followed by medulloblastoma, ependymoma and craniopharyngeoma. The combination of imaging morphology, tumor localisation and patient age at manifestation form the basis of the neuroradiological differential diagnosis. (orig.)

Is the golden hour optimally used in South Africa for children ...

African Journals Online (AJOL)

Results. Fifty-five children were included in the final analysis. The median duration of stay in the Trauma Unit was 205 minutes (interquartile range 135 - 274). Conclusion. Several factors were identified that unnecessarily prolonged the time that patients stayed in the trauma unit following arrival in hospital for polytrauma ...

Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation. A planning study

Energy Technology Data Exchange (ETDEWEB)

Botticella, A.; Defraene, G. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Nackaerts, K. [KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Leuven (Belgium); Deroose, C. [KU Leuven - University of Leuven, University Hospitals Leuven, Nuclear Medicine, Leuven (Belgium); Coolen, J. [KU Leuven - University of Leuven, University Hospitals Leuven, Radiology Department, Leuven (Belgium); Nafteux, P. [University Hospitals Leuven, Department of Thoracic Surgery, Leuven (Belgium); Vanstraelen, B. [University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Joosten, S.; Michiels, L.A.W. [Fontys University of Applied Science, Institute Paramedical Studies, Medical Imaging and Radiotherapeutic Techniques, Eindhoven (Netherlands); Peeters, S. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Ruysscher, D. de [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht (Netherlands)

2017-04-15

After lung-sparing radiotherapy for malignant pleural mesothelioma (MPM), local failure at sites of previous gross disease represents the dominant form of failure. Our aim is to investigate if selective irradiation of the gross pleural disease only can allow dose escalation. In all, 12 consecutive stage I-IV MPM patients (6 left-sided and 6 right-sided) were retrospectively identified and included. A magnetic resonance imaging-based pleural gross tumor volume (GTV) was contoured. Two sets of planning target volumes (PTV) were generated for each patient: (1) a ''selective'' PTV (S-PTV), originating from a 5-mm isotropic expansion from the GTV and (2) an ''elective'' PTV (E-PTV), originating from a 5-mm isotropic expansion from the whole ipsilateral pleural space. Two sets of volumetric modulated arc therapy (VMAT) treatment plans were generated: a ''selective'' pleural irradiation plan (SPI plan) and an ''elective'' pleural irradiation plan (EPI plan, planned with a simultaneous integrated boost technique [SIB]). In the SPI plans, the average median dose to the S-PTV was 53.6 Gy (range 41-63.6 Gy). In 4 of 12 patients, it was possible to escalate the dose to the S-PTV to >58 Gy. In the EPI plans, the average median doses to the E-PTV and to the S-PTV were 48.6 Gy (range 38.5-58.7) and 49 Gy (range 38.6-59.5 Gy), respectively. No significant dose escalation was achievable. The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM. (orig.) [German] Beim malignen Pleuramesotheliom (MPM) ist nach lungenschonender Radiotherapie das lokale Scheitern an Stellen eines frueheren, sichtbaren Tumors die dominierende Form des Scheiterns. Unser Ziel ist es, zu untersuchen, ob die selektive

Smart Home, Smart Grid, Smart Meter - digitale Konzepte und das Recht an Daten

Science.gov (United States)

Spiecker genannt Döhmann, Indra

Modernes Energiemanagement setzt auf ein intelligent gesteuertes Energieinformationsnetz, das Smart Grid. In diesem ist der Smart Meter, die intelligente Messstelle beim Nutzer, ein zentrales Instrument für den wechselseitigen Austausch von Informationen. Allerdings werfen die über diverse Gesetze forcierten Informationsströme erhebliche datenschutzrechtliche Fragen auf. Der Beitrag stellt zentrale datenschutzrechtliche Leitlinien und Probleme vor und behandelt auch offene Fragestellungen.

Viertes LSDMA Symposium: Neue Entwicklungen im Bereich Big Data

OpenAIRE

Çayoğlu, Uğur

2015-01-01

Auch in diesem Jahr trafen sich zahlreiche Wissenschaftler aus unterschiedlichen Wissenschaftsgebieten beim internationalen Symposium „The Challenge of Big Data in Science“, der Helmholtz Initiative Large-Scale Data Management and Analysis (LSDMA). Das Steinbuch Centre for Computing veranstaltete diese Tagung nun das vierte Mal. Es waren über 90 Teilnehmer aus Deutschland, Frankreich, Spanien, China und den Vereinigten Staaten zu Gast.

The lectin complement pathway serine proteases (MASPs) represent a possible crossroad between the coagulation and complement systems in thromboinflammation

DEFF Research Database (Denmark)

Kozarcanin, H; Lood, C; Fog, Lea Munthe

2016-01-01

by AT during clotting without the assistance of heparin. In all other cases the MASPs were, as previously reported, inactivated by C1-INH. In systemic lupus erythematosus patients with thrombotic disease and in polytrauma patients, the levels of activated MASP-1 and MASP-2 in complex with both AT and C1-INH...

Positive FAST without hemoperitoneum due to fluid resuscitation in blunt trauma.

Science.gov (United States)

Slutzman, Jonathan E; Arvold, Lisa A; Rempell, Joshua S; Stone, Michael B; Kimberly, Heidi H

2014-10-01

The focused assessment with sonography in trauma (FAST) examination is an important screening tool in the evaluation of blunt trauma patients. To describe a case of a hemodynamically unstable polytrauma patient with positive FAST due to fluid resuscitation after blunt trauma. We describe a case of a hemodynamically unstable polytrauma patient who underwent massive volume resuscitation prior to transfer from a community hospital to a trauma center. On arrival at the receiving institution, the FAST examination was positive for free intraperitoneal fluid, but no hemoperitoneum or significant intra-abdominal injuries were found during laparotomy. In this case, it is postulated that transudative intraperitoneal fluid secondary to massive volume resuscitation resulted in a positive FAST examination. This case highlights potential issues specific to resuscitated trauma patients with prolonged transport times. Further study is likely needed to assess what changes, if any, should be made in algorithms to address the effect of prior resuscitative efforts on the test characteristics of the FAST examination. Copyright © 2014 Elsevier Inc. All rights reserved.

Traumatic Mitral Valve and Pericardial Injury

Directory of Open Access Journals (Sweden)

Nissar Shaikh

2013-01-01

Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

The impact of stigma on community reintegration of Veterans with traumatic brain injury and the well-being of their caregivers.

Science.gov (United States)

Phelan, Sean M; Bangerter, Lauren R; Friedemann-Sanchez, Greta; Lackore, Kandace A; Morris, Megan A; Van Houtven, Courtney H; Carlson, Kathleen F; van Ryn, Michelle; Harden, Kristin J; Griffin, Joan M

2018-05-02

To assess the association between perceived stigma and discrimination and caregiver strain, caregiver well-being, and patient community reintegration. A cross-sectional survey study of 564 informal caregivers of Veterans of US wars in Iraq and Afghanistan who experienced traumatic brain injuries or polytrauma (TBI/PT). Care settings of community dwelling former inpatients of any US Veterans Polytrauma Rehabilitation Center. 564 (67%) caregivers of former inpatients, identified through next-of-kin records and subsequent nominations INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Caregiver strain, depression, anxiety, loneliness, and self-esteem; as well as care recipient community reintegration, a key aspect of TBI/PT rehabilitation. Family stigma was associated with strain (b=.40, preintegration (b=-.17, p=.001). Caregiver stigma-by-association was associated with strain (b=.39, preintegration (b=-.11, p=.001). Perceived stigma may be a substantial source of stress for caregivers of Veterans with TBI/PT, and may contribute to caregivers' poor health outcomes and the community reintegration of the Veterans for whom they provide care. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A rare case of severe third degree friction burns and large Morel-Lavallee lesion of the abdominal wall.

Science.gov (United States)

Brown, Darnell J; Lu, Kuo Jung G; Chang, Kristina; Levin, Jennifer; Schulz, John T; Goverman, Jeremy

2018-01-01

Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma; therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.

Efficient radiologic diagnosis of pelvic and acetabular trauma; Rationelle bildgebende Diagnostik von Becken- und Azetabulumverletzungen

Energy Technology Data Exchange (ETDEWEB)

Kreitner, K.F.; Mildenberger, P.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Rommens, P.M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Unfallchirurgie

2000-01-01

In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury. (orig.) [German] Bei der Klaerung einer Verletzung des Beckens oder des Azetabulums stellen konventionelle Uebersichtsaufnahmen weiterhin die Basis der bildgebenden Diagnostik dar. Art und Umfang werden bestimmt von lokalen Gegebenheiten (z.B. Verfuegbarkeit von CT-Geraeten) sowie vom klinischen Zustand des Patienten. Aufgrund der diagnostischen Ungenauigkeit der konventionellen Roentgendiagnostik gerade im Bereich des stabilitaetsbedeutsamen dorsalen Beckenringes und des Azetabulums schliesst sich beim klinisch stabilen

Entwicklung und Evaluation computerbasierter Trainingsaufgaben für das wissenschaftliche Schreiben

OpenAIRE

Proske, Antje

2006-01-01

Wissenschaftliches Schreiben ist eine sehr komplexe Aufgabe, die eine Vielzahl unterschiedlicher Aktivitäten umfasst. Viele Studierende haben jedoch Schwierigkeiten, die damit verbundenen Anforderungen selbständig zu bewältigen. Im Mittelpunkt des Interesses der vorliegenden Arbeit stand daher die Entwicklung und Evaluation interaktiver computerbasierter Trainingsaufgaben, die Studienanfänger beim Erwerb von Grundkompetenzen des wissenschaftlichen Schreibens unterstützen. Zentrale Anliegen di...

Kooperative Textproduktion : zur gemeinsamen Herstellung wissenschaftlicher Texte im Vergleich von ungeübten, fortgeschrittenen und sehr geübten SchreiberInnen

OpenAIRE

Lehnen, Katrin

2000-01-01

Was kennzeichnet wissenschaftliche Schreibkompetenz und wie manifestiert sie sich im Produktionsprozess? An welchen Normen orientieren sich SchreiberInnen beim Formulieren und welche Darstellungsstrategien machen sie sich zu eigen? Eine Möglichkeit, etwas darüber herauszubekommen, ist die Untersuchung kooperativer Textproduktionen. Dabei handelt es sich um Situationen, in denen mindestens zwei Personen gemeinsam einen Text planen, schreiben und/oder überarbeiten. Das Besondere ist, dass Proze...

Innovative Techniken und Algorithmen im Bereich Computational-Finance und Risikomanagement

OpenAIRE

Liang, Qian

2012-01-01

Diese Dissertation besteht aus zwei aktuellen Themen im Bereich Finanzmathematik, die voneinander unabhängig sind. Beim ersten Thema, "Flexible Algorithmen zur Bewertung komplexer Optionen mit mehreren Eigenschaften mittels der funktionalen Programmiersprache Haskell", handelt es sich um ein interdisziplinäres Projekt, in dem eine wissenschaftliche Brücke zwischen der Optionsbewertung und der funktionalen Programmierung geschlagen wurde. Im diesem Projekt wurde eine funktionale Biblio...

Augmented Reality als Vergleichswerkzeug am Beispiel der Automobilindustrie

OpenAIRE

Nölle, Stefan

2007-01-01

In der Automobilindustrie lässt sich am Markt ein starker Wettbewerb beobachten. Um Produktentwicklungskosten zu senken, kommen besonders Computer Aided Design Techniken zum Einsatz. Im Verlauf des Produktentstehungsprozess ergibt sich beim Prototypenbau ein Übergang von virtuellen zu realen Bauteilen. In dieser Phase sind wesentliche Arbeiten die Ver- und Abgleiche realer Bauteile mit ihren computergenerierten Konstruktionsvorgaben. Dieser so genannte Soll-/ Ist-Vergleich zwischen virtuellen...

Step-by-step external fixation of unstable pelvis with separate anterior and posterior modules

Directory of Open Access Journals (Sweden)

Ivan Viktorovich Borozda

2016-02-01

Conclusions: The modular approach applied is the advantage of the transosseous osteosynthesis allowing for a separate anterior (anti-shock fixation and final posterior reposition of the pelvic ring preceded by the stabilization of vital functions. The above mentioned method gives an opportunity to increase the amount of techniques applied for the pelvic external fixation in polytrauma cases.

Pitfalls in the MR diagnosis of primary malignant bone tumors; Pitfalls in der MR-Diagnostik primaer maligner Knochentumoren

Energy Technology Data Exchange (ETDEWEB)

Bader, T.R. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteologie; Imhof, H.; Breitenseher, M.J. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteologie]|[Wien Univ. (Austria). Einrichtung UOG Magnetic Resonanz; Dominkus, M. [Universitaetsklinik fuer Orthopaedie, Wien (Austria)

1998-06-01

MRI has gained an undisputed place in the evaluation of malignant bone tumors, not only for verifying results of conventional radiography and clarifying differential diagnoses; it has also become increasingly important for the assessment of the malignant/benign nature of the tumor, its growth rate, definition of adequate sites for biopsy, local preoperative staging, and evaluation of the response to chemotherapy. However, several pitfalls have to be observed regarding choice of technical parameters (coils, sequences, imaging planes), tissue differentiation, and tumor staging. When staging malignant tumors, critical aspects which have to be observed are tumor extension, integrity of the cortical bone, soft tissue components, infiltration of a joint or neurovascular bundle. The use of contrast agents provides important additional information but can also give rise to misinterpretations. Thus, all features of a tumor have to be observed in order to establish a final diagnosis. Particular difficulties can occur with the interpretation of MR images of osteomyelitis, osteoid osteoma, stress and insufficiency fractures, bone infarcts, myositis ossificans, hemangiomas, and aneurysmal bone cysts. (orig.) [Deutsch] Bei der Diagnostik von malignen Knochentumoren hat die MRT einen fixen Platz nicht nur in der Verifikation der Nativdiagnostik und der Differentialdiagnostik, sondern zunehmende Bedeutung bei der primaeren Beurteilung von Dignitaet und Wachstumsgeschwindigkeit, Definition einer geeigneten Biopsiestelle, beim lokoregionaeren, praeoperativen Staging und der Evaluation des Ansprechens auf Chemotherapie. Zahlreiche Pitfalls finden sich jedoch bei der Wahl der technischen Parameter (Spulen, Sequenzen, Schichtebenen), der Tumordifferenzierung und beim Staging von malignen Tumoren. Beim Staging sind die kritischen Punkte die Beurteilung von Tumorausdehnung, Integritaet der Kortikalis, Vorhandensein einer Weichteilkomponente, Infiltration eines Gelenks oder des

Initial screening test for blunt cerebrovascular injury: Validity assessment of whole-body computed tomography.

Science.gov (United States)

Laser, Adriana; Kufera, Joseph A; Bruns, Brandon R; Sliker, Clint W; Tesoriero, Ronald B; Scalea, Thomas M; Stein, Deborah M

2015-09-01

Our whole-body computed tomography protocol (WBCT), used to image patients with polytrauma, consists of a noncontrast head computed tomography (CT) followed by a multidetector computed tomography (40- or 64- slice) that includes an intravenous, contrast-enhanced scan from the face through the pelvis. WBCT is used to screen for blunt cerebrovascular injury (BCVI) during initial CT imaging of the patient with polytrauma and allows for early initiation of therapy with the goal of avoiding stroke. WBCT has not been directly compared with CT angiography (CTA) of the neck as a screening tool for BCVI. We hypothesize that WBCT is a valid modality to diagnose BCVI compared with neck CTA, thus screening patients with polytrauma for BCVI and limiting the need for subsequent CTA. A retrospective review of the trauma registry was conducted for all patients diagnosed with BCVI from June 2009 to June 2013 at our institution. All injuries, identified and graded on initial WBCT, were compared with neck CTA imaging performed within the first 72 hours. Sensitivity was calculated for WBCT by the use of CTA as the reference standard. Proportions of agreement also were calculated between the grades of injury for both imaging modalities. A total of 319 injured vessels were identified in 227 patients. On initial WBCT 80 (25%) of the injuries were grade I, 75 (24%) grade II, 45 (14%) grade III, 41 (13%) grade IV, and 58 (18%) were classified as indeterminate: 27 vertebral and 31 carotid lesions. Twenty (6%) of the 319 injuries were not detected on WBCT but identified on subsequent CTA (9 grade I, 7 grade II, 4 grade III); 6 vertebral and 14 carotid. For each vessel type and for all vessels combined, WBCT demonstrated sensitivity rates of over 90% to detect BCVI among the population of patients with at least one vessel injured. There was concordant grading of injuries between WBCT and initial diagnostic CTA in 154 (48% of all injuries). Lower grade injures were more discordant than higher

Normzahlen, Toleranzen, Passungen

Science.gov (United States)

Böge, Gert; Böge, Wolfgang

Vor allem wegen der Kosten ist es sinnvoll, sich beim Festlegen von Maßen aller Art auf Vorzugszahlen zu beschränken (Baugrößen, Drehzahlen, Drehmomente, Leistungen, Drücke usw.). Man verwendet dazu eine geometrisch gestufte Zahlenfolge (siehe Teil Mathematik). Abb. 40.1 zeigt, dass bei der geometrischen Stufung die Werte im unteren Bereich fein, im oberen grob gestuft sind. Das ist nicht nur technisch sinnvoll.

Synthese und Charakterisierung wasserfreier Seltenerdmetall-Nitrate, -Acetate und -Oxyacetate

OpenAIRE

Heinrichs, Christina

2013-01-01

Durch thermische Entwässerung der Seltenerdmetall(SE)-Nitrat-Hydrate und der SE-Acetat-Hydrate im Argon-Strom/Vakuum konnten wasserfreie SE-Nitrate und SE-Nitrat-Monohydrate bzw. wasserfreie SE-Acetate erhalten werden. Es gelang zudem, SE-Oxyacetate durch thermische Zersetzung der SE-Acetate darzustellen. Des Weiteren wurde beim Erhitzen von Praseodym-Carbonat-Hydrat ein Pr-Carbonat-Hydroxid erhalten. Die Verbindungen wurden mittels Röntgenpulverdiffraktometrie und an ausgewählten Beispielen ...

Wissenschaftliches Schreiben in der Fremdsprache Deutsch : am Beispiel von Abschlussarbeiten französischer Studierender

OpenAIRE

François, Audrey

2006-01-01

Die vorliegende Arbeit befasst sich mit dem wissenschaftlichen Schreiben in der Fremdsprache Deutsch am Beispiel von Abschlussarbeiten französischer Studierender. Das Ziel der Dissertation ist herauszufinden, wie französische Germanistikstudierende die innere und äußere Form ihrer universitären Abschlussarbeit gestalten. Dabei soll untersucht werden, ob französische fortgeschrittene DaF-Lernende beim wissenschaftlichen Schreiben bestimmte Schwierigkeiten haben, die nicht allen DaF-Lerne...

3D-Druck von Kunststoff-Medizinprodukten

OpenAIRE

Polzin, Christian; Seitz, Hermann

2012-01-01

Das Additive Manufacturing gewinnt im Bereich der Medizintechnik zur Herstellung von Prototypen bis hin zu Endprodukten zunehmend an Bedeutung. Ein großes Hemmnis stellen allerdings die relativ hohen Fertigungskosten dar. Hier bietet der verstärkte Einsatz der 3D-Drucktechnologie (3D Printing) ein erhebliches Potential zur Reduktion der Kosten. Aus dieser Motivation heraus wurde ein 3D-Druckverfahren zur Herstellung biokompatibler, sterilisierbarer Kunststoffmodelle entwickelt. Beim 3D-Druck-...

Concrete core tempering in a passive house. Simulation behaviour of a single-family house; Betonkerntemperierung im Passivhaus. Simulationsverhalten eines Einfamilienhauses

Energy Technology Data Exchange (ETDEWEB)

Mahler, B; Seiwald, H [Steinbeis-Transferzentrum Energie-, Gebaeude- und Solartechnik; Koch, K P [Rehau AG und Co., Erlangen-Eltersdorf (Germany)

2004-07-01

New office buildings often have concrete core tempering systems for combined heating and cooling. The technology may be applied to well-insulated domestic buildings as well, provided that certain boundary conditions are met. [German] Beim Neubau von Buerogebaeuden findet die Betonkerntemperierung fuer kombinierte Heiz- und Kuehlsysteme immer mehr Verbreitung. Im Zuge des stark reduzierten Heizleistungsbedarfs hochgedaemmter Wohngebaeude bietet sich die Betonkerntemperierung unter bestimmten Voraussetzungen auch hier als Heizsystem an. (orig.)

Fractured Ribs and the CT Funky Fat Sign of Diaphragmatic Rupture

Directory of Open Access Journals (Sweden)

Iclal Ocak

2016-01-01

Full Text Available Traumatic diaphragmatic rupture remains a diagnostic challenge for both radiologists and surgeons. In recent years, multidetector CT has markedly improved the diagnosis of diaphragmatic injury in polytrauma patients. Herein, we describe two cases of subacute presentation of traumatic diaphragmatic rupture from a penetrating rib fracture and subsequent intrathoracic herniation of omental fat, representing the CT “funky fat” sign.

Non union of the neck of radius: a case report and review of the ...

African Journals Online (AJOL)

Fractures of the neck of radius are frequent in trauma. They happen without being noticed at the moment of injury of the elbow or in the context of polytrauma. A case of non union of the radius neck occurring in a young person due to ignorance, during first consultation has been reported by the authors. They insist on the ...

Optimization of radiotherapy planning for Non-Small Cell Lung Cancer (NSCLC) by {sup 18}FDG-PET; Optimierung der Bestrahlungsplanung beim nicht-kleinzelligen bronchialkarzinom (NSCLC) mit Hilfe von {sup 18}FDG-PET

Energy Technology Data Exchange (ETDEWEB)

Schmidt, S.; Nestle, U.; Kirsch, C.M. [Abt. fuer Nuklearmedizin, Universitaetskliniken des Saarlandes, Homburg/Saar (Germany); Walter, K. [Abt. fuer Strahlentherapie, Marienkrankenhaus Amberg (Germany); Licht, N.; Schnabel, K. [Abt. fuer Strahlentherapie, Universitaetskliniken des Saarlandes, Homburg/Saar (Germany); Ukena, D. [Innere Medizin V, Universitaetskliniken des Saarlandes, Homburg/Saar (Germany)

2002-10-01

Aim: In recent years, FDG-PET examinations have become more important for problems in oncology, especially in staging of bronchogenic carcinoma. In the retrospective study presented here, the influence of PET on the planning of radiotherapy for patients with non-small-cell lung cancer (NSCLC) was investigated. Methods: The study involved 39 patients with NSCLC who had been examined by PET for staging. They received radiotherapy on the basis of the anterior/posterior portals including the primary tumour and the mediastinum planned according to CT- and bronchoscopic findings. The results of the PET examination were not considered in initial radiotherapy planning. The portals were retrospectively redefined on the basis of FDG uptake considering the size and localization of the primary tumour; and FDG activities outside the mediastinal part of the portals. Results: In 15 out of 39 patients, the CT/PET-planned portals differed from the CT-planned ones. In most cases (n = 12) the CT/PET field was smaller than the CT field. The median geometric field size of the portals was 179 cm{sup 2}, after redefinition using PET 166 cm{sup 2}. In 20 patients with disturbed ventilation caused by the tumour (atelectosis, dystelectosis), a correction of the portal was suggested significantly more frequently than in the other patients (p = 0.03). Conclusions: Our results demonstrate the synergism of topographical (CT) and metabolic (FDG-PET) information, which could be helpful in planning radiotherapy of bronchial carcinoma, especially for patients with disturbed ventilation. (orig.) [German] Ziel: Die FDG-PET-Untersuchung hat in den vergangenen Jahren bei onkologischen Fragestellungen insbesondere beim Staging des Bronchialkarzinoms wachsende Bedeutung erlangt. In der vorliegenden retrospektiven Untersuchung wurde der Einfluss der PET auf die Strahlentherapieplanung bei Patienten mit non-small-cell lung cancer (NSCLC) untersucht. Methoden: Die Untersuchung umfasste 39 Patienten mit

Bone scintigraphy for horses; Die Skelettszintigrafie beim Pferd

Energy Technology Data Exchange (ETDEWEB)

Jahn, Werner [Pferdeklinik Bargteheide (Germany)

2010-03-15

Scintigraphy (bone scan) is being used approximately since 1980 in the horse under general anaesthesia. With the construction of custom-made overhead gantries for gamma-cameras scintigraphy found widespread entry in big equine referral hospitals for bone-scanning of the standing horse. Indications for the use of a bone scan in the horse are inflammatory alterations in the locomotor apparatus. It is primarily used for diagnosis of lameness of unknown origin, suspect of stress fracture or hairline fracture and for horses with bad riding comfort with suspected painful lesions in the spine. (orig.)

Effects of overhead power lines on the bird population of the Radenhaeuser Lache area in the Marburg-Biedenkopf district, Hessen; Auswirkungen von Freileitungen auf die Voegel der Radenhaeuser Lache, Landkreis Marburg-Biedenkopf/Hessen

Energy Technology Data Exchange (ETDEWEB)

Kliebe, K.

1997-12-01

In the Radenhaeuser Lache area in the county of Marburg-Biedenkopf 122 birds belonging to at least 18 species were found dead (85.2%) or injured (14.8%) in the period from 1991 to the end of July 1997. In four cases collisions with the high voltage overhead power lines (OHL) running above the flat expanse of water (42 lines of 110 kV and 380 kV) were actually seen. Collisions with the conductors seem to occur with equal frequency when birds come in to land and when they take off in flocks (particularly ducks and lapwings) whether or not this is owing to some disturbance or other (birds of prey, human beings, helicopters or hot-air balloons). (orig.) [Deutsch] Im Bereich der Radenhaeuser Lache (Kreis Marburg-Biedenkopf) wurden seit 1991 bis Ende Juli 1997 122 Voegel in mindestens 18 Arten tot (85,2%) oder verletzt (14,8%) registriert. Kollissionen mit den das Flachgewaesser ueberspannenden Hochspannungsleitungen (42 Seile mit 110 bzw. 380 kV) wurden in vier Faellen durch Sichtbeobachtungen nachgewiesen. Leitungsanfluege geschehen wohl gleichrangig beim Landeanflug und beim scharenweisen Abflug (vor allem Enten und Kiebitze) ohne oder auf Grund von Stoerungen (jagende Greifvoegel, Menschen, Hubschrauber und Heissluftballons). (orig.)

Free thyroid hormones in patients with severe non-thyroidal illness

International Nuclear Information System (INIS)

Boettger, I.; Schneck, H.W.; Technische Univ. Muenchen

1985-01-01

Free thyroid hormone radioligand assays and indirect methods for FT 4 and FT 3 were applied to measurement in sera of patients with severe NTI (hemodialysis, intensive-care, polytrauma). FT 4 by different techniques was low-normal to decreased by a kinetic two-tube and a T 4 -analogue tracer single-tube assay whereas another two-tube technique measured normal to low-normal but in some instances increased FT 4 levels. Indirect parameters behaved in a similar fashion. FT 3 was decreased in most of the cases as were the indirect parameters, mostly due to affected T 4 -T 3 conversion. Direct and indirect parameters for free thyroid hormones changed in parallel also during follow-up of NTI. There was no clear protein or albumen effect upon the two-tube FT 4 and the two-tube FT 3 assay(s). Supersensitively determined basal TSH was found to be decreased in some cases with severe NTI (polytrauma). The findings taken together are consistent with (pseudo) sedondary hypothyroidism in severe NTI. The data show the free thyroid hormone assays tested to be rather reliable with little or no disturbance by severe NTI or specifically hypoalbumenemia. (orig.)

Wer sich den Göttern widersetzt, der stirbt jung : Untersuchung der Unvermeidbarkeit des Suizids in Die Leiden des jungen Werthers hinsichtlich der Strömung des „Sturm und Drang“

OpenAIRE

Andersson, Rasmus

2015-01-01

Der Ausgang des Romans Die Leiden des Jungen Werther (1774, von Johann Wolfgang von Goethe) wird beim ersten Anblick oft als tragische Folge einer unglücklichen und unerwiderten Liebe zu Lotte angesehen. In dieser vorliegenden Arbeit wird der weit erforschten Frage der Unvermeidbarkeit des Suizids im Werk eine alternative Deutung geliefert. Diese ist außerhalb des Romans angesiedelt, und zeigt, dass der Suizid schon in der Epoche angelegt ist.

Technische Feuchtgebiete zur Nachreinigung von Abwasser:Stickstoff, Abwasserdesinfektion, Spurenstoffe

OpenAIRE

Rühmland, Sabine

2015-01-01

Stickstoff, Spurenstoffe und Krankheitserreger können auch in geringen Mengen Schäden in Gewässern bzw. beim Menschen verursachen. In dieser Arbeit soll geklärt werden, inwieweit das naturnahe Abwasserreinigungsverfahren der technischen Feuchtgebiete zur Nachreinigung von Abwasser geeignet ist. Dafür wurden in Berlin sieben bewachsene Bodenfilter und Abwasserteiche im techni-schen Maßstab einer Kläranlage mit Nährstoffelimination nachgeschaltet. Ein Sandfilter, ein Sandfilter mit Lehm und...

Hüftgelenks-Endoprothesen

Science.gov (United States)

Widmer, Markus; von Felten-Rösler, Ursula; Wintermantel, Erich

Die Hüftgelenk-Endoprothese wird im vorliegenden Buch als herausragendes Beispiel eines lasttragenden orthopädischen Implantates aufgeführt. Lasttragende Implantate werden in dieser Monographie den metabolisch induktiven Implantaten gegenübergestellt, bei denen Kräfte eine untergeordnete Rolle sowohl in der Werkstoffentwicklung als auch beim späteren Einsatz im Empfängerorganismus darstellen. Zu den metabolisch induktiven Implantaten werden beispielsweise Zellträger und “drug-release”-Systeme gerechnet.

Umfassende molekulargenetische Diagnostik für angeborene Hörstörungen auf Basis neuer Sequenziertechniken

OpenAIRE

Bolz, HJ; Neuhaus, C; Bergmann, C; Eisenberger, T

2011-01-01

Hintergrund: Etwa 2/3 der angeborenen Hörstörungen (im Folgenden synonym "Taubheit") sind genetisch bedingt. Aufgrund der genetischen Heterogenität (>50 bekannte Gene) war eine umfassende molekulare Diagnostik bislang finanziell und zeitlich nicht leistbar. Diese ist aber wichtig, u.a. um zwischen isolierter und syndromaler Taubheit (mit z.T. schweren Komplikationen wie plötzlichem Herztod beim Jervell und Lange-Nielsen-Syndrom) zu unterscheiden. Durch neue Sequenziermethoden (next-generatio...

Isolation und Charakterisierung retroviraler Partikel und Proteine zur Untersuchung immunsuppressiver Effekte

OpenAIRE

Pietsch, Heiko

2016-01-01

Obgleich auf dem Gebiet der Transplantationsmedizin in jüngster Zeit beachtliche Fortschritte erzielt worden sind, ist der Mangel an Organspendern ein fortbestehendes Problem. Im Rahmen der Xenotransplantation können Schweine als Spender zur Transplantation von Zellen oder Organen beim Menschen dienen. Um die Sicherheit der Xenotransplantation zu gewährleisten, ist sowohl die Entwicklung sensitiver Nachweismethoden als auch die Einschätzung des Gefahrenpotentials durch eine Infektion für den ...

Modernisation of Leipzig main station. Reconstruction into ''Promenaden'' shopping mall; Sanierung Hauptbahnhof Leipzig. Umbau zum ''Promenaden''-Einkaufscenter

Energy Technology Data Exchange (ETDEWEB)

Schmid, W. [Pressebuero fuer Technische Gebaeudeausruestung, Muenchen (Germany)

1999-07-01

Leipzig main station was modernized, and a service center and shopping mall was installed. The main problem consisted in maintaining an efficient train service, so that project management was considered particularly important. [German] Mit der umfassenden Renovierung des Leipziger Hauptbahnhofs wurde ergaenzend zur Sanierung der Verkehrsdrehscheibe ein Dienstleistungszentrum geschaffen. Eine der zu bewaeltigenden Schwierigkeiten beim Umbau war die Gewaehrleistung des Bahnbetriebs, so dass besonderer Wert auf ein umfassendes Projektmanagement gelegt wurde. (orig.)

Trauma care in German-speaking countries: have changes in the curricula led to changes in practice after 10 years?

Science.gov (United States)

Kuhn-Régnier, Sarah; Stickel, Michael; Link, Björn-Christian; Fischer, Henning; Babst, Reto; Beeres, Frank J P

2018-01-06

Traditionally, in the German-speaking countries, trauma patients are treated by general surgeons specialized in trauma surgery known as the Unfallchirurg. Over the last decade, a trend towards a lower influence of surgeons and a higher influence of subspecialties in the emergency department has been noted. With additional transformations in the health care system towards highly specialized medicine and the arising of new (sub-) specialties, diversification in the management of the trauma patient appears to occur. The new curricula for surgical disciplines providing trauma care will widen this issue even further, moreover, triggered by the Anglo-American medical model. The primary aim of this study was to evaluate the current situation in German-speaking countries concerning the management of trauma patients. The interfaces between emergency physicians, orthopaedic and general surgeons have been investigated concerning the management of the trauma patients. Additionally, different future scenarios have been evaluated. An online questionnaire was submitted to members of the German Society of Trauma and Orthopaedic Surgery [Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)], including both general and orthopaedic surgeons, emergency physicians and also some members from Austria, the Netherlands and Switzerland. Questions dealt with demographic data, the current situation in the clinic of the responders in terms of management of mono- and polytrauma patients as well as fracture care. In addition, various future scenarios were evaluated. 293 members of the DGOU answered the questionnaire. The majority of the responders (45%) were orthopaedic surgeons and 34% were general trauma surgeons. Sixty-two per cent of hospitals run their emergency departments with emergency physicians. Treatment of both mono- and polytrauma patients in the emergency department is equally distributed between general and orthopaedic surgeons. Fracture care, however, is

Study of colored anodized aluminum with calcon in sulfuric acidic solution using cyclic voltammetry and impedance measurement methods

Energy Technology Data Exchange (ETDEWEB)

Norouzi, P.; Ganjali, M.R.; Golmohamaddi, M.; Mousavi, S. [Department of Chemistry, Faculty of Science, University of Tehran, Tehran (Iran); Vatankhah, G. [Iranian Organization for Science and Technology (IROST), Isfahan Center, A5 Ghezelbash Avenue, Tohid Street, Isfahan 8173954541 (Iran)

2003-04-01

The effect of coloring condition of Al with Calcon (sodium 2,2'-dihydroxy-azonaphthalene-4-sulfonate), on the corrosion resistance of Al in 0.1 M sulfuric acid solution was studied, using cyclic voltammetry and measurement of impedance noise methods. The changes in the corrosion resistance of colored aluminum electrodes were evaluated by measuring the magnitude of impedance and cyclic voltammetric responses of anodized and colored electrodes. An irreversible corrosion response was observed at the cyclic voltammogram of the colored aluminum electrode. The current and threshold potential of corrosion responses strongly depends on the applied conditions during anodizing, coloring and sealing stages. In addition, significant changes in impedance at the ac voltammogram and noise level at some ac frequencies were observed, when the electrodes were colored under various conditions. In this regard, the surface of the electrode was studied by Scanning Electron Microscopy (SEM). Comparison of SEM images of the colored and uncolored aluminum specimens showed that the colored surface contained a significant numbers of pits. The results indicated that coloring aluminum with Calcon could reduce corrosion resistance of aluminum and increase roughness of the oxide film. (Abstract Copyright [2003], Wiley Periodicals, Inc.) [German] Mit Hilfe zyklischer Voltammetrie und Messungen mit Impedanzrauschmethoden wurde der Einfluss der Faerbungsbedingungen von Aluminium mit Calcon (Natrium 2,2'-Dihydroxyazonaphthalen-4-Sulfonat) auf den Korrosionswiderstand von Aluminium in 0,1 M Schwefelsaeure untersucht. Die Veraenderungen des Korrosionswiderstandes von gefaerbten Aluminiumelektroden wurden durch Messungen der Hoehe der Impedanzreaktion bzw. der Reaktion bei der zyklischen Voltammetrie von anodisierten und gefaerbten Elektroden beurteilt. Eine irreversible Korrosionsreaktion wurde beim zyklischen Voltammogramm der gefaerbten Aluminiumelektrode beobachtet. Der Strom und das

Weiterentwicklung Gruppenleiter/innen-Kurs: Ein Projekt in der Freiwilligenarbeit des CVJM/CVJF Regionalverband Basels: Projektbericht

OpenAIRE

Fankhauser, Miriam

2016-01-01

Im folgenden Bericht geht es um das Projekt «Weiterentwicklung Gruppenleiter/innen-Kurs – Ein Pro- jekt in der Freiwilligenarbeit des CVJM/CVJF Regionalverband Basels». Dieses Projekt wurde von der Studentin Miriam Fankhauser im Rahmen der Praxisausbildung an der Hochschule Luzern für Soziale Arbeit durchgeführt. In Auftrag gegeben wurde das Projekt vom CVJM/CVJF Regionalverband Basel. Beim eben genannten Projekt ging es darum, den Gruppenleiter/innen-Kurs weiterzuentwickeln. Der Kurs rich...

Positive Effekte des Mindestlohns auf Arbeitsplatzqualität und Arbeitszufriedenheit

OpenAIRE

Pusch, Toralf; Rehm, Miriam

2017-01-01

Über den Zusammenhang zwischen Mindestlöhnen und Änderungen bei der Arbeitsplatzqualität ist bisher wenig bekannt. Nach der Mindestlohneinführung in Deutschland stieg die Arbeitsplatzzufriedenheit insgesamt. Neben höheren Stunden- und Bruttolöhnen und verringerten Arbeitszeiten gibt es als möglichen Grund auch eine arbeitsorganisatorische Aufwertung der Arbeitsplätze. Bei bestehenden Beschäftigungsverhältnissen konnten Hinweise auf Verbesserungen beim Betriebsklima und einer mehr auf Mitarbei...

Medien und Berufsvorstellungen von Kindern: eine experimentelle Studie zum Einfluss von Kinderbüchern auf das Berufsspektrum von Kindergartenkindern

OpenAIRE

Brüggemann, Tim; Gehrau, Volker; Handrup, Jutta

2015-01-01

"Der Beitrag thematisiert zunächst den Stand der beruflichen Orientierung von Jugendlichen sowie die pädagogischen Bemühungen beim Übergang Schule-Beruf, insbesondere im Hinblick auf eine Erweiterung des häufig engen Spektrums von Berufen, die bei der Berufswahl berücksichtig werden. Dabei richten sich die Bestrebungen, diesem Problem entgegenzuwirken, bislang vor allem auf Jugendliche. Anschließend wird anhand vorliegender Ergebnisse aus der Medienforschung diskutiert, in welcher Weise Masse...

Dynamische Programm-Code-Verwaltung und -Optimierung für eingebettete Systeme

OpenAIRE

Schell, Dominic

2009-01-01

Bei Desktop-PCs ist ein großer Hauptspeicherausbau im Bereich jenseits von 1 GB dank gesunkener Speicherpreise und auf Grund gestiegener Anforderungen keine Seltenheit mehr. Es existiert jedoch eine Unmenge Kleinstrechner, wie z.B. im Automobilbereich eingesetzte Steuergeräte, die sich einen großen Speicherausbau wegen des Platzbedarfs der Speicherchips, deren Energiekonsum und den zusätzlichen Kosten nicht leisten können. Ein wichtiges Ziel beim Erzeugen der Software für eingebettete Systeme...

Endometriose - eine epigenetische Erkrankung?

OpenAIRE

Imesch, P; Samartzis, E P; Fink, D

2011-01-01

Endometriose wird in ihrer Pathogenese bis heute nur unzureichend verstanden. Dies hat zur Folge, dass die Therapieoptionen, insbesondere die nicht-chirurgischen Behandlungen, nicht kausal ausgelegt sind und viele Fragen bei der betroffenen Patientin wie beim Arzt offen bleiben. Gerade das genaue Verständnis der frühen Phasen der Endometrioseentstehung und ihrer molekularen Vorgänge wären aber in der Entwicklung neuer nicht-chirurgischer Behandlungspläne sehr hilfreich und dringend nötig.

Hypothermia and near-drowning associated with life-threatening injuries: A remarkable recovery: A case report

Directory of Open Access Journals (Sweden)

Tariq Cachalia

2016-08-01

Full Text Available A young male suffered multiple severe injuries after a fall and near-drowning. On presentation to the emergency department (ED, he was in a critical and unstable condition and his chances of survival were deemed very low. This case illustrates the management of the hypothermic multi-trauma patient and the remarkable recovery made possible by a high standard of care. Keywords: Polytrauma, Shock, Hypothermia, Coagulopathy, Trauma care

Warrior Transition Command Information Briefing to 2011 AMEDD Pre-Command Course: Soldier Success Through Focused Commitment

Science.gov (United States)

2011-02-22

JTF CAPMED Veterans Affairs – Veterans Health Administration – Veterans Benefits Administration – Federal Recovery Coordinators – Polytrauma...investment of families is critical • Initial interview should reveal services that the Soldier and Family needs • Increased Social Workers exposure for...Soldier has his/her own unique set of challenges • Early involvement and investment of Families is critical • We cannot do enough for the Families of

Interdisciplinary approach to the management of childhood ependymomas; Die interdisziplinaere Therapie von Ependymomen im Kindesalter

Energy Technology Data Exchange (ETDEWEB)

Timmermann, B.; Kortmann, R.D.; Bamberg, M. [Abt. Strahlentherapie der Univ. Tuebingen (Germany); Kuehl, J. [Kinderklinik der Univ. Wuerzburg (Germany); Willich, N. [Abt. Strahlentherapie der Univ. Muenster (Germany)

2002-09-01

Material and Method: Based on historical reports, the recent literature, present guidelines, and ongoing trials an overview is provided for the management of ependymomas in childhood. Results: Local tumor control is the most important aim. Recurrences occur predominantly at the primary tumor region. The main instrument is surgery to effect maximal tumor resection. The addition of radiotherapy could improve survival significantly from 10% to 50%. Regarding the volume of irradiation there is confidence today that local fields are sufficient for all non-disseminated ependymomas. Local dose escalation has been introduced using hyperfractionated schedules. In recent studies this has been shown to increase local control up to 70%. Regarding chemotherapy in ependymomas trials have shown limited efficacy to date. For metastatic disease standard treatment has shown to be insufficient and high dose chemotherapy regimens to increase survival are in study. In younger children radiotherapy should be delayed using early chemotherapy. With preirradiation chemotherapy survival rates of 63.3% for children under age of 3 were achieved. (orig.) [German] Material und Methode: Auf der Grundlage der historischen Entwicklung, aktueller Literatur, geltender Leitlinien und laufender Studien wird ein Ueberblick ueber das Management von Ependymomen gegeben. Ergebnisse: Die lokale Tumorkontrolle ist von ausschlaggebender prognostischer Bedeutung; nur wenige Rezidive treten ausserhalb des Primaertumorgebietes auf. Daher dominiert eine moeglichst komplette Resektion das Therapiekonzept. Bei intrakraniellen Tumoren hat die postoperative Strahlentherapie die Ueberlebenschance deutlich verbessern koennen von ehemals 10 auf ueber 50%. Bei der Zielvolumendefinition hat bei nicht metastasierten Ependymomen unabhaengig von Histologie oder Tumorsitz die ausschliessliche Behandlung der Tumorregion aehnliche Erfolge gezeigt wie eine Liquorraumbehandlung. Mit lokaler Dosiseskalation durch Hyperfraktionierung konnte nach amerikanischen Ergebnissen eine Steigerung der lokalen Tumorkontrolle auf 70% erreicht werden. Eine Chemotherapie hat in den bisherigen Studien keine sicheren Ueberlebensvorteile gezeigt. Metastasierte Erkrankungen konnten mit den bisherigen Therapiekonzepten nur ungenuegend beherrscht werden und fuehrten zur Einfuehrung intensiverer Behandlungsprotokolle. Bei juengeren Kindern konnte durch eine hoch dosierte postoperative Chemotherapie der Beginn der Strahlentherapie verzoegert werden, um die Reifung des Gehirns nicht zu beeintraechtigen, und fuehrte zu einer 5-Jahres-Ueberlebenswahrscheinlichkeit von 63,3%. (orig.)

The vehicle dynamics control system of Bosch; Die Fahrdynamikregelung von Bosch

Energy Technology Data Exchange (ETDEWEB)

Zanten, A.T. van [Robert Bosch GmbH, Stuttgart (Germany); Erhardt, R. [Robert Bosch GmbH, Stuttgart (Germany); Pfaff, G. [Robert Bosch GmbH, Stuttgart (Germany)

1996-11-01

Vehicle handling at the physical limit of adhesion between the tires and the road is extremely difficult. In such situations the driver may be supported by controlling the longitudinal and the lateral forces on the tires. The Vehicle Dynamics Control System of Bosch (VDC) does that by controlled braking of individual wheels which makes the vehicle motion approach the nomial motion intended by the driver. It uses signals to derive the driver`s intent (steering wheel angle, brake pressure, engine torque) and signals to dervie the actual motion of the vehicle (yaw rate, lateral acceleration). The support of the driver is not limited to coasting conditions. Also during full braking (ABS), partial braking, engine drag, free rolling and acceleration (ASR) of the vehicle the system supports the driver in all safety critical situations. In this paper an overview of the VDC is given. The goal of the development of VDC, the physical background, the concept of the system, the control and the controller algorithm are described. The benefit of VDC is demonstrated by an experimental test. (orig.) [Deutsch] Fahrdynamikregelsysteme FDR sind Regelsysteme im Bremssystem und Antriebsstrang, die das seitliche Ausbrechen des Fahrzeugs verhindern. Waehrend ABS das Blockieren der Raeder beim Bremsen und ASR das Durchdrehen der Raeder beim Antrieb verhindert, verhindert FDR das Schleudern und das Schieben des Fahrzeugs. (orig.)

Free thyroid hormones in patients with severe non-thyroidal illness

Energy Technology Data Exchange (ETDEWEB)

Boettger, I.; Schneck, H.W.

1985-11-01

Free thyroid hormone radioligand assays and indirect methods for FT/sub 4/ and FT/sub 3/ were applied to measurement in sera of patients with severe NTI (hemodialysis, intensive-care, polytrauma). FT/sub 4/ by different techniques was low-normal to decreased by a kinetic two-tube and a T/sub 4/-analogue tracer single-tube assay whereas another two-tube technique measured normal to low-normal but in some instances increased FT/sub 4/ levels. Indirect parameters behaved in a similar fashion. FT/sub 3/ was decreased in most of the cases as were the indirect parameters, mostly due to affected T/sub 4/-T/sub 3/ conversion. Direct and indirect parameters for free thyroid hormones changed in parallel also during follow-up of NTI. There was no clear protein or albumen effect upon the two-tube FT/sub 4/ and the two-tube FT/sub 3/ assay(s). Supersensitively determined basal TSH was found to be decreased in some cases with severe NTI (polytrauma). The findings taken together are consistent with (pseudo) sedondary hypothyroidism in severe NTI. The data show the free thyroid hormone assays tested to be rather reliable with little or no disturbance by severe NTI or specifically hypoalbumenemia.

Experimentelle, analytische und numerische Untersuchungen des Rührreibschweißprozesses

OpenAIRE

Hoßfeld, Max

2016-01-01

Mit dem Rührreibschweißverfahren steht seit einigen Jahren eine Fügetechnologie zur Verfügung, mit der viele fügetechnische Problemstellungen speziell beim Fügen von Aluminiumlegierungen gelöst oder vermieden werden können. Mittels Rührreibschweißen können sämtliche Aluminiumlegierungen zuverlässig, hocheffizient und mit einem sehr hohen Verbindungswirkungsgrad gefügt werden. Dabei weisen rührreibgeschweißte Verbindungen bereits ohne Nachbehandlung sehr gute statische und zyklische Festigkeit...

Success in the protection of the ozone layer is at risk. An interview concerning the German view on CFC- and H-CFC-phaseout all over the world; Bisherige Erfolge zum Schutz der Ozonschicht sind gefaehrdet. Ein Fachgespraech ueber die deutsche Meinung zum FCKW- und H-FCKW-Phaseout ueberall in der Welt

Energy Technology Data Exchange (ETDEWEB)

Kraus, H.W.; Weissenborn, P.

1995-11-01

This article repeats an interview with the commissioner of international measures for the protection of the ozone layer of the Federal Ministry of the Environment which took place in the run-up to the 7th conference of the signatory states of the Montreal Protocol. (BWI) [Deutsch] Der vorliegende Beitrag gibt ein Interview wieder, das mit dem Beauftragten fuer internationale Massnahmen zum Schutz der Ozonschicht beim Bundesumweltministerium im Vorfeld der 7. Konferenz der Vertragsstaaten zum Montrealer Protokoll gefuehrt wurde. (BWI)

Erinnerungen. Aus dem Feldzuge der Franzosen in Russland unter Napoleon im Jahre 1812, von einem preußischen Bombardier, dem jetzigen Major Weinberger. Unveröffentlichtes Manuskript (1849), herausgegeben von Peter-Michael Berger

OpenAIRE

Weinberger, Friedrich Ludwig

2012-01-01

Friedrich Ludwig Weinberger (1794–1869) diente im Juni 1812 als Freiwilliger bei der Königsberger Garnisonsartillerie. Diese 400 Soldaten wurden von Napoleon in die Garde seiner Grande Armée zur Invasion Russlands zwangsweise eingegliedert. Als einer von nur 13 Überlebenden seiner Truppe kehrte Weinberger im März 1813 aus russischem Gewahrsam zurück. Über seine Erlebnisse beim Vormarsch, den Kämpfen, der Besetzung Moskaus, dem Rückzug und der Heimkehr verfasste er einen Bericht, den er m...

Einführung in die Konstruktionsmethodik

Science.gov (United States)

Linke, Petra; Weidermann, Frank

Für die Entwicklung eines konkurrenzfähigen Produktes ist eine sehr gute Idee von entscheidender Bedeutung. Eine mittelmäßige Idee, konstruktiv gut umgesetzt reicht beim heutigen Verdrängungswettbewerb nicht mehr, um am Markt bestehen zu können. Rund 80% der Kosten eines Produktes werden in der Konstruktion festgelegt. Deshalb steht am Anfang einer Produktentwicklung immer eine intensive Ideenfindung. Der konstruktive Entwicklungsprozess ist dann weiter gegliedert in Planen und Klären der Aufgabe, Konzipieren, Entwerfen und Ausarbeiten.

Freizeit beim Feind. US-amerikanische Soldaten in Ost-Berlin

Directory of Open Access Journals (Sweden)

Stefanie Eisenhuth

2018-04-01

Full Text Available This article focuses on an almost forgotten type of ›border crosser‹ in the divided city of Berlin: the members of the American military community. To them (as well as to the members of the French and British forces, the Berlin Wall marked the front line of the Cold War. At the same time, though, they were allowed to cross the border and spend their free time in East Berlin. Especially in the 1970s and 1980s, when the dollar was tumbling, American families took advantage of the favourable exchange rate and crossed the border for cheap shopping, dining and entertainment. Due to Berlin’s status, the GDR government had to tolerate this kind of tourism, but nevertheless tried to prevent any personal contact between Americans and East Germans. The regime could also benefit financially from the Western tourists. This demonstrates the ambivalence of the Honecker era, the concurrence of an increased openness and internal erosion. The study is based on documents from the GDR’s Ministry for State Security, the West Berlin Senate Chancellery and the US Berlin Brigade as well as on contemporary newspaper articles. * * * Der Aufsatz widmet sich einer ungewöhnlichen Gruppe von Berliner Grenzgängern: den vor Ort stationierten US-Soldaten. Für sie (wie auch für die Soldaten der britischen und französischen Armee markierte die Mauer einerseits die Front des Kalten Krieges, andererseits durften sie diese ohne große Kontrollen passieren und ihre Freizeit in Ost-Berlin verbringen – was sie besonders in den 1970er- und 1980er-Jahren auch intensiv taten, denn in Zeiten der Dollarkrise versprach die östliche Stadthälfte viel Vergnügen, Restaurantbesuche und Einkaufsmöglichkeiten für wenig Geld. Die DDR-Regierung war genötigt, die Grenzgänge zu tolerieren. Von dieser Form des Tourismus konnte sie finanziell profitieren, versuchte konkrete Kontaktaufnahmen aber zu vermeiden. Der Umgang mit den Grenzgängen amerikanischer Soldaten und ihrer Familien verdeutlicht somit auch die Ambivalenz von politischer Öffnung und zunehmender Überwachung, von internationaler Verflechtung und Binnenerosion in der Ära Honecker. Der Beitrag stützt sich vor allem auf Dokumente des Ministeriums für Staatssicherheit (MfS, der Berliner Senatskanzlei und der amerikanischen Berlin Brigade sowie auf zeitgenössische Presseartikel.

Finally clarity when energy saving; Endlich Klarheit beim Energiesparen

Energy Technology Data Exchange (ETDEWEB)

Anon.

2012-07-01

How much money do users in mechanical engineering and plant construction save in the implementation of energy efficiency measures? What actions bring which savings? Festo AG and Co. KG (Esslingen, Federal Republic of Germany) provides answers to these questions in terms of the pneumatic control system.

Radiotherapy for shoulder impingement; Bestrahlung beim Impingementsyndrom des Schultergelenks

Energy Technology Data Exchange (ETDEWEB)

Adamietz, B. [Universitaetsklinikum Erlangen (Germany). Inst. fuer Radiologie; Sauer, R.; Keilholz, L. [Universitaetsklinikum Erlangen (Germany). Strahlentherapeutische Klinik

2008-05-15

Background and Purpose: Up to now, degenerative shoulder diseases were summarized by the term 'periarthritis humeroscapularis'. Actual shoulder diseases can be differentiated etiopathologically according to a primary and secondary impingement syndrome. Narrowing of the subacromial space, which is caused by an osseous shape variant, leads to primary impingement. Secondary impingement develops, when the subacromial space is reduced by swelling tissue below the osseous shoulder roof. This study aimed for the exact diagnosis to indicate therapy and to classify the results according to the Constant score. Patients and Methods: From August 1999 to September 2002, 102 patients with 115 shoulder joint conditions underwent radiation therapy (RT). All joints received two RT series (6 x 0.5 Gy/series) applied in two to three weekly fractions, totaling a dosage of 6.0 Gy (250 kV, 15 mAs, 1-mm Cu filter). The second RT course started 6 weeks after the end of the first. 115 shoulders were examined before RT, 6 weeks after the second RT course and, finally, during the follow-up from January to May 2003. Results: Pain relief was achieved in 94/115 shoulder joints (82%) after 18-month follow-up (median). A significant difference existed between secondary impingement and primary/non-impingement according to response. Tendinosis calcarea, bursitis subdeltoidea, tendovaginitis of the long biceps tendon, and capsulitis adhaesiva responded well to therapy. Conclusion: Shoulder diseases of secondary impingement demonstrate a good response to RT. Less or no benefit was found in primary impingement syndrome or complete rotator cuff disruption and acute shoulder injuries, respectively. (orig.)

Trichinella britovi beim Rotfuchs (Vulpes vulpes) in Österreich

DEFF Research Database (Denmark)

Krois, E.; Nöckler, K.; Duscher, G.

2005-01-01

infections in foxes. Materials and methods: Masseter and tongue samples from 1,546 foxes with known origin (sample coordinates from the provinces of Carinthia [n=401], Salzburg [108], Styria [493], Tyrol [395] and Vorarlberg [149] were determined by Geographic Information System), sent to the State...... Veterinary Laboratory in Moedling for rabies testing, were examined for Trichinella with the compression technique. Positive samples were evaluated quantitatively by digestion and differentiated by PCR. Results: 24 foxes (1.55%) were positive (Carinthia: 1.52%, Salzburg: 2.77%, Styria: 1.62%, the Tyrols: 1.......26%, Vorarlberg: 1.44%). In addition to the formerly known distribution of vulpine trichinellosis, positive animals were also found close to the border to Slovenia. Highest numbers of larval per gram muscle tissue (lpg) were found in the tongues (1-257 lpg compared to 0-43 lpg in masseter muscle tissue...

Verletzungspotential für Kinder und Jugendliche beim Trampolinspringen

OpenAIRE

Kosev, I; Folz, B

2015-01-01

Hintergrund: 62% der Deutschen haben ein Trampolin in ihrem Garten. Die Sprunggeräte gehören inzwischen fast zur Standardspielausrüstung. Im Rahmen unserer Beobachtungen über Unfallverletzungen der Kopf-Hals-Region zeigte sich, dass das Trampolinspringen mit Verletzungen im Kopf/Hals-Bereich einhergehen kann. In der vorliegenden Arbeit handelt es sich um eine prospektive Analyse der in den letzten Jahren an unserer Klinik behandelten Patienten mit Trampolinverletzungen. Methode: In dieser Ü...

Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans. Welcome

Science.gov (United States)

2010-04-01

Reed Army Medical Center, 33 percent had traumatic brain injury (as of March 2009). Due to medical and technological advances, we have seen a...Right to Appeal PEB Decision - Module 4, pages 139-141 PEG Tube (Per Cutaneous Gastronomy Tube) - Module 1, page 23 PRC (VA Polytrauma Rehabilitation...Per Cutaneous Gastronomy Tube (PEG tube) - Module 1, page 23 Peripheral Fatigue - Module 2, page 17 IN D EX 29 Permanent Disability Retired List (PDRL

Interobserver variability in target volume delineation of hepatocellular carcinoma. An analysis of the working group ''Stereotactic Radiotherapy'' of the German Society for Radiation Oncology (DEGRO)

Energy Technology Data Exchange (ETDEWEB)

Gkika, E.; Kirste, S. [Medical Center - University of Freiburg, Department of Radiation Oncology, Freiburg im Breisgau (Germany); Tanadini-Lang, S.; Andratschke, N.; Guckenberger, M. [University Hospital Zuerich, Department of Radiation Oncology, Zurich (Switzerland); Holzner, P.A.; Neeff, H.P. [Medical Center - University of Freiburg, Department of Visceral Surgery, Freiburg (Germany); Rischke, H.C. [Medical Center - University of Freiburg, Department of Radiation Oncology, Freiburg im Breisgau (Germany); Medical Center - University of Freiburg, Department of Nuclear Medicine, Freiburg (Germany); Reese, T. [University Hospital Halle-Wittenberg, Department of Radiation Oncology, Halle-Wittenberg (Germany); Lohaus, F. [Technische Universitaet Dresden, Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden (Germany); German Cancer Research Center (DKFZ), Heidelberg (Germany); Technische Universitaet Dresden, OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden (Germany); National Center for Tumor Diseases (NCT), Dresden (Germany); German Cancer Consortium (DKTK), Dresden (Germany); Duma, M.N. [Helmholtz Zentrum Munich, Institute of Innovative Radiotherapy, Department of Radiation Sciences, Munich (Germany); TU Munich, Department of Radiation Oncology, Klinikum Rechts der Isar, Munich (Germany); Dieckmann, K. [Medical University Vienna, Department of Radiation Oncology, General Hospital Vienna, Vienna (Austria); Semrau, R. [University Hospital of Cologne, Department of Radiation Oncology, Cologne (Germany); Stockinger, M. [University Hospital Mainz, Department of Radiation Oncology, Mainz (Germany); Imhoff, D. [University Hospital Frankfurt, Department of Radiation Oncology, Frankfurt (Germany); Saphir Radiosurgery Center, Frankfurt (Germany); Kremers, N. [Medical Center - University of Freiburg, Department of Radiology, Freiburg (Germany); Haefner, M.F. [University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Nestle, U.; Grosu, A.L.; Brunner, T.B. [Medical Center - University of Freiburg, Department of Radiation Oncology, Freiburg im Breisgau (Germany); University of Freiburg, Faculty of Medicine, Freiburg (Germany); German Cancer Consortium (DKTK), Freiburg (Germany); German Cancer Research Center (DKFZ), Heidelberg (Germany)

2017-10-15

Panel zu evaluieren. Die Analyse wurde von der Arbeitsgruppe Stereotaxie der deutschen Gesellschaft fuer Radioonkologie (DEGRO) durchgefuehrt. Die GTVs von 3 anonymisierten HCC-Patienten wurden von 16 Aerzten aus 9 Zentren mit Expertise in der Leberstereotaxie anhand multiphasischer Computertomogramme (CT) beurteilt. Beim ersten Patienten war der Tumor sehr gut abgrenzbar. Der zweite Patient hatte ein multilokulaeres HCC (ein Konglomerat und ein peripherer Herd) und war zuvor mittels transarterieller Chemoembolisation (TACE) behandelt worden. Der periphere Herd lag direkt neben der TACE-Stelle. Der dritte Patient hatte einen schwer abzugrenzenden Tumor wegen ausgedehnten Leberinhomogenitaeten bei ausgepraegter Leberzirrhose und einer begleitenden Pfortaderthrombose (PVT). Die IOA wurde nach Landis und Koch evaluiert. Die IOA war beim ersten Patienten exzellent (Kappa: 0,85); im zweiten Fall moderat (Kappa: 0,48) fuer den peripheren Herd und substanziell (Kappa 0,73) fuer das Konglomerat. Beim peripheren Herd ist diese Inkonsistenz durch TACE kaudal des Tumors entstanden. Beim dritten Patienten war die IOA mit einem Kappa-Wert von 0,34 ausreichend aufgrund signifikanter Heterogenitaet hinsichtlich der genauen Tumorabgrenzung und dem PVT. Die IOA war bei den gut abgrenzbaren Tumoren sehr gut. In komplexeren Faellen mit Perfussionsinhomogenitaeten oder Lipiodolanreicherung durch Vortherapien war die IOA beeintraechtigt. (orig.)

Pseudoaneurysm of the superior gluteal artery following polytrauma

Energy Technology Data Exchange (ETDEWEB)

Lee, Dennis [Vancouver General Hospital, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Legiehn, Gerald M. [Vancouver General Hospital, Interventional Radiology, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Munk, Peter L. [Vancouver General Hospital, MSK Section, University of British Columbia and Department of Radiology, Vancouver, BC (Canada)

2007-09-15

Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

Pseudoaneurysm of the superior gluteal artery following polytrauma

International Nuclear Information System (INIS)

Lee, Dennis; Legiehn, Gerald M.; Munk, Peter L.

2007-01-01

Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

Mesenchymal Stem Cells after Polytrauma: Actor and Target

Directory of Open Access Journals (Sweden)

Markus Huber-Lang

2016-01-01

Full Text Available Mesenchymal stem cells (MSCs are multipotent cells that are considered indispensable in regeneration processes after tissue trauma. MSCs are recruited to damaged areas via several chemoattractant pathways where they function as “actors” in the healing process by the secretion of manifold pro- and anti-inflammatory, antimicrobial, pro- and anticoagulatory, and trophic/angiogenic factors, but also by proliferation and differentiation into the required cells. On the other hand, MSCs represent “targets” during the pathophysiological conditions after severe trauma, when excessively generated inflammatory mediators, complement activation factors, and damage- and pathogen-associated molecular patterns challenge MSCs and alter their functionality. This in turn leads to complement opsonization, lysis, clearance by macrophages, and reduced migratory and regenerative abilities which culminate in impaired tissue repair. We summarize relevant cellular and signaling mechanisms and provide an up-to-date overview about promising future therapeutic MSC strategies in the context of severe tissue trauma.

Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

Science.gov (United States)

2014-11-01

detail elsewhere.13,41 After silver staining, sections were washed thoroughly in distilled water, mounted on gelatin -coated slides, and counterstained...neuropathological changes resulting from a single BOP exposure are modest and largely consist of limited fiber degeneration that is evident in silver -stained...Walter Reed Army Institute of Research, Silver Spring, MD 20910 Age-dependent variations in the pathophysiology of blast-induced traumatic brain

Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

Science.gov (United States)

2015-10-01

Gould , 1994; Yu et al ., 2004; Montaron et al ., 2006); with males showing...ety, and depression (Gentilini et al ., 1985; Schoenhuber and Gentilini, 1988 ; Ponsford et al ., 1995). Blast induced traumatic brain injury (bTBI...into neuronal circuits (Kempermann, 2002a; Kozorovitskiy and Gould , 2003; Abrous et al ., 2005; Hagg, 2005; Ming and Song, 2005; Zhao et al .,

Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

Science.gov (United States)

2010-05-28

devoid of any obvious cell loss or injury when assessed using either Nissl or Fluoro Jade stains , they consistently showed widespread fiber degeneration...injured brain after thionine (l) or silver (r) staining . experimental parameters (e.g. driver volume, tube position, Mylar membrane thickness, and type...5. Thionine- (top) and silver- (bottom) stained brain sections following exposure to 126 kPa airblast at the mouth of the tube. From Long et al

Treatment of chronic back pain; Schmerztherapie der Wirbelsaeule

Energy Technology Data Exchange (ETDEWEB)

Schumacher, M. [Universitaetsklinik Freiburg (Germany). Sektion Neuroradiologie, Neurozentrum

2002-09-01

The comprehensive survey addresses all therapies available, including non-invasive and invasive methods, and the drug therapies. (orig./CB) [German] Die invasive Therapie wird untergliedert in die Behandlung von Bandscheibenvorfaellen (intradiskale Therapie), Infiltrationsbehandlungen (Blockadetherapie) von schmerzleitenden nervalen Strukturen (epidurale Injektion, Wurzelblockade, Grenzstrangblockade) und die Ausschaltung von artikulaer ausgeloesten Schmerzen (Facettenblockade, Iliosakralgelenkblockade). Dazu kommen zwei Therapieverfahren, die besonderen Prozessen im Rahmen spezifischer Rueckenschmerzen vorbehalten sind - die perkutane Vertebroplastie sowie Embolisationen von schmerzausloesenden Tumoren. Behandlungsgrundsaetze. Als Behandlungsgrundsaetze lassen sich trotz der genannten Einschraenkung folgende Hinweise geben: - Der Einsatz von invasiven Methoden ist nur sinnvoll in interdisziplinaerer Zusammenarbeit, da die meisten Schmerzformen sich nicht an definierte Fachgebiete halten. - Vor jeder invasiven Therapie muessen die Moeglichkeiten der konservativen und medikamentoesen Schmerzbehandlung ueber mindestens 6 Wochen ausgelotet worden sein. Invasive Verfahren sind Methode der 2. Wahl und induzieren haeufiger als konservative Verfahren eine Chronifizierung. - Die genaue Kenntnis der Multikausalitaet, der unterschiedlichen Erscheinungsformen des Schmerzes und der Schmerzperzeption werden bei dem behandelnden Arzt vorausgesetzt. - So lange wie moeglich sollten strukturerhaltende Behandlungen den neurodestruktiven Techniken vorgezogen werden. - Blindpunktionen gewaehrleisten nicht die gezielte Applikation am Wirkort. Von den behandelnden Aerzten ist daher zu fordern, dass sie die bildgesteuerten Applikationstechniken beherrschen. (orig.)

Bishop Thomas Lewis O’Beirne and his church-building programme in the diocese of Meath 1798-1823

OpenAIRE

Gallagher, Mary Caroline

2009-01-01

The first quarter of the nineteenth century was a time of great change and uncertainty in Ireland. The rebellion of 1798 was followed in 1801 by the Act of Union, which brought about legislative and ecclesiastical union from Britain. If the Church of Ireland was ever to make a success of its mission in-Ireland, it was in these early years of the nineteenth century. On the eve of this opportunity Thomas Lewis O’Beime, an Irish convert and former Roman Catholic seminarian, was tr...

[Classification of severely injured patients in the G-DRG System 2008].

Science.gov (United States)

Juhra, C; Franz, D; Roeder, N; Vordemvenne, T; Raschke, M J

2009-05-01

Since the introduction of a per-case reimbursement system in Germany (German Diagnosis-Related Groups, G-DRG), the correct reimbursement for the treatment of severely injured patients has been much debated. While the classification of a patient in a polytrauma DRG follows different rules than the usual clinical definition, leading to a high number of patients not grouped as severely injured by the system, the system was also criticized in 2005 for its shortcomings in financing the treatment of severely injured patients. The development of financial reimbursement will be discussed in this paper. 167 patients treated in 2006 and 2007 due to a severe injury at the University-Hospital Münster and grouped into a polytrauma-DRG were included in this study. For each patient, cost-equivalents were estimated. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK cost-calculation method. The reimbursement was calculated using the G-DRG-Systems of 2007, 2008 and 2009. Cost-equivalents/costs and clinical parameters were correlated. A total of 167 patients treated in 2006 and 2007 for a severe injury at the Münster University Hospital and grouped into a polytrauma DRG were included in this study. Cost equivalents were estimated for each patient. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK (Institute for the Hospital Remuneration System) cost calculation method. Reimbursement was calculated using the G-DRG systems of 2007, 2008 and 2009. Cost equivalents/costs and clinical parameters were correlated. With the ongoing development of the G-DRG system, reimbursement for the treatment of severely injured patient has improved, but the amount of underfinancing remains substantial. As treatment of severely injured patients must be reimbursed using the G-DRG system, this system must be further adapted to better meet the needs of severely injured patients. Parameters such as total surgery time, injury

Lower limb fractures associated with multiligament knee injury

OpenAIRE

Stagnaro, Joaquin; Yacuzzi, Carlos; Barla, Jorge; Zicaro, Juan Pablo; Costa-Paz, Matias

2017-01-01

Objectives: Knee ligament injuries related to lower limb fractures are common and frequently unnoticed. Management of acute polytrauma is usually focused in the bone lesion and a complete physical examination might be really difficult. The purpose of this study was to analyze a series of patients who suffered multiligament knee injuries associated to a lower limb fracture. Hypothesis: The use of magnetic resonance imaging (MRI) during the initial management can lead to an early diagnosis of l...

Die Internen Und Externen Interferenzfehler Beim Lernprozess Des Deutschen Als Zweitfremdsprache Für Türkische Muttersprachler Und Vorschläge Zur Fehlertherapie Internal And External Interference Errors In The Process Of Learning German As A Second Foreign Language And Methods To Prevent Mistakes

Directory of Open Access Journals (Sweden)

Adnan OFLAZ

2013-09-01

Full Text Available Das Ziel dieser Untersuchung liegt darin, die verschiedenen Arten von Interferenzen, die beim Lernprozess der deutschen Sprache auftreten, zuerst theoretisch aufzuklären, dann systematisch mit der kontrastiven Methode durch eine Fehleranalyse zu bestimmen und danach auszuwerten. Die Beeinflussung der Sprache von einer anderen Sprache verursacht Überschneidungen. Interferenzfehler können wir in den Bereichen “Phonologie, Orthographie, Morphologie, Syntax, Semantik, Pragmatik oder auch Textlinguistik erkennen. Anschließend werden Vorschläge zur Fehlerkorrektur auf den grammatikalischen, ortographischen und lexikalischen Ebenen vorgenommen. Betrachtet man dies aus dem kognitiven Blickwinkel, kann jeder unschwer erkennen, dass die Vorkenntnisse retroaktive und proaktive Effekte haben. Das heißt, diese Kenntnisse können den Lernprozess entweder positiv oder negativ beeinträchtigen. Von diesem Ausgangspunkt aus werden in dieser Arbeit die Wechselwirkungen, die sowohl von der erstgelernten Fremdsprache als auch von der Muttersprache abhängig sind, der Reihe nach identifiziert, klassifiziert und abschliessend analysiert. Auf den Ergebnissen dieser Fehleranalyse basierend, machen Studenten unter dem Einfluss der interlingualen Interferenzen meist Fehler bei der Wortstellung, der Zeitform „Perfekt“, Pluralbildung, der Deklination der Adjektive, der Groß- bzw Kleinschreibung und bei dem Gebrauch der Konjunktionen sowie auf den lexikalischen Ebenen. Unter dem Einfluss der intralingualen Interferenzen machen sie Fehler bei der Bildung der Zeitformen „Perfekt und Präteritum“ und bei der Konjugation des Verbs. The primary aim of this study is to analyze the different types ofinterferences that may occur in the process of learning the Germanlanguage both theoretically and systematically by making use of thecontrastive method in order to detect and evaluate common errors. In asecond step, methods to correct these errors on a grammatical

Ein schlankes Datenmodell für E-Books: die providerneutrale Aufnahme

Directory of Open Access Journals (Sweden)

Manfred Müller

2015-12-01

Full Text Available Der Artikel zeigt verschiedene Lösungsansätze, wie je nach Prinzipien der Verbund-Datenhaltung eine providerneutrale E-Book-Beschreibung modelliert sein kann. Die skizzierten Datenmodelle bieten einen Ausblick, welche Chancen in der frühzeitigen Adaption des providerneutralen Datenmodells beim Übergang zu den Datenstrukturen in den Cloud-basierten Erschließungsumgebungen bestehen. The article demonstrates current approaches to provider-neutral ebook records in German unioncatalogs and gives a perspective on how to transfer the outlined data models into cloud-based catalog systems.

RANK/RANK-Ligand/OPG: Ein neuer Therapieansatz in der Osteoporosebehandlung

Directory of Open Access Journals (Sweden)

Preisinger E

2007-01-01

Full Text Available Die Erforschung der Kopplungsmechanismen zur Osteoklastogenese, Knochenresorption und Remodellierung eröffnete neue mögliche Therapieansätze in der Behandlung der Osteoporose. Eine Schlüsselrolle beim Knochenabbau spielt der RANK- ("receptor activator of nuclear factor (NF- κB"- Ligand (RANKL. Durch die Bindung von RANKL an den Rezeptor RANK wird die Knochenresorption eingeleitet. OPG (Osteoprotegerin sowie der für den klinischen Gebrauch entwickelte humane monoklonale Antikörper (IgG2 Denosumab blockieren die Bindung von RANK-Ligand an RANK und verhindern den Knochenabbau.

Beginn und Dosisanpassung einer intensivierten konventionellen Insulintherapie (ICT beim Erwachsenen

Directory of Open Access Journals (Sweden)

Lohr R

2012-01-01

Full Text Available Eine intensivierte Insulintherapie (ICT ist die Behandlung der Wahl bei Diabetes mellitus Typ 1 und auch bei vielen Menschen mit insulinpflichtigem Typ-2-Diabetes. Bei Therapiebeginn müssen individuell Insuline ausgewählt und die richtige Dosierung festgelegt werden. Im weiteren Verlauf ist dann die Anpassung der Insulintherapie an besondere Alltagssituationen wie Sport oder akute Erkrankungen vorrangig. Eine gute Patientenschulung und eine gute Zusammenarbeit zwischen Betroffenem und Behandlerteam sind entscheidend, um diese komplizierte Therapie erfolgreich umzusetzen.

Infektion mit Epstein-Barr-Virus und Tumor-Entstehung beim Menschen

Science.gov (United States)

Kirchner, H.

1981-08-01

The Epstein-Barr Virus (EBV) is the only infectious agent for which a close association with human malignant tumors has been clearly demonstrated. These tumors are one type of nasopharyngeal carcinoma which is frequent in parts of East Asia and the Burkitt lymphoma which predominantly occurs in parts of Africa and New Guinea. Nonetheless, the EBV is the causative agent of infectious mononucleosis (IM), a benign, self-limiting lymphoproliferative disease of adolescents. The major difference between the countries in which the EBV-induced tumors occur and those in which IM occurs is the late primary EBV infection in the latter, whereas primary infection with EBV occurs in the first year of life in the former. All theories of viral carcinogenesis have to explain the long latency period between primary infection and tumor growth and how an ubiquitous virus may be oncogenic. Thus, invariably, one has to assume a role of cofactors, which may be of cytogenetic nature or may be represented by additional infections or by chemical agents. Since most modern theories of carcinogenesis consider a multi-step development of tumors, the theory that infection with an ubiquitous virus at the right time of life represents one step to carcinogenesis seems to be tenable.

Postoperative Verlaufskontrollen beim Ulcus cruris nach Shave-Operation und Hauttransplantation

OpenAIRE

Pantelaki, Ioanna

2016-01-01

\\(\\bf Hintergrund:\\) Die Arbeit hat das Ziel die Shave-Operation mit Meshgraft-Deckung hinsichtlich der Einheilungsrate und der Schmerzreduktion zu untersuchen. \\(\\bf Methoden:\\) 56 Patienten mit einem Ulcus cruris unterzogen sich dem genannten Eingriff. Vor und 6 Monate nach der Operation wurden die Ulkusgröße, die bakterielle Besiedlung und die Schmerzintensität analysiert. \\(\\bf Ergebnis:\\) Bei 42,86% der Patienten konnte eine Abheilung erreicht werden, wobei die Ergebnisse hoch sign...

Epidemiologische Studie zur Verbreitung porziner Circoviren beim Wildschwein in Deutschland

OpenAIRE

Knell, Sebastian Christoph

2007-01-01

PMWS, weltweit die wirtschaftlich bedeutendste Erkrankung in der Schweineinproduktion, wird mit PCV 2 assoziiert. Weitere Erkrankungen wie Reproduktionsstörungen und der „porcine respiratory disease Complex (PRDC)“ werden mit dem Virus assoziiert und das Virus gilt als ein Faktor für das „Porzine Dermatitis und Nephropathie Syndrom“ (PDNS). Porzine Circoviren vom Typ I, die als Zellkulturkontaminante entdeckt wurden, gelten als nicht pathogen. Der Erreger beider Typen ist in den Hausschweine...

Einfluss freier Fettsäuren auf die Insulinsekretion beim Menschen

OpenAIRE

Steigenberger, Mirjam Elisabeth

2008-01-01

Zu den pathophysiologischen Grundlagen des Diabetes mellitus Typ 2 gehören die Insulinresistenz und die gestörte Insulinsekretion. Ziel dieser Arbeit war es, zu untersuchen, ob der Spiegel der freien Fettsäuren im Nüchternplasma bei Risikopersonen für Diabetes mellitus Typ 2 die Insulinsekretion beeinträchtigt. Hierfür untersuchten wir in einer Querschnittsuntersuchung 1055 Probanden mit positiver Familienanamnese für Typ 2 Diabetes mellitus. Unabhängig von Alter, Geschlecht, Insulinsensitivi...

Der Strafgrund beim untauglichen und baim tauglichen Versuch / Claus Roxin

Index Scriptorium Estoniae

Roxin, Claus

2017-01-01

Kuritegelikust kavatsusest kuriteokatse toimepanekul Saksa ja Hispaania karistusõiguses. Ajakirjanumber sisaldab erinevaid artikleid Hispaania ja Saksa karistusõigusest ning on pühendatud hispaania õigusteadlase Santiago Mir Puig'i 70. sünnipäevale

Imaging of appendicitis in adults; Bildgebung der Appendizitis beim Erwachsenen

Energy Technology Data Exchange (ETDEWEB)

Karul, M.; Berliner, C.; Keller, S.; Yamamura, J. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology; Tsui, T.Y. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of General, Visceral- and Thoracic Surgery

2014-06-15

Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2 mm, cross-sectional diameter greater than 6 mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. (orig.)

Advanced thermal management of diesel engines; Neues Thermomanagement beim Dieselmotor

Energy Technology Data Exchange (ETDEWEB)

Wenzel, Wolfgang; Becker, Michael [BorgWarner, Ludwigsburg (Germany). Konzernvorentwicklung fuer Pkw-Antriebssysteme; Shutty, John [BorgWarner, Auburn Hills (United States). Regelung und Simulation in der Konzernvorentwicklung

2013-05-01

The potential of thermal management with respect to CO{sub 2} reduction is given by faster warm-up of engine and drivetrain, reduced losses from water pump and fan and finally the operation of the engine in an optimal temperature range. In a new approach, BorgWarner applies a variable coolant pump and a controlled coolant valve to a conventional cooling system. Both components, as well as the viscous fan clutch, are controlled by a newly developed controls approach.

Transkriptionelle Regulation des Wachstumsfaktors Gastrin beim kleinzelligen- und nichtkleinzelligen Bronchialkarzinom

OpenAIRE

Zippert, Renate

2000-01-01

Die transkriptionelle Regulation der Expression von Gastrin in SCLC- und NSCLC-Zellen war bisher nicht untersucht worden. Die Klonierung der 5´-flankierenden Sequenzen des Gastringens und die Herstellung von Gastrinpromotor-Reportergenkonstrukten ermöglichte eine vergleichende funktionelle Untersuchung der Gastrinpromotor-Aktivität in der SCLC-Zellinie H69, der NSCLC-Zellinie 32M1 und der Mesotheliom-Zellinie MSTO-211H. Die vorliegenden Untersuchungen konnten so eine zelltypspezifisc...

Bilateral Traumatic Fracture of Neck of Femur in a Child: A Case Report

Directory of Open Access Journals (Sweden)

D Dhar

2013-07-01

Full Text Available Bilateral femoral neck fractures are rare in the pediatric age group, and only a few cases have been reported following major trauma in children. A 9-year old girl presented with bilateral femoral neck fractures following a motor vehicle accident. The patient was managed with early operative fixation of the fractures with a successful outcome. This case highlights the importance of awareness of the occurrence of bilateral femoral neck fractures in the polytrauma patients. This case is presented due to its rarity.

Whole-body computed tomography in polytrauma: techniques and management

International Nuclear Information System (INIS)

Linsenmaier, Ulrich; Kroetz, Michael; Rock, Clemens; Rieger, Johannes; Pfeifer, Klaus Juergen; Reiser, Maximilian; Haeuser, Hannes; Bohndorf, Klaus

2002-01-01

An interdisciplinary team should be involved in the diagnosis and management of severely injured patients. The adoption of criteria for starting treatment for multiple trauma avoids underestimation of seriousness of injury. These criteria are established by the circumstances of the accident, the patterns of trauma, and the vital findings. Basic diagnosis comprises a limited number of plain films in the trauma room, including supine chest, lateral cervical spine, and pelvis, and ultrasound of abdomen, pleura, and pericardium. Organ diagnosis using CT is complementary and depends on the clinical findings and findings from the basic investigations. We recommend spiral CT (skull base 2/2/4 mm, cerebrum 8/8/8 mm native) and after intravenous contrast medium thoracic (5/7.5/5 mm) and abdominal CT (8/12/8 mm). Image reconstruction of bony structures can be added. The CT and the trauma center should be in close proximity; time-consuming transfers must be avoided. If this is not possible, a CT can be integrated in the trauma room. Our hospital trauma registry contains over 2200 entries. A quality committee has been established and external quality control is implemented. (orig.)

Heterotopic bone formation as a result of abdominal polytrauma

International Nuclear Information System (INIS)

Petkov, G.; Penev, B.; Kirova, G.; Ruskova, E.; Karagiozov, P.

2015-01-01

Full text: Heterotopic bone formation within the abdominal cavity is a rare complication of the posttraumatic abdominal surgery. There are only few cases reported in the medical literature and most of them involve the mesentery or the abdominal wall. A case of 49y-old men is presented who developed intraabdominal heterotopic ossifications as a consequence of numeral exploratory laparotomies performed after a blunt abdominal trauma. The condition was detected during the follow-up MDCT 11 months later. The case is of interest because of the rarity of the condition and the diffuse character of the calcifications in the abdominal structures, which could pose some differential diagnostic difficulties

Whole-body computed tomography in polytrauma: techniques and management

Energy Technology Data Exchange (ETDEWEB)

Linsenmaier, Ulrich; Kroetz, Michael; Rock, Clemens; Rieger, Johannes; Pfeifer, Klaus Juergen; Reiser, Maximilian [Department of Radiology, Klinikum der Universitaet Muenchen (Germany); Haeuser, Hannes; Bohndorf, Klaus [Department of Radiology, Klinikum Augsburg (Germany)

2002-07-01

An interdisciplinary team should be involved in the diagnosis and management of severely injured patients. The adoption of criteria for starting treatment for multiple trauma avoids underestimation of seriousness of injury. These criteria are established by the circumstances of the accident, the patterns of trauma, and the vital findings. Basic diagnosis comprises a limited number of plain films in the trauma room, including supine chest, lateral cervical spine, and pelvis, and ultrasound of abdomen, pleura, and pericardium. Organ diagnosis using CT is complementary and depends on the clinical findings and findings from the basic investigations. We recommend spiral CT (skull base 2/2/4 mm, cerebrum 8/8/8 mm native) and after intravenous contrast medium thoracic (5/7.5/5 mm) and abdominal CT (8/12/8 mm). Image reconstruction of bony structures can be added. The CT and the trauma center should be in close proximity; time-consuming transfers must be avoided. If this is not possible, a CT can be integrated in the trauma room. Our hospital trauma registry contains over 2200 entries. A quality committee has been established and external quality control is implemented. (orig.)

Error in objecto - warum E-Books keine Bücher sind

Directory of Open Access Journals (Sweden)

Ruth Katzenberger

2014-12-01

Full Text Available Elektronische Medien gewinnen für Bibliotheken zunehmend an Bedeutung. Trotz dieser Entwicklung bestehen in der bibliothekarischen Praxis erhebliche Unsicherheiten beim Umgang mit elektronischen Medien. Das liegt vor allem daran, dass ein gedrucktes Buch und seine elektronische Version den gleichen Inhalt haben. So liegt der Schluss nahe, dass es sich beim Print-Buch und seinem elektronischen Pendant um ein Zwillingspaar handelt, das in der bibliothekarischen Arbeit gleich behandelt werden kann. Dieser Eindruck wird verstärkt, wenn bei der elektronischen Ausleihe der E-Books von Ausleihe, Vormerkung und Widerruf gesprochen wird. Nachfolgend soll verdeutlich werden, dass der digitale Zwilling des Printbuches aus rechtlicher Sicht gerade kein „echter Zwilling“ ist. Dieser Beitrag umreißt die rechtliche Problematik, die sich ergibt, sobald Bibliotheken ihren Nutzern E-Books zur Verfügung stellen. Although electronic media are becoming more and more important for libraries, there is still considerable uncertainty about how to deal with these materials. Electronic media and print media have the same content. Therefore, librarians tend to think that a printed book and its electronic counterpart are, as it were, a pair of twins which can be treated alike. This assumption is reinforced by the  use of traditional terminology like “borrowing” and “reservation” in the contect of e-books, e-papers etc. However, from a legal point of view, the digital twin is not a twin at all.  The paper describes the legal problems connected to e-lending in libraries.

Non-granulomatous prostatitis: MR appearance with an endorectal surface coil; Nichtgranulomatoese Prostatitis: Erscheinungsbild im MRT mit endorektaler Oberflaechenspule (``Endo-MRT``)

Energy Technology Data Exchange (ETDEWEB)

Szolar, D.H.M. [Magnetresonanztomographie-Zentrum, Univ. Graz (Austria); Ranner, G. [Magnetresonanztomographie-Zentrum, Univ. Graz (Austria); Preidler, K.W. [Magnetresonanztomographie-Zentrum, Univ. Graz (Austria); Lax, S. [Inst. fuer Pathologische Anatomie, Univ. Graz (Austria)

1995-01-01

Inflammatory conditions of the prostate are often idfficult to distinguish from early stages of prostate cancer with imaging techniques. The use of an endorectal surface coil in MRI of the prostate gland has been reported to provide superior resolution and better imaging of details than MRI with a body coil in the diagnosis of early prostate cancer. We report a 34-year-old patient with nonspecific non-granlomatous prostatitis in whom T{sub 2}-weighted endorectal surface coil magnetic resonance imaging (ESCMRI) showed a region of markedly decreased signal intensity in the periphery of the gland. The low signal intensity of the lesion, its sharp demarcation from the normal part of the peripheral zone of the prostate and the marked bulge of the surface contour without capsular breach of the organ were interpreted as evidence of a bioptically proven benign inflammatory condition. (orig.) [Deutsch] Die Unterscheidung entzuendlicher Prozesse von Fruehstadien maligner Neoplasien der Prostata mittels Magnetresonanztomographie bereitet immer wieder Schwierigkeiten. Die Anwendung einer Oberflaechenspule erlaubt durch hoehere Aufloesung eine exaktere Beurteilung der Prostatakapsel, was eine hoehere Treffsicherheit beim Nachweis moeglicher organueberschreitender Infiltrationen bedeutet. Wir praesentieren den Fall eines 34jaehrigen Mannes mit unspezifischer, nichtgranulomatoeser Prostatitis, bei dem das MR-Tomogramm mit endorektal plazierter Oberflaechenspule (Endo-MRT) in der Peripherzone ein Areal deutlich herabgesetzter Signalintensitaet auf T{sub 2}-gewichteten Aufnahmen zeigte. Die scharfe Begrenzung der ausgedehnten signalarmen Laesion gegenueber dem nichtbefallenen Anteil der Peripherzone beim im Endo-MRT identifizierbarer intakter Kapsel liess ein organueberschreitendes Malignom ausschliessen und bestaetigte durch histologische Aufarbeitung der Bioptate den Endo-MRT-Verdachtsbefund einer Prostatitis. (orig.)

[Helsinki declaration on patient safety in anaesthesiology -part 10: infection control/hygiene].

Science.gov (United States)

Kerwat, Klaus; Wulf, Hinnerk

2013-11-01

There is a plethora of laws, regulations, guidelines and recommendations relating to infection control and hygiene. Major issues are the prevention of nosocomial infections, staff protection and environmental protection. Of the highest relevance are the infection control law [Infektionsschutzgesetz (IfSG)], the hygiene regulations of the German federal states [Hygieneverordnungen der Bundesländer], the German technical rules for biological materials [Technische Regel Biologische Arbeitsstoffe 250 (TRBA 250)] - biological materials in health-care and welfare work [Biologische Arbeitsstoffe im Gesundheitswesen und in der Wohlfahrtspflege], the guidelines for hospital hygiene and prevention of infection of the commission for hospital hygiene and prevention of infection of the Robert-Koch Institute [Richtlinie für Krankenhaushygiene und Infektionsprävention von der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut], the recommendations of the commission on anti-infectives, resistance and therapy of the Robert-Koch Institute [Empfehlungen der Kommission Antiinfektiva, Resistenz und Therapie (ART) beim Robert Koch-Institut]. Of subordinate importance are, e.g., the recommendations of the German Society for Anesthesiology and Intensive Medicine (DGAI). It is practically impossible for an anesthesiologist working in a hospital to have knowledge of all laws, regulations, guidelines and recommendations. And this is also not reasonable. Thus it is necessary to distinguish the relevant from the irrelevant. Checklists can be useful here. The most important and effective individual action in hospital hygiene is and remains hand hygiene as is propagated in the action "clean hands", irrespective of all laws, regulations, guidelines and recommendations. © Georg Thieme Verlag Stuttgart · New York.

SINTAP: draft of a unified European failure assessment procedure. An introduction; SINTAP: Entwurf einer vereinheitlichten europaeischen Fehlerbewertungsprozedur. Eine Einfuehrung

Energy Technology Data Exchange (ETDEWEB)

Zerbst, U.; Kocak, M. [GKSS-Forschungszentrum Geesthacht GmbH (Germany). Inst. fuer Werkstofforschung; Wiesner, C. [The Welding Institute (TWI), Cambridge (United Kingdom). Structural Integrity Dept.; Hodulak, L. [Fraunhofer-Institut fuer Werkstoffmechanik (IWM), Freiburg im Breisgau (Germany)

1999-07-01

Fracture mechanics based flaw assessment concepts are increasingly used in industrial regulations and standards. A considerable number of different guidelines and procedures are available which are partly based on each other but also exhibit significant differences. At this background, the EU sponsored SINTAP, an interdisciplinary Brite Euram project. SINTAP stands for 'Structural Integrity Assessment Procedures for European Industry'. From 1996 to 1999 seventeen organisations from nine European countries participated in the project the aim of which was to unify the available procedures. The present report is an introduction into the content, the structure and the scientific background of the procedure which was generated within SINTAP. (orig.) [German] Bruchmechanische Bewertungskonzepte werden international in zunehmendem Masse Bestandteil industrieller Regelwerke und Fachbereichsstandards. Bereits heute existiert eine Vielzahl derartiger Vorschriften und Rechnerprogramme, die teilweise aufeinander aufbauen, teilweise aber auch signifikante Unterschiede aufweisen. Vor diesem Hintergrund wurde durch die EU von 1996 bis 1999 SINTAP, ein interdisziplinaeres Brite-Euram-Projekt gefoerdert, dessen Ziel in einer Vereinheitlichung der vorhandenen Ansaetze bestand, und an dem siebzehn Institutionen aus neun europaeischen Laendern beteiligt waren. SINTAP steht fuer 'Structural Integrity Assessment Procedures for European Industry'. Der vorliegende Bericht ist eine Einfuehrung in Inhalt, Struktur und wissenschaftlichen Hintergrund der im Ergebnis des Projektes entstandenen SINTAP-Prozedur. (orig.)

What is ''good technology''? On the heuristic competence of the engineer; ''Was ist eine ''gute'' Technologie? Zur heuristischen Kompetenz des Ingenieurs

Energy Technology Data Exchange (ETDEWEB)

Ulrich, H.G. [Erlangen-Nuernberg Univ. (Germany). Inst. fuer Systematische Theologie

1999-07-01

This paper is intended to contribute to the discourse of this book both in a direct and indirect way, in so far as the paper can be searched for the aspects and insight brought in from the perspective of the humanities, and what impact these may have on innovative processes for technological progress. The author refers for instance to aspects of ethics that go beyond the existing concept of ethics of technology, and also refer to the connection between ethics and aesthetics, so as to maintain a wider view encompassing the latter aspects. (orig./CB) [German] Der folgende Beitrag will zum Gesamtthema nicht nur direkt, sondern auch indirekt etwas beitragen, sofern er daraufhin befragt werden kann, was durch eine geisteswissenschaftliche Perspektive ins Spiel kommt und was sich daraus fuer die Innovation von technologischen Entwicklungen ergeben koennte. Dabei ist generell wichtig, dass nicht nur interdisziplinaere Kooperationen (wie zwischen Techniksoziologie und Technologie) eine Rolle spielen, sondern auch das Herausarbeiten bestimmter Aufgaben, die quer zu den Faechern oder Wissenschaftszweigen verlaufen. Das betrifft beispielsweise Aspekte der Ethik, die ueber das hinausgehen, was als Ethik der Technik bisher konzipiert worden ist. Das betrifft auch den Zusammenhang von Ethik und Aesthetik. Dafuer sollte der Blick offen bleiben. (orig.)

Critical care considerations in the management of the trauma patient following initial resuscitation

Directory of Open Access Journals (Sweden)

Shere-Wolfe Roger F

2012-09-01

Full Text Available Abstract Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.

Schaltungsunterlagen

Science.gov (United States)

Döring, Peter

Beim Zeichnen von Schaltplänen werden alle zugehörigen Maschinen, Geräte, Schaltteile und Leitungen nicht maßstabsgetreu und der tatsächlichen Ausführung ähnlich gezeichnet, sondern durch genormte graphische Symbole dargestellt. Die Ausführungen in diesem Kapitel sollen dazu eine Hilfestellung geben. Behandelt werden folgende Themen: Wichtige VDE-Bestimmungen; Diagrammdarstellungen; Schaltzeichen nach DIN; Kennzeichnung von elektrischen Betriebsmitteln; Schaltungsunterlagen der Energietechnik; Schaltungsunterlagen der Elektronik; Schaltzeichen für Binäre Elemente; Entwurf von Schaltungen: Einzelplatinen, Gedruckte Schaltungen; Projektierung. Zahlreiche Tabellen und Abbildungen dienen zur Erläuterung.

Mit Expertenwissen zu Aussagen über künftige Entwicklungen — der Horizon Report Higher Education

Directory of Open Access Journals (Sweden)

Rudolf Mumenthaler

2014-03-01

Full Text Available Der Horizon Report Higher Education dient auch für Hochschulbibliotheken als wichtige Referenz zur Bewertung aktueller Trends und künftiger Entwicklungen. Der Autor stellt die dem Report zugrunde liegende Methode vor, beleuchtet diese kritisch und reflektiert die Aussagekraft der Prognosen. Die Stärken des Horizon Report liegen in der breiten Abstützung, der Offenheit des Verfahrens und der Publikation sowie der Ausarbeitung der von Expertinnen und Experten ausgewählten Themen. Gewisse Schwächen sieht der Autor in der Abhängigkeit von anderen Trendstudien sowie beim Auswahlverfahren der Trendthemen.

Multimedia und Lernstiltyp. Unterstützt Online-Distance-Learning unterschiedliche Lernstiltypen und führt zu mehr Lernerfolg?

Directory of Open Access Journals (Sweden)

Petra Lindemann-Matthies

2006-09-01

Full Text Available In der vorliegenden Studie haben wir uns mit der Frage beschäftigt, ob Lernerfolg, Multimedianutzung und der Lernstiltyp nach Kolb (1984 im Distance- Learning-Kurs VIRT.UM, der online angeboten wird, zusammenhängen. Dabei stellte sich heraus, dass Studierende beim Arbeiten mit VIRT.UM zwar selektiv unter den ihnen angebotenen Multimediatypen auswählten, die Auswahl aber nicht von ihrem jeweiligen Lernstiltyp abhing. Der Lernerfolg der Studierenden wurde durch die Nutzung bestimmter Multimediatypen gefördert, hing aber ebenfalls nicht vom Lernstiltyp ab. Hierfür gibt es verschiedene, sich nicht ausschliessende Erklärungen.

Bluetooth in the car: chances and limits; Bluetooth im Auto: Moeglichkeiten und Grenzen

Energy Technology Data Exchange (ETDEWEB)

Hascher, W.

2000-06-01

Car manufacturers, electronic suppliers and research institutions such as the MIT in the U.S. everywhere work on complementing or replaced the wiring harness by radio links. One way of doing this is ''Bluetooth'', a short-distance-radio technology on the 2.4GHz-band.(orig.). [German] Weltweit wird in den Automobilkonzernen, bei den Elektronik-Zulieferfirmen und in Forschungseinrichtungen (z.B. beim MIT in den USA) daran gearbeitet, den 'Kabelbaum' im Kfz durch Funkverbindungen zu ergaenzen bzw. Teile davon zu ersetzen. Eine Loesung hierfuer ist 'Bluetooth', eine Kurzstrecken-Funktechnologie im 2,4-GHz-Band. (orig.)

The ENTRIA project. Selected disciplinary and interdisciplinary research topics; Das ENTRIA-Projekt. Ausgewaehlte disziplinaere und interdisziplinaere Forschungsthemen

Energy Technology Data Exchange (ETDEWEB)

Roehlig, Klaus-Juergen [Technical Univ. Clausthal, Clausthal-Zellerfeld (Germany); Hocke, Peter [KIT Karlsruhe (Germany). Inst. for Technology Assessment and Systems Analysis; Smeddinck, Ulrich [Braunschweig Technical Univ. Braunschweig (Germany); Walther, Clemens [Hannover Univ. (Germany). Inst. for Radioecology and Radiation Protection

2015-07-01

ENTRIA (''Disposal Options for Radioactive Residues: Interdisciplinary Analyses and Development of Evaluation Principles'', www.entria.de) is a joint research project carried out by twelve departments and institutes from German universities and major research institutions and one partner from Switzerland. It is financed by the German Ministry of Education and Research (BMBF). Scientists representing natural sciences, civil engineering, philosophy, law, social and political sciences, and technology assessment carry out disciplinary and interdisciplinary research addressing three options to manage especially high-level radioactive waste: - Final disposal in deep geological formations without any arrangements for retrieval, - disposal in deep geological formations with arrangements for monitoring and retrieval, and - (prolonged) surface (or near-surface) storage. In the paper, the following selected research topics - both disciplinary and interdisciplinary - are briefly introduced in order to provide an impression of the project scope: - Surface storage, - reference concepts for emplacement in deep geological formations with retrievability and monitoring, - radiation exposure and justification of measures, - interdisciplinary perspectives on dose limits, - comparative studies on nuclear waste governance, - nuclear waste governance in Switzerland, - public involvement and the German Site Selection Act, and - citizens' jury.

Integrated project: Microbiological and physiological studies on the presence of residual concentrations in mineral-oil-contaminated soils after rehabilitation. Final report. Pt. 2; Mikrobiologische und physiologische Untersuchungen zur Frage der Restkonzentration bei der Sanierung mineraloelkontaminierter Boeden. Abschlussbericht. T. 2

Energy Technology Data Exchange (ETDEWEB)

Miethe, D.; Riis, V.; Stimming, M.

1996-01-04

It has been known for a long time that microorganisms are able to utilise mineral oils. Today various methods are practised which exploit autochthonous microorganisms` ability to utilise mineral oils. The main problem of microbial decomposition of hydrocarbons is that mineral oil residues remain. The aim of the present research project was therefore to determine the limits of the metabolisability of the substrate and find out why residues remain. Mineral oils and residual fractions differ markedly in their decomposability. Intermediate distillates are easily decomposed to a degree of 95-97% by well-adapted consorts. For high-boiling mineral oils (bp>400 C) the degree of decomposition is approx. 60%. Extracts from contaminated sites range from 40 to 60% in their degree of decomposability. The incomplete microbial decomposition of mineral oils is mainly due to their structure. There remain chemically and thermally extremely, inert hydrocarbons (mainly aliphatic and aromatic fused-ring systems) which are either hardly metabolisable or not at all. An important factor in soils or at other contaminated sites is that some of the substrate is not available because it is bound to the matrix thus increasing the proportion of residue. The next task after examining and presenting the causes of incomplete decomposition is to minimise residual mineral oil concentrations remaining after microbial decomposition. Here the use of special surfactants or of auxiliary substrates could point a way. Project applications to this end have already been submitted to the Federal Ministry for Education and Research. (orig.) [Deutsch] Dass Mikroorganismen in der Lage sind, Mineraloele zu verwerten, ist seit langem bekannt. Verfahren, die das Potential autochthoner Mikroorganismen zur Verwertung von Mineraloelen nutzen sind Praxis. Hauptproblem beim mikrobiellen Abbau der Kohlenwasserstoffe ist das Verbleiben von Mineraloelresten. Das Ziel des Forschungsvorhabens war die Ermittlung der Grenzen

[First aid and management of multiple trauma: in-hospital trauma care].

Science.gov (United States)

Boschin, Matthias; Vordemvenne, Thomas

2012-11-01

Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. © Georg Thieme Verlag Stuttgart · New York.

Damage control in orthopedics and traumatology

International Nuclear Information System (INIS)

Martinez R, Alfredo

2006-01-01

The damage control allows the clinician to institute a rapid process that avoids early death from over aggressive treatment of an injury and lack of attention to the underlying physiological state of victim. This concept allows rapid control and support of the patients underlying physiological condition in an attempt to avoid the triad of death: bleeding, hypothermia and metabolic acidosis. We revised the several indications to damage control in orthopedics in the patients with polytrauma, isolated extremity injury as femur fracture, and the geriatric patients and crane cephalic trauma

Pelvic fractures-A guide to classification and management

Energy Technology Data Exchange (ETDEWEB)

Slater, S.J. [Department of Radiology, Leeds Teaching Hospitals, Leeds (United Kingdom); Radiology Academy, Leeds General Infirmary, Jubilee Wing, Great George St., Leeds LS1 3EX (United Kingdom)], E-mail: s.j.slater@doctors.org.uk; Barron, D.A. [Department of Radiology, Leeds Teaching Hospitals, Leeds (United Kingdom); Musculoskeletal Radiology Dept, Leeds General Infirmary, Jubilee Wing, Great George St, Leeds LS1 3EX (United Kingdom)], E-mail: Dominic.barron@leedsth.nhs.uk

2010-04-15

Pelvic fractures are common in polytrauma and continue to pose a difficult management dilemma for even the most experienced clinicians. Due to the high energy mechanisms involved, there are often multiple other injuries and many specialists may be involved. Deriving an effective management strategy relies on early diagnosis and prioritisation of the most immediately life-threatening injuries. Contrary to ATLS advice, CT can be used to facilitate this even in the haemodynamically unstable patient. This article defines the role of CT in pelvic fractures and provides an overview of fracture classification.

Pelvic fractures-A guide to classification and management

International Nuclear Information System (INIS)

Slater, S.J.; Barron, D.A.

2010-01-01

Pelvic fractures are common in polytrauma and continue to pose a difficult management dilemma for even the most experienced clinicians. Due to the high energy mechanisms involved, there are often multiple other injuries and many specialists may be involved. Deriving an effective management strategy relies on early diagnosis and prioritisation of the most immediately life-threatening injuries. Contrary to ATLS advice, CT can be used to facilitate this even in the haemodynamically unstable patient. This article defines the role of CT in pelvic fractures and provides an overview of fracture classification.

A rare case of Shewanella putrefaciens bacteremia in a patient of road traffic accident

Directory of Open Access Journals (Sweden)

Ritesh Ranjan

2017-01-01

Full Text Available Shewanella putrefaciens rarely causes human infection. These are mostly found in environment and food stuffs. Shewanella are often found in mixed culture. It has been implicated in cellulitis, otitis media, and septicemia. It may be found in respiratory tract, urine, feces, and pleural fluid. There is no definite guideline for therapeutic option. In general, these are susceptible to various antimicrobial agents but are often resistant to penicillin and cephalothin. We report a rare case of bacteremia by S. putrefaciens in a patient of head injury with polytrauma after a road traffic accident.

Can ultrasound extended emergency (EFAST) replace the chest radiograph in the initial approach to trauma?

International Nuclear Information System (INIS)

Aguirre Jimenez, Marcela

2010-01-01

The sensitivity diagnosed between ultrasound Extended emergency (EFAST) and portable radiography was compared. Life-threatening pathologies are detected in the initial approach to trauma, through an analysis comparative between EFAST and portable chest radiography. So, the need or not both studies or if the use of EFAST as the only diagnostic method in primary evaluation of trauma can be limited. The study has concluded that the EFAST can be used as the only tool for polytrauma patients, although in this analysis the sample has been very small [es

Imaging of spine injuries

International Nuclear Information System (INIS)

Lomoschitz, F. . e-mai: friedrich.lomoschitz@univie.ac.at

2001-01-01

Spinal trauma requires a prompt and detailed diagnosis for estimating the prognosis and installing proper therapy. Conventional radiograms are the first imaging modality in most cases. In the cervical and the lumbar spine, a CT has to be performed in patients with polytrauma and a higher risk of complications or with signs of instability. Especially for imaging the cervicocranium, multiplanar reformations in sagittal and coronal planes are necessary. For fractures of the thoracic spine, MR imaging is superior to CT because of the better detection of associated neurologic complications. (author)

Traumatic skeletal changes

International Nuclear Information System (INIS)

Troeger, J.; Schofer, O.

1985-01-01

Skeleton scintiscanning is indicated in the following cases: (1) Suspected bone injury after clinical examination, the radiograph of the skeletal region in question contributing findings that either do not confirm suspision, or make not clear whether the changes observed are traumatic. (2) Polytrauma. (3) When the accident scenario reported by the persons taking care of the child does not sufficiently explain the skeletal changes observed, or when these persons expressly deny the possibility of a trauma being the cause of findings observed. (4) Suspected or proven battered-child syndrome. (orig./MG) [de

Die emotionale Dimension während der Sprechproduktion im Fremdsprachenlernprozess

Directory of Open Access Journals (Sweden)

Bahar İŞİGÜZEL

2017-12-01

Full Text Available Die Gefühle bzw. Emotionen der Lernenden beim Fremdsprachenlehr- und Lernprozess spielen eine wichtige Rolle. Mit der Verknüpfung der Emotion und Kognition beim Lernprozess, haben die positiven Gefühle eine große Bedeutung für den Lernerfolg. Als eine produktive Fertigkeit hat das Sprechen eine wesentlich intensive Beziehung mit den Emotionen, weil es in der realen Zeit fließend laufen muss. Der Lernende soll bei der Sprechproduktion spontan die richtigen Wörter auf die richtige Art und Weise anwenden und sie auch noch verständlich aussprechen. Leider erreicht die Sprechfertigkeit meistens eine niedrigere Niveaustufe als die anderen drei (Schreiben, Lesen und Hören Fertigkeiten im Fremdsprachenunterrichtprozess. Diese qualitative Untersuchung konzentriert sich auf die Daten (Tonaufnahme, die anhand eines Interviews während einer Sprechproduktionsübung im universitären Fremdsprachenunterricht gesammelt wurden. Um die emotionale Dimension der Lernenden während der Sprechproduktion zu identifizieren, wurden im Einzelinterview die Frage „Wie fühlst du dich während du eine Fremdsprache (Englisch sprichst?“ gestellt. Die Teilnehmer dieser Untersuchung waren 29 Studenten, die im WS 2016 - 2017 an Universität Nevşehir Hacı Bektaş Veli (Türkei immatrikuliert waren. Die Auswertung des Interviews folgte mit einer Transkription und einer Interpretation der Tonaufnahmen. Die Meinungen zu der emotionalen Dimension während der Sprechproduktion der Studenten wurden kategorisiert. Die Resultate dieser qualitativen Untersuchung zeigen, dass die emotionale Dimension der Lernenden im universitären Kontext sich in drei Kategorien (positiv, negativ und frühere Ausbildung verteilen.

Webbasierte linguistische Forschung: Möglichkeiten und Begrenzungen beim Umgang mit Massendaten

Directory of Open Access Journals (Sweden)

Juska-Bacher, Britta

2013-12-01

Full Text Available Over the past ten to fifteen years, web-based methods of sociological research have emerged alongside classical methods such as interviews, observations and experiments, and linguistic research is increasingly relying upon them as well. This paper provides an overview of three web-based approaches, i.e. online surveys, crowd-sourcing and web-based corpus analyses. Examples from specific projects serve to reflect upon these methods, address their potential and limitations, and make a critical appraisal. Internet-based empirical research produces vast and highly diverse quantities of (speaker-based or textual data, presenting linguistic research with new opportunities and challenges. New procedures are required to make effective use of these resources.

Who has priority during the regulation?; Wer hat Vorrang beim Abregeln?

Energy Technology Data Exchange (ETDEWEB)

Janzing, Bernward

2013-04-15

The remote control of wind power plants by direct marketers raises questions - not only on the technology, but also on the hierarchy of actors. From the technical perspective, the current practice of feed-in is not particularly well developed. So far, the regulation of wind turbines via radio ripple control is carried out in stages to 60, 30 and 0 %. The traditional ripple control technology does not send a message back to the sender if the wind turbine has received the signal and reacts to it. Smart meter and digital control technology can provide assistance in this case. Consequences for the plant safety result from this regulation: The performance of a wind turbine shall be reduced only with a gradient of ten percent of the initial output per minute. If the data transfer is interrupted, the reduction of the power will be closed automatically after 30 minutes.

Lean-burn stratified combustion at gasoline engines; Magere Schichtverbrennung beim Ottomotor

Energy Technology Data Exchange (ETDEWEB)

Breitbach, Hermann [Daimler AG, Stuttgart (Germany). Entwicklung Einspritzung und Betriebsstoffe; Waltner, Anton [Daimler AG, Stuttgart (Germany). Verbrennungsentwicklung Pkw-Ottomotoren; Landenfeld, Tilo [Robert Bosch GmbH, Schwieberdingen (Germany). Hochdruckeinspritzung Piezo; Porten, Guido [Robert Bosch GmbH, Schwieberdingen (Germany). Systementwicklung Benzindirekteinspritzung

2013-05-01

Spray-guided lean-burn combustion is an integral part of the Mercedes-Benz technology strategy for highly efficient and clean gasoline engines. With regard to the excellent fuel efficiency combined with outstanding specific power, a good combustion system robustness and the low particulate emissions, the concept offers a very good cost/benefit ratio especially for the Euro 6 emission legislation. Thus, Mercedes-Benz believes, that the sprayguided lean-burn combustion offers the by far highest future viability of gasoline engine combustion systems.

Spiral CT for evaluation of chest trauma; Spiral-CT beim Thoraxtrauma

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Roehnert, W. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Weise, R. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik

1997-07-01

After implementation of spiral CT in our department, we carried out an analysis for determining anew the value of CT as a modality of chest trauma diagnosis in the emergency department. The retrospective study covers a period of 10 months and all emergency patients with chest trauma exmined by spiral CT. The major lesions of varying seriousness covered by this study are: pneumothorax, hematothorax, pulmonary contusion or laceration, mediastinal hematoma, rupture of a vessel, injury of the heart and pericardium. The various fractures are not included in this study. In many cases, spiral CT within relatively short time yields significant diagnostic findings, frequently saving additional angiography. A rigid diagnostic procedure cannot be formulated. Plain-film chest radiography still remains a diagnostic modality of high value. (Orig.) [Deutsch] Nach Einfuehrung der Spiral-CT in unserer Einrichtung versuchten wir, den Stellenwert der Computertomographie in der Notfalldiagnostik des Thoraxtraumas neu zu bestimmen. Dazu wurden retrospektiv ueber einen Zeitraum von 10 Monaten alle mittels Spiral-CT untersuchten Notfallpatienten mit Thoraxverletzungen ausgewertet. Im Vordergrund standen folgende Befunde unterschiedlichen Schweregrades: Pneumothorax, Haematothorax, Lungenkontusion/-lazeration, Mediastinalhaematom, Gefaessruptur, Herz- und Herzbeutelverletzung. Auf die unterschiedlichen Frakturen wird bewusst nicht naeher eingegangen. In vielen Faellen liefert die Spiral-CT mit relativ geringem Zeitaufwand wesentliche diagnostische Aussagen. Haeufig kann auf eine Angiographie verzichtet werden. Ein starres diagnostisches Stufenschema laesst sich nicht definieren. Die Thoraxuebersichtsaufnahme besitzt einen unveraendert hohen Stellenwert. (orig.)

Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

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Galloway Robert

2009-12-01

Full Text Available Abstract Background Blunt Traumatic Pericardial Rupture (BTPR with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. Methods We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury Conclusion BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with: Cardiovascular instability with no obvious cause Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.

Latest progress of research on acute abdominal injuries

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Ionut Negoi

2016-01-01

Full Text Available Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly difficult to manage due to the frequent altered mental status of the patients and severity of associated injuries. The review article aims to make an uptodate study of the current strategies for therapeutic approach of abdominal injuries in polytrauma setting. Review of the medical literature is up to 2015, by using the PubMed/Medline, Science Direct, Cochrane Library and Web of Science databases. We have used different combinations of the keywords of “abdominal trauma”, “liver”, “spleen”, “renal”, to review the reference list of retrieved articles for further relevant studies. Nowadays, we are facing a major change in abdominal trauma therapeutic approach, due to the continuous extending indications and very high successful rate of selective nonoperative management, completed or not with minimally invasive techniques like angiography and angiographic embolization. New imaging methods offer a high-quality characterization of solid organ injuries, being a secure support for decision algorithm in polytrauma patients. After a continuous decrease in number of laparotomies for trauma, new techniques should be developed for maintaining and developing the trauma surgeons' skills. According to the current standards, for a low morbidity and mortality, the trauma patients may be approached by a multidisciplinary and experienced trauma team. Even if nonoperative management is continuously expanding, this may be applied only by a trained and skillful trauma surgeon, who is able to perform difficult surgical techniques at any moments.

Videobasierte Systeme

Science.gov (United States)

Knoll, Peter

Videosensoren spielen für Fahrerassistenz systeme eine zentrale Rolle, da sie die Interpretation visueller Informationen (Objektklassifikation) gezielt unterstützen. Im Heckbereich kann die Video sensorik in der einfachsten Variante die ultraschallbasierte Einparkhilfe bei Einpark- und Rangiervorgängen unterstützen. Beim Nachtsichtsystem NightVision wird das mit Infrarotlicht angestrahlte Umfeld vor dem Fahrzeug mit einer Frontkamera aufgenommen und im Fahrzeugcockpit auf einem Display dem Fahrer angezeigt (s. Nachtsichtsysteme). Andere Fahrerassistenzsysteme verarbeiten die Videosignale und generieren daraus gezielt Informationen, die für eigenständige Funktionen (z. B. Spurverlassenswarner) oder aber als Zusatzinformation für andere Funktionen ausgewertet werden (Sensordatenfusion).

Management of maxillofacial trauma in emergency: An update of challenges and controversies

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Anson Jose

2016-01-01

Full Text Available Trauma management has evolved significantly in the past few decades thereby reducing mortality in the golden hour. However, challenges remain, and one such area is maxillofacial injuries in a polytrauma patient. Severe injuries to the maxillofacial region can complicate the early management of a trauma patient owing to the regions proximity to the brain, cervical spine, and airway. The usual techniques of airway breathing and circulation (ABC management are often modified or supplemented with other methods in case of maxillofacial injuries. Such modifications have their own challenges and pitfalls in an already difficult situation.

Disruption of the proximal tibiofibular joint in the setting of multi-ligament knee injury

Energy Technology Data Exchange (ETDEWEB)

Porrino, Jack A. [University of Washington, Department of Radiology, 4245 Roosevelt Way NE, Box 354755, Seattle, WA (United States)

2015-08-15

Instability of the proximal tibiofibular joint is a relatively uncommon condition when in isolation; however, instability of the proximal tibiofibular joint is far more frequent in those presenting with a severe multi-ligament injury of the knee. If this joint is left unstable, repair of a co-existent injury of the posterolateral corner may fail, regardless of the proficiency of the technique. We present two patients with disruption of the proximal tibiofibular joint, including the MRI appearance, who initially presented to our hospital for management of significant polytrauma, as well as multi-ligament injury of the ipsilateral knee. (orig.)

Disruption of the proximal tibiofibular joint in the setting of multi-ligament knee injury

International Nuclear Information System (INIS)

Porrino, Jack A.

2015-01-01

Instability of the proximal tibiofibular joint is a relatively uncommon condition when in isolation; however, instability of the proximal tibiofibular joint is far more frequent in those presenting with a severe multi-ligament injury of the knee. If this joint is left unstable, repair of a co-existent injury of the posterolateral corner may fail, regardless of the proficiency of the technique. We present two patients with disruption of the proximal tibiofibular joint, including the MRI appearance, who initially presented to our hospital for management of significant polytrauma, as well as multi-ligament injury of the ipsilateral knee. (orig.)

A rare pleural effusion in a young male

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Shabana Begum

2015-01-01

Full Text Available A 28-year-old male presented with fever with right-sided chest pain for 2 weeks. Clinicoradiological picture was suggestive of right-sided pleural effusion. He had history of polytrauma following a road traffic accident and had to undergo emergency laparotomy a month ago. Microscopic and culture examination of the pleural fluid showed neutrophilia, high bilirubin content and presence of gram-negative bacilli. Ultrasound of the abdomen showed the presence of biloma in the liver and right subdiaphragmatic space with fistulous communication into the right thoracic cavity. The patient was managed successfully with complete recovery.

Emergency management of renal and genitourinary trauma: best practices update [digest].

Science.gov (United States)

Bryant, Whitney K; Shewakramani, Sanjay; Zaurova, Milana

2017-08-22

In up to 10% of patients who experience abdominal trauma, renal and urogenital systems will be involved. In polytrauma patients with other potentially life-threatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in preventable complications. This review provides a best-practice approach to the diagnosis and management of renal and genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid long-term urinary sequelae such as hypertension, incontinence, erectile dysfunction, chronic kidney disease, and nephrectomy. [Points & Pearls is a digest of Emergency Medicine Practice.].

Veterans' informal caregivers in the "sandwich generation": a systematic review toward a resilience model.

Science.gov (United States)

Smith-Osborne, Alexa; Felderhoff, Brandi

2014-01-01

Social work theory advanced the formulation of the construct of the sandwich generation to apply to the emerging generational cohort of caregivers, most often middle-aged women, who were caring for maturing children and aging parents simultaneously. This systematic review extends that focus by synthesizing the literature on sandwich generation caregivers for the general aging population with dementia and for veterans with dementia and polytrauma. It develops potential protective mechanisms based on empirical literature to support an intervention resilience model for social work practitioners. This theoretical model addresses adaptive coping of sandwich- generation families facing ongoing challenges related to caregiving demands.

The wrong and wounding road: Paediatric polytrauma admitted to a ...

African Journals Online (AJOL)

first 5 years of life,[2] and much effort has been put into reducing these causes. Death from ..... Mars M, Hadley GP. Gunshot injuries in infants and children in KwaZulu-Natal: An emerging epidemic, S Afr Med J 1998;88(4):444-447. 11. Campbell NM, Colville JG, van der Heyde Y, et al. Firearm injuries to children in Cape ...

Relation between lifespan polytrauma typologies and post-trauma mental health.

Science.gov (United States)

Contractor, Ateka A; Brown, Lily A; Weiss, Nicole H

2018-01-01

Most individuals experience more than one trauma. Hence, it is important to consider the count and types of traumas (polytraumatization) in relation to post-trauma mental health. The current study examined the relation of polytraumatization patterns to PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and alterations in arousal and reactivity [AAR]), depression, and impulsivity facets (lack of perseverance, lack of premeditation, negative urgency, sensation seeking) using a web-based sample of 346 participants. Age, gender, race, and ethnicity were covariates. Results of latent class analyses indicated a three-class solution: Low Experience, Moderate Experience - Predominent Threat/Indirect PTEs (Moderate Experience), and High Experience - Predominant Interpersonal PTEs (High/Interpersonal). Multinomial logistic regression results indicated that ethnicity and gender were significant covariates in predicting Low versus High/Interpersonal Class, and Moderate Experience versus High/Interpersonal Class membership, respectively. The High/Interpersonal Class had higher scores on most PTSD clusters, depression, and the impulsivity facets of lack of perseverance and negative urgency compared to the other classes. The Low and Moderate Experience Classes differed on PTSD's avoidance and AAR clusters (lower in the former). Individuals exposed to multiple PTE types, particularly interpersonal traumas, may be at risk for more severe post-trauma symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

Cross-disciplinary management of polytrauma patients: radiological screening and comparison

International Nuclear Information System (INIS)

Messmer, P.; Loew, R.; Jacob, A.L.

2001-01-01

The comprehensive survey addresses the various modalities available today for trauma screening and presents a comparative assessment of their value in respect of type of trauma and evidence provided. (orig./CB) [de

Pan computed tomography for blunt polytrauma: Are we doing too ...

African Journals Online (AJOL)

organ injuries, and better selection of patients needing intensive care or those ... Trauma Service, Pietermaritzburg, South Africa, during the 12-month period .... technology.[14] .... emergency room, while in our setting, pan CT is only performed.

Severe Blunt Hepatic Trauma in Polytrauma Patient - Management and Outcome.

Science.gov (United States)

Doklestić, Krstina; Djukić, Vladimir; Ivančević, Nenad; Gregorić, Pavle; Lončar, Zlatibor; Stefanović, Branislava; Jovanović, Dušan; Karamarković, Aleksandar

2015-01-01

Despite the fact that treatment of liver injuries has dramatically evolved, severe liver traumas in polytraumatic patients still have a significant morbidity and mortality. The purpose of this study was to determine the options for surgical management of severe liver trauma as well as the outcome. In this retrospective study 70 polytraumatic patients with severe (American Association for the Surgery of Trauma [AAST] grade III-V) blunt liver injuries were operated on at the Clinic for Emergency Surgery. Mean age of patients was 48.26±16.80 years; 82.8% of patients were male. Road traffic accident was the leading cause of trauma, seen in 63 patients (90.0%). Primary repair was performed in 36 patients (51.4%), while damage control with perihepatic packing was done in 34 (48.6%). Complications related to the liver occurred in 14 patients (20.0%). Liver related mortality was 17.1%. Non-survivors had a significantly higher AAST grade (p=0.0001), higher aspartate aminotransferase level (p=0.01), lower hemoglobin level (p=0.0001), associated brain injury (p=0.0001), perioperative complications (p=0.001) and higher transfusion score (p=0.0001). The most common cause of mortality in the "early period" was uncontrolled bleeding, in the "late period" mortality was caused by sepsis and acute respiratory distress syndrome. Patients with high-grade liver trauma who present with hemorrhagic shock and associated severe injury should be managed operatively. Mortality from liver trauma is high for patients with higher AAST grade of injury, associated brain injury and massive transfusion score.

An interesting case report of vertebral artery dissection following polytrauma

Directory of Open Access Journals (Sweden)

Vikas Acharya

2016-01-01

Conclusion: Our report displays select images related to this case report and emphasizes the consideration of routine imaging in head and neck traumatic injuries to diagnose internal carotid and/or vertebral artery dissections much earlier.

Results of VGB research work with respect to operation of BWR pipes made of austenitic SS; Ergebnisse des VGB-Forschungsvorhabens zur Absicherung des Betriebsverhaltens austenitischer Staehle in SWR-Rohrleitungen

Energy Technology Data Exchange (ETDEWEB)

Kilian, R [Siemens AG Energieerzeugung KWU, Erlangen (Germany); Bruemmer, G [Hamburgische Electricitaets-Werke AG, Hamburg (Germany)

1998-11-01

von Formfehlern beim Schweissen (z.B. Kantenversatz, Quetschfalten); 4. Reduzierung der Zugeigenspannungen beim Schweissen; 5. Einhaltung der neuen VGB-Wasserchemie-Richtlinien. (orig./MM)

Vorschrift oder Thunfisch? – Zur Langzeitverfügbarkeit von Forschungsdaten

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Tim Hasler

2013-10-01

Full Text Available Ich mache ihm ein Angebot, das er nicht ablehnen kann.” Diese Aussage aus einem gänzlich anderen Kontext lässt sich recht treffend übertragen als Wunsch von Dienstleistern und Zweck von Dienstleistungen für Datenproduzenten im Forschungsdatenmanagement. Zwar wirkt Druck zur Datenübergabe nicht förderlich, die Eröffnung einer Option aber sehr wohl. Im vorliegenden Artikel geht es um das Verständnis der Nachhaltigkeit von Forschung und ihren Daten anhand der Erkenntnisse und Erfahrungen aus der ersten Phase des DFG-Projekts EWIG. [Fn 01] Eine Auswahl von Fallstricken beim Forschungsdatenmanagement wird anhand der Erkenntnisse aus Expertengesprächen und eigenen Erfahrungen beim Aufbau von LZA-Workflows vorgestellt. Erste Konzepte in EWIG zur Datenübertragung aus unterschiedlich strukturierten Datenquellen in die „Langfristige Domäne” werden beschrieben. "I'm gonna make him an offer he can't refuse". This quote from a completely different context can be aptly rendered as a statement of service providers as well as the purpose of services for data producers in the field of research data management. Although pressure is not the leverage of choice if you want researchers to deposit their research data in some kind of repository, offering an option does the trick quite well. In this article we present some of the concepts for sustainability of research and its data from the first phase the of the project EWIG, funded by the Deutsche Forschungsgemeinschaft. A selection of pitfalls in research data management is presented based on the findings from expert interviews and our own experiences in the construction of LTP workflows. First concepts in EWIG to transfer data from differently structured data sources into the "Permanent Domain" are described.

Gebändigtes Knallgas: Brennstoffzellen im mobilen und stationären Einsatz

Science.gov (United States)

Waidhas, Manfred; Landes, Harald

2001-07-01

Die Brennstoffzelle hat aus technischer Sicht einen hohen Stand erreicht. Die PEMFC konnte ihre Zuverlässigkeit in einer Reihe von Nischenanwendungen, aber auch in Form erster mobiler und dezentraler Prototypen beweisen. Die SOFC und die MCFC konnten bereits in Anlagen von 100 kW und mehr in Erprobung gehen. Um jedoch wirtschaftlich konkur-renzfähig zu den etablierten Technologien der mobilen und dezentralen Energiewandlung zu werden, muss noch eine drastische Kostenreduktion sowohl beim Brennstoffzellen-Stack als auch bei den zu seinem Betrieb notwendigen Hilfsaggregaten erreicht werden. Für Fahrzeugantriebe muss außerdem eine Antwort auf die noch offene Treibstofffrage (Infrastruktur, H2-Erzeugung und H2-Speicherung) gefunden werden.

Seismic methods for the characterisation of reservoirs in developing old natural gas fields in Germany; 3D Seismische Verfahren zur Reservoircharakterisierung bei der Entwicklung alter Erdoelfelder in Deutschland

Energy Technology Data Exchange (ETDEWEB)

Krajewski, P.; Stahl, E.; Bischoff, R. [Preussag Energie GmbH, Lingen (Germany); Guderian, K.; Hasse, G.; Schmiermann, I. [BEB Erdoel und Erdgas GmbH, Hannover (Germany); Groot, P. de [De Groot-Bril Earth Sciences BV, Enschede (Netherlands)

1998-12-31

Two examples are chosen to describe the possiblities and limitations of using 3D seismic data for the interpretation of structures and the seismic characterisation of reservoirs. New techniques of seismic classification offer a great deal of possibilities, especially if - as in the case of Ruehme - there is a sufficiency of data from many borehole locations which enables the training of algorithms.(orig.) [Deutsch] Anhand zweier Beispiele wurden die Moeglichkeiten aber auch die Grenzen des Einsatzes 3D seismischer Daten bei der strukturellen Interpretation und der seismischen Reservoircharakterisierung aufgezeigt. Neuartige Techniken der seismischen Klassifizierung erweitern die Moeglichkeiten dabei betraechtlich, insbesondere, wenn - wie beim Beispiel Ruehme - durch die vielen Bohrlokationen ausreichend Daten zum Trainieren der Algorithmen zur Verfuegung stehen. (orig.)

Una vez más: sobre el tratamiento jurídico-penal del hecho de conciencia

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Claus Roxin

2014-06-01

Full Text Available El presente escrito hace referencia a la discusión sobre las consecuencias del derecho fundamental a la libertad de conciencia en el derecho penal. En especial se analizan las diferentes posturas que existen en la doctrina sobre el tratamiento jurídico-penal de los hechos de conciencia: las posibilidades de justificación, de exculpación y de atenuación. Asimismo se presentan nuevos argumentos a favor de una posible exculpación por ausencia de necesidad preventiva de punición (Entschuldigung beim Fehlen einer präventiven Bestrafungsnotwendigkeit y se contrasta esta postura con las sustentadas por Jorge Figueiredo Dias y Wolfgang Frisch.

Rezension zu: Beate Hochholdinger-Reiterer: Kostümierung der Geschlechter. Schauspielkunst als Erfindung der Aufklärung. Göttingen: Wallstein Verlag 2014.

Directory of Open Access Journals (Sweden)

Claudia Daiber

2016-07-01

Full Text Available Von geschlechtlichen Einlagerungen in Sprache und deren Funktionen beim Schreiben der Theatergeschichte der deutschsprachigen Aufklärung handelt die von Beate Hochholdinger-Reiterer vorgelegte Habilitationsschrift. Die von ihr aufgedeckten sprachlichen Codes, die als ‚heimliche Archive‘ fungieren, werden auf die durch sie vermittelte symbolische Ordnung der Geschlechter hin analysiert. Prozesse der Literarisierung, Institutionalisierung und Subventionierung führten in dieser Epoche zur Etablierung des ‚einen‘ Theaters. Diese Prozesse verhandelten jedoch gleichermaßen Fragen des Nationalstaates und der Geschlechterordnung mit und konstruierten hinsichtlich letzterer eine ‚patrilineare Genealogie‘, die ‚andere‘ Diskurse mit ‚anderen‘ Ordnungen, die es in den Umbrüchen nachweislich auch gab, stimmlos gelassen haben.

Superiority of the practical method to theory: Diagnose of service life of ropes in overhead transmission grids; Praktische Methode der Theorie ueberlegen: Diagnose der Lebensdauer von Freileitungsseilen

Energy Technology Data Exchange (ETDEWEB)

Brueckner, W.F.

2005-02-07

In designing overhead transmission lines, cable tension is of prior importance. High tension means shorter life unless vibration dampers are installed. On the other hand, higher tension will reduce the overall cost to an optimum level. The author presents experience and measured vibration sensitivities. (orig.) [German] Beim Entwurf von Freileitungen ist die Zugspannung der Seile von besonderer Bedeutung. Erhoehte Seilzugspannungen verringern die Lebensdauer der Seile, soweit die Schwingungsgefahr nicht durch geeignete Schwingungsdaempfer vermieden wird. Mit erhoehter Seilzugspannung verringern sich auch die Kosten der gesamten Freileitung bis zur optimalen Grenze, die von den Kosten je km fuer verschiedene Spannweiten zu bestimmen ist. Der Verfasser beschreibt Erfahrungen ueber die gemessene Schwingungsgefaehrdung der Seile. (orig.)

Quantitative information literacy: Designing an online course at the interface between information literacy and statistical literacy

Directory of Open Access Journals (Sweden)

Christina Kläre

2017-04-01

Während sich die Informationskompetenzunterstützung in unterschiedlichen Dienstleistungsausprägungen in Bibliotheken etabliert hat, spielt das Komplement Statistikkompetenz dort höchstens eine untergeordnete Rolle. Der Aufsatz erläutert die Erstellung des Online-Selbstlernkurses „Daten und Statistiken recherchieren und nutzen“ an der Universitätsbibliothek Duisburg-Essen und zeigt, wie ein solcher Onlinekurs eine Brücke zwischen den beiden Kompetenzen und insbesondere den Auskunftsdiensten der Bibliothek und der statistischen Methodenlehre schlagen kann. Der Aufsatz berücksichtigt vor allem die Anwendersicht unter Bezug auf die didaktischen Analysen und Entscheidungen beim Design des an Subject Guides/Forschungsführern orientierten Moodle-Kurses für die Zielgruppe Studierende der Wirtschafts-, Sozial- und Politikwissenschaften.

Focal lesions in whole-body MRI in multiple myeloma. Quantification of tumor mass and correlation with disease-related parameters and prognosis; Fokale Laesionen in der Ganzkoerper-MRT beim multiplen Myelom. Quantifizierung der Tumorlast und Korrelation mit krankheitstypischen Parametern und Prognose

Energy Technology Data Exchange (ETDEWEB)

Brandelik, S.C.; Kauczor, H.U. [Universitaetsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Krzykalla, J.; Hielscher, T. [Deutsches Krebsforschungszentrum (dkfz), Biostatistik, Heidelberg (Germany); Hillengass, J. [Universitaetsklinikum Heidelberg, Haematologie und Onkologie, Heidelberg (Germany); Kloth, J.K. [Radiologie Loebau, Loebau (Germany); Weber, M.A. [Universitaetsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsmedizin Rostock, Diagnostische und Interventionelle Radiologie, Rostock (Germany)

2018-01-15

In this study, we evaluated methods of quantification of tumor mass in whole-body MRI (wb-MRI) in multiple myeloma and correlated these with disease-related parameters in serum and bone marrow. We retrospectively evaluated wb-MRIs of 52 patients with focal infiltration pattern and a total of 700 focal lesions (subsequently called lesions). We determined the longest diameter (LD), the segmented volume (SV), and the morphology (spherical or non-spherical). We correlated total number/volume of the lesions with clinical parameters and prognosis and furthermore LD with SV. After that we analyzed the agreement of SV and estimated volume (EV) using the volume formula of a sphere based on LD. Results showed no significant correlations of total number/volume with prognosis or clinical parameters. The latter were situated predominantly in the normal range. Furthermore, 10% of lesions were spherical. SV and LD correlated significantly in single lesions and on patient level. SV was in lesions <6 cm{sup 3} systematically larger and in lesions ≥6 cm{sup 3} smaller than EV. In 95%, we found in small lesions a deviation of EV versus SV from +0.9 cm{sup 3} to -4.6 cm{sup 3} and in large lesions from +160 cm{sup 3} to -111 cm{sup 3} (EV-SV). Quantification of tumor mass in the focal infiltration pattern is performed more accurately by volumetry than LD due to the predominant existence of non-spherical lesions. The patient cohort with clinical parameters predominantly in the normal range is distributed to ISS stage I and partly pretreated, a fact that makes interpretation of absent correlations more difficult. Consider also a variation in activity of lesions and a diffuse infiltration not detectable by MRI. (orig.) [German] In dieser Studie wurden Methoden der Tumorlastquantifizierung in der Ganzkoerper-Magnetresonanztomographie (GK-MRT) beim Multiplen Myelom untersucht und mit krankheitstypischen Parametern in Serum und Knochenmark korreliert. Die GK-MRT von 52 Patienten mit

A surgical approach in the management of mucormycosis in a trauma patient.

Science.gov (United States)

Zahoor, B A; Piercey, J E; Wall, D R; Tetsworth, K D

2016-11-01

Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach. This prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. Anti-fungal therapy should be used secondarily as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

Die kognitiv-metaphorische Motiviertheit beim Erlernen von Idiomen am Beispiel eines Aufgabenblattes

Directory of Open Access Journals (Sweden)

Kispál, Tamás

2011-01-01

Full Text Available The cognitive metaphorical motivation of idioms is one of the most treated subjects in English-language articles about teaching of idioms. In German-language phraseodidactic literature it is a rather rare phenomenon. The metaphorical motivation of several idiomatic expressions is undoubted. In this article we argue for their cognitive metaphorical motivation. It is hypothesized that the joint representation of several typical context examples, with idioms of the same conceptual metaphor, not only promotes the recognition and understanding of idioms but also the detection of cognitive metaphorical motivation of idioms. Context-sensitive tasks make a significant contribution to uncovering and learning the metaphorical idioms for learners of German as a foreign language. The learning-enhancing role of this method for the acquisition of idioms and their meanings are to be illustrated with the example of the conceptual metaphor life is a journey, the metaphorical idioms based on this conceptual metaphor, and an example worksheet.

Knee and ankle injuries from playing football; Knie- und Sprunggelenkverletzungen beim Fussballspiel

Energy Technology Data Exchange (ETDEWEB)

Kramer, J.; Scheurecker, G. [Roentgeninstitut am Schillerpark, Linz (Austria)

2010-05-15

Soccer is the most common sport activity worldwide. Over the last two decades the increase in soccer players has mainly been due to increased interest by females. In general, soccer is a relatively safe sport activity, especially if minor injuries resulting in short periods of absence from playing or training are neglected. However, due to the high number of soccer players severe injuries are also frequent. These are a problem not only for the injured player and the team but may also become problematic for the socio-economic system. In up to 80-90% structures of the lower extremities are injured. For sufficient radiological diagnosis knowledge of the biomechanics of the soccer game and some details about the history of the injury may be of help. To prevent soccer injuries or keep the degree of injury low, special programs had been developed. (orig.) [German] Fussball ist die weltweit am meisten verbreitete Sportart. Der Zuwachs an Fussballspieler(innen) in den letzten beiden Jahrzehnten wird jedoch hauptsaechlich auf das verstaerkte Interesse an weiblichen Spielern zurueckgefuehrt. Das Fussballspiel gilt grundsaetzlich, insbesondere wenn man geringfuegige Verletzungen, die keine therapeutischen Massnahmen notwendig machen, sondern lediglich eine kurzfristige Trainings- oder Spielpause bedingen, als eine relativ sichere Sportart. Auf Grund der Vielzahl an SpielerInnen kommt es allerdings doch zu einer betraechtlichen Anzahl durchaus sehr schwerer Verletzungen. Diese Tatsache stellt ein Problem fuer Spieler und Team dar und mag moeglicherweise auch fuer das soziooekonomische System problematisch werden. Von Verletzungen sind v. a. auf Grund der Natur des Spieles die unteren Extremitaeten betroffen. Zur Durchfuehrung einer suffizienten radiologischen Diagnostik sind Kenntnisse der moeglichen Verletzungsmechanismen und eine Anamneseerhebung von nicht zu unterschaetzendem Wert. Um jedoch derartige Laesionen zu vermeiden bzw. gering zu halten, wurde ueber die Jahre hinweg immer mehr Wert auf Praevention gelegt. (orig.)

Einsatzverhalten genuteter CBN-Schleifscheiben mit keramischer Bindung beim Außenrund-Einstechschleifen

OpenAIRE

Kirchgatter, Mathias

2010-01-01

Industrielle Schleifprozesse für Bauteile aus gehärteten Stahlwerkstoffen werden vermehrt mit keramisch gebundenen CBN-Schleifscheiben durchgeführt, die sich bei vielen Anwendungen aufgrund ihres Eigenschaftsprofils und der erweiterten Einstellbarkeit der Bindungsspezifikationen gegenüber anderen Schleifwerkzeugtypen durchsetzen. Der Optimierungsdruck der Großserien- und Massenfertigungsprozesse hat bereits zu einer beachtlichen Entwicklung hinsichtlich der Leistungsfähigkeit dieses Werkzeugt...

Safety relief valve instabilities; Instabiles Verhalten beim Betrieb von direkt belasteten Sicherheitsventilen

Energy Technology Data Exchange (ETDEWEB)

Neuhaus, Thorsten; Bloemeling, Frank; Jung, Andreas; Schaffrath, Andreas [TUeV NORD SysTec GmbH und Co. KG, Hamburg (Germany)

2012-11-01

The opening and closing of safety relief valves induce pressure vibrations and respective loads on the piping system. The quantification of the internal pressure load and the pipe segment forces for the proof of the structural integrity of the piping system and the supports is performed using the code DYVRO. It is not clear whether the calculated result of high-frequent opening and closing shows a realistic behavior or is caused by a simplified modeling. The contribution offers strategic recommendations to avoid unrealistic calculations.

Radiation exposure on flights; Strahlenexposition beim Fliegen. Ein Fall fuer den Strahlenschutz

Energy Technology Data Exchange (ETDEWEB)

Blettner, Maria [Mainz Univ. (Germany). Inst. fuer Medizinische Biometrie, Epidemiologie und Informatik (IMBEI); Boehm, Theresia; Eberbach, Frieder [Vereinigung Cockpit e.V. Main Airport Center (MAC), Frankfurt (Germany). AG Strahlenschutz; Bottollier-Depois, Jean-Francois [Institut de Radioprotection et de Surete Nucleaire (IRSN), Fontenay-aux-Roses (France); Clairand, Isabelle; Huet, Christelle [Institut de Radioprotection et de Surete Nucleaire (IRSN), Fontenay-aux-Roses (France). Ionizing Radiation Dosimetry Lab.; Frasch, Gerhard [Bundesamt fuer Strahlenschutz, Oberschleissheim/Neuherberg (Germany). Beruflicher Strahlenschutz und Strahlenschutzregister; Hammer, Ga el P. [Laboratoire National de Sante E.P., Dudelange (Luxembourg). Registre Morphologique des Tumeurs; Mares, Vladimir; Ruehm, Werner [Helmholtz Zentrum Muenchen Deutsches Forschungszentrum fuer Gesundheit und Umwelt GmbH, Neuherberg (Germany); Voelkle, Hansruedi [Fribourg Univ. (Switzerland). Physikdept.

2014-09-01

Extend and effects of radiation doses occuring during flights are treated under various aspects. Part of them are, in the first line, radiation exposure of the flying staff and the results of epidemiologic studies regarding the health consequences, as well as aspects of practical radiation protection for the flying staff. Computer programs for dose calculation on flights round off the theme. (orig.)

Schweißbereichsdiagramme Instrumente zur Qualitätssicherung beim Widerstandspunktschweißen

DEFF Research Database (Denmark)

Weber, G.; Widmer, R.; Rasmussen, Mogens Hørslev

2001-01-01

and electrode force, the influence of the sheet material, of the welding current form and of the electrode cape shape is examined. By the example of a medium frequency inverter welding gun, an optimization of the welding parameters of welding current, welding time and electrode force with three...

Multi-parametric MR imaging for prostate carcinoma; Multiparametrische MR-Bildgebung beim Prostatakarzinom

Energy Technology Data Exchange (ETDEWEB)

Schlemmer, Heinz-Peter [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Abt. Radiologie

2017-03-15

Multi-parametric NMR imaging in case of prostate carcinoma can improve diagnostics, allows reliable prognostic estimations and helps to find the optimum individual therapy. The contribution is focused to deliver the needed methodological tools and background knowledge for the daily routine.

Radiotherapy and radiooncology: An interdisciplinary approach. 4. tot. new rev. and enl. ed.; Strahlentherapie und Radioonkologie aus interdisziplinaerer Sicht

Energy Technology Data Exchange (ETDEWEB)

Karstens, J.H.; Bremer, M.; Meyer, A.; Warszawski, A.; Bruns, F. (eds.) [Medizinische Hochschule Hannover (Germany). Abt. fuer Strahlentherapie und Spezielle Onkologie

2005-07-01

This is the 4th, completely revised edition of the successful book on modern cancer therapy. The focus of this edition is on interdisciplinary cooperation. Current knowledge, both legal and medical, is presented in a clear and well-structured form. The text is supplemented by many illustrative drawings and pictures. The book addresses students and other readers interested in oncology and provides useful and detailed information on radiation therapy of benign and malignant diseases. (orig.)

Inflammatory bowel diseases (IBD) - critical discussion of etiology, pathogenesis, diagnostics, and therapy; Chronisch entzuendliche Darmerkrankungen - Kritische Diskussion von Aetiologie, Pathogenese, Diagnostik und Therapie

Energy Technology Data Exchange (ETDEWEB)

Ochsenkuehn, T.; Sackmann, M.; Goeke, B. [Medizinische Klinik II, Klinikum der Universitaet Muenchen-Grosshadern (Germany)

2003-01-01

rather be adapted to the patient's individual inflammatory pattern than be oriented to schematic treatment rules.New endoscopic and radiologic techniques provide the necessary diagnostic tools. (orig.) [German] Zielsetzung Die chronisch entzuendlichen Darmerkrankungen (CED) Morbus Crohn und Colitis ulcerosa befallen ca. jeden 500.Menschen. Obwohl sich, angetrieben durch therapeutische Erfolge der Zytokinforschung, immer mehr medizinische Einrichtungen mit Fragestellungen rund um die CED beschaeftigen, stellen diese Erkrankungen fuer Patient und Arzt immer noch eine lebenslange Herausforderung dar.Die enge interdisziplinaere Zusammenarbeit zwischen Gastroenterologie, Radiologie und Chirurgie ist entscheidend fuer ein effizientes Diagnose- und Therapiekonzept, dessen Grundlagen wir in unserer Uebersichtsarbeit erlaeutern wollen.Methodik Aus der Sicht des den Patienten betreuenden Gastroenterologen werden, basierend auf aktuellen Publikationen und Erfahrungswerten einer CED-Klinik, Aspekte aus Aetiologie,Pathogenese,Diagnostik und Therapie der CED dargestellt.Ergebnisse Eine genetisch beeinflusste, ueberschiessende und anhaltende Immunreaktion gegen die eigene Darmflora scheint eine der wichtigsten Ursachen dieser Erkrankungen zu sein.Auch Umwelteinfluesse sind von Belang.So wurde z.B.lange Zeit der Einfluss des Zigarettenrauchens beim Morbus Crohn als unguenstig eingeschaetzt, nun zeigt sich sogar, dass Rauchen einen eindeutigen Risikofaktor in Genese und Unterhaltung dieser Erkrankung darstellt.Da die CED und insbesondere der Morbus Crohn als systemische Erkrankungen betrachtet werden muessen, setzen therapeutische Ueberlegungen eine genaue Kenntnis des Organbefalls voraus.So kann z.B.durch den Einsatz der MRT-Enteroklysmatechnik eine strahlungsarme Untersuchung derjenigen Teile des Verdauungstrakts erreicht werden, die bisher einer routinemaessigen Inspektion nicht zugaenglich waren,wie z.B.das untere Jejunum und das obere Ileum. Therapeutisch scheint es zu einem

Research Advances In Medical Care For Polytrauma Injuries And Blast Injuries

Science.gov (United States)

2011-01-25

instead it uses a thin, hot ceramic membrane that has a voltage applied to it. It is insensitive to environmental conditions. Benefits The...Ceramic Oxygen Generator uses a metal reinforced composite, thin-film ceramic membrane to generate oxygen. Producing 1 liter of oxygen requires 30

The high-risk polytrauma patient and inferior vena cava filter use.

Science.gov (United States)

Berber, Onur; Vasireddy, Aswin; Nzeako, Obi; Tavakkolizadeh, Adel

2017-07-01

The aim of this study was to assess the impact on practice of vena cava filter insertion guidelines (Eastern Association for the Surgery of Trauma: practice management guidelines). The study was performed at a level 1 trauma centre with data from the 'Trauma Audit and Research Network' cross-referenced to hospital data. A total of 1138 specific 'high-risk' major trauma patients were identified over a 6-year period. The mean age was 46 years (18-102) and the male to female ratio was 3.3:1. The average Injury Severity Score was 23.6 (4-75). The overall DVT rate was 2.6% and the PE rate was 1.8%. A retrievable IVC filter was inserted in 42 cases (3.8%). The filter retrieval rate was 23.8% at a mean of 68.5days (4-107). Only one complication was reported of a breakthrough PE despite filter. Applying the EAST guidelines to this cohort would have suggested filter insertion in 279 (24.6%) cases. The kappa concordance value between observed practice and the 'EAST filter group' was 0.103 (poor). The PE rate in the 'EAST filter group' was 2.2% vs 1.6% in the 'no filter group' (p=0.601, no statistical difference) and the observed odds ratio was 0.814 (95% CI 0.413, 1.602). The EAST guidelines are useful but may be overestimating the need for filter insertion. Copyright © 2017 Elsevier Ltd. All rights reserved.

Shock index as a mortality predictor in patients with acute polytrauma

Institute of Scientific and Technical Information of China (English)

Kevin Fernando Montoya; Jos Daniel Charry; Juan Sebastin Calle-Toro; Luis Ramiro Niez; Gustavo Poveda

2015-01-01

Objective: To evaluate whether the shock index (SI), given by the formula SI = heart rate /systolic blood pressure (HR / SBP), is useful for predicting mortality at 24 h in trauma patients admitted to the emergency department of a university hospital in Colombia. Methods: A database of trauma patients admitted between January 2013 and December 2013 was constructed; the result according to the shock index was determined, generating a dichotomous variable with two groups: Group A (SI 0.9). Univariate analysis was performed. Results: A total of 666 patients were analyzed, 83.3% (555) had SI 0.9. The mean age for Groups A and B was 32.4 and 35.4 respectively. The average injury severity score for both groups was 9.6 and 17.6 respectively. Mortality at 24 h after injury for both groups was 3.1% (P = 0.032) and 59.5% (P = 0.027) respectively. Conclusions: An initial shock index greater than 0.9 implies a worse prognosis 24 h after injury. The shock index predicts mortality in multiple trauma patients in the emergency department, and is also a quick and applicable in all hospital.

New opportunities to measure pressures inside combustion engine without having separate drilling for the pressure-sensors; Neue Moeglichkeiten der Druckindizierung in Verbrennungsmotoren ohne separate Messbohrung

Energy Technology Data Exchange (ETDEWEB)

Brechbuehl, S.; Schnepf, M.; Sonntag, R.; Wolfer, P. [Kistler Instrumente AG, Winterthur (Switzerland)

2000-07-01

beim Ottomotor, bzw. Gluehbirne beim Dieselmotor installiert werden koennen, hat in den letzten Jahren an Bedeutung zugenommen. Wegen des geringen Platzangebotes zur Unterbringung des Drucksensors in Messzuendkerzen und Gluehkerzenadaptern stellen heutige Ausfuehrungen immer einen Kompromiss dar zwischen Signalguete, Montagefreundlichkeit, sowie der Aufrechterhaltung der Originalfunktionalitaet. So musste bei der Druckmessung mit Gluehkerzenadaptern in Dieselmotoren bisher auf die Gluehfunktion gaenzlich verzichtet werden. In der vorliegenden Arbeit wurde ein neu entwickelter Gluehkerzenadapter vorgestellt, in welchem neben einem piezoelektrischen Drucksensor auch eine Gluehwendel mit voller Heizleistung integriert ist. Mit dieser Messgluehkerze sind jetzt Druckmessungen beim Kaltstart und waehrend des Nachgluehbetriebs unter realen Betriebsbedingungen moeglich. Bei der Druckmessung mit Messzuendkerzen in Ottomotoren musste bisher zur Erzielung einer guten Signalqualitaet eine exzentrische Lage der Mittelelektrode in Kauf genommen werden. In der vorliegenden Arbeit wurde ein neu entwickelter Zuendkerzenadapter mit zentrischer Mittelelektrode vorgestellt. Diese Betriebs-Messzuendkerze ermoeglicht eine Zylinderdruckmessung mit guter Signalqualitaet bei unveraenderter Funkenlage. Durch die zentrische Keramik wird das Aufsetzen des Originalzuendrails wesentlich erleichtert. Das Herz beider Neuentwicklungen ist eine Miniatur-Sensorik, welche mit neuen Kristallen eine hoehere Empfindlichkeit und Temperaturstabilitaet aufweist. (orig.)

Surveillance of anal carcinoma after radiochemotherapy. A retrospective analysis of 80 patients

Energy Technology Data Exchange (ETDEWEB)

Sauter, Matthias; Vavricka, Stephan R. [Triemli Hospital, Department of Medicine, Division of Gastroenterology, Zurich (Switzerland); University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich (Switzerland); Keilholz, Georg; Kranzbuehler, Helmut; Lombriser, Norbert [Triemli Hospital, Division of Radiation-Oncology, Zurich (Switzerland); Heinrich, Henriette; Misselwitz, Benjamin [University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich (Switzerland); Winder, Thomas [University Hospital Zurich, Department of Oncology, Zurich (Switzerland)

2017-08-15

Surveillance after radiochemotherapy of anal carcinoma (ACa) with curative intent is recommended in guidelines, but data regarding the effectiveness of follow-up are lacking. We aimed to assess the performance of an ACa surveillance program in a real-life setting. We retrospectively summarized clinical history, physical findings, and follow-up investigations (endoanal ultrasound, endoscopy, CT scan) obtained during 42 months (±27 months) from 80 patients after radiochemotherapy of ACa. In 7/80 cases (8.8%) an incomplete response to therapy was identified at or before the 6-month time point after the end of treatment; 4 of the 7 cases were identified during scheduled follow-up. In 6 cases (7.5%), recurrent disease was found after the 6-month time point. Recurrence was systemic in 5 cases and local/inguinal in 1 case. In 3 of the 6 cases (50%), recurrence was identified during scheduled follow-up. In one asymptomatic patient, a single liver metastasis was detected during scheduled follow-up and the patient remains free of disease 19 months after surgery. Surveillance resulted in a high rate of false-positive findings (70 findings in 604 investigations), of which only 14 could be confirmed. Scheduled follow-up after treatment of ACa detected recurrent disease at systemic sites, enabling potentially curative treatment in a single case. Effectiveness of abdominal imaging during follow-up after ACa treatment should be tested in a prospective trial. (orig.) [German] Nach kurativ intendierter kombinierter Radiochemotherapie beim Analkarzinom (ACa) wird von den Guidelines eine Nachsorge empfohlen, die Datenlage hierzu ist jedoch mangelhaft. Ziel unserer Studie war es, die Wertigkeit der Nachsorge beim ACa in einem ''Real-life''-Setting zu evaluieren. Es erfolgte die retrospektive Aufarbeitung der Nachsorge inklusive Anamnese, klinischer Untersuchung und Nachsorgeuntersuchungen (untere Endosonographie, Endoskopie, Computertomographie Abdomen

Seed loss in prostate brachytherapy. Operator dependency and impact on dosimetry

Energy Technology Data Exchange (ETDEWEB)

El-Bared, Nancy; Sebbag, Natanel; Beliveau-Nadeau, Dominic; Hervieux, Yannick; Larouche, Renee; Taussky, Daniel; Delouya, Guila [Centre hospitalier de l' Universite de Montreal - Hopital Notre-Dame, Departement de Radio-Oncologie, Montreal, QC (Canada)

2016-05-15

Seed verloren: 20% der Implantate beim erfahrenen Arzt und 17,2 % beim weniger erfahrenen Arzt (p = 0,4). Eine Migration zum Thorax wurde in 5,9% nachgewiesen (6,9 vs. 2,2 %; p = 0,004). Die durchschnittliche Seed-Verlustrate war 0,57% [Standardabweichung (SD) 1,39] und der Prozentsatz an abgegangenen Seeds pro implantierten Seeds 0,14% (SD 0,65). Der erfahrenere Arzt hatte im Vergleich zum weniger erfahrenen Arzt einen hoeheren Prozentsatz abgegangener Seeds (0,36% vs. 0,25%; p = 0,055) sowie von Seeds im Thorax (0,1% vs. 0,02%; p < 0,001). Beim Verlust von mindestens einem Seed wurde eine Reduktion der D90 um 4,2 Gy (p < 0,001) und der V150 um 3,5% (p = 0,002) festgestellt. Ein Seed-Abgang senkt V150 und D90 signifikant. Ob ein Seed-Abgang nachgewiesen werden kann, haengt vom behandelnden Arzt ab. (orig.)

Metallurgical phenomena in laser finishing: Interdependences between solidification morphologies and hot cracking in laser welding of mostly austenitic materials. Final reportc; Metallkundliche Phaenomene der Laserstrahlmaterialbearbeitung. Teilvorhaben: Zusammenhaenge zwischen Erstarrungsmorphologien und Heissrissentstehung beim Laserschweissen von vornehmlich austenitischen Werkstoffen. Abschlussbericht

Energy Technology Data Exchange (ETDEWEB)

Schobbert, H.

2000-06-01

be performed by using measuring results of this newly developed test assembly. For the first time, different types of hot cracks in correlation to the change of primary solidification mode could be detected. The primary austenitic weld metals of the materials 1.4828 and 1.4306, which formed due to the change of solidification mode, showed a susceptibility to DDC. The results of this research project are a contribution to quantify the change of solidification mode and thus, the restriction of hot cracking resistance of the tested materials. (orig.) [German] Als ein spezifisches Problem des Laserschweissens stellt sich bei den wirtschaftliche wuenschenswerten hohen Schweissgeschwindigkeiten jedoch heraus, dass besonders austenitische Staehle mit einer Zusammensetzung in der Naehe der eutektischen Rinne ihren Erstarrungsmodus aendern und damit die Heissrisssicherheit eingeschraenkt sein kann. Vor diesem Hintergrund sind in der Forschungsarbeit die beim Laserschweissen entstehenden Erstarrungsmorphologien dieser Staehle in der Naehe der eutektischen Rinne besonders unter dem Aspekt kurzeitmetallurgisch bedingter kinetischer Effekte unter den Bedingungen einer schneller Erstarrung untersucht worden. Fuer drei im praktischen Einsatz weit verbreitete nichtrostende Staehle (1.4828, 1.4306 und 1.4404) wird ein von der Erstarrungsgeschwindigkeit abhaengiger Wechsel des primaeren Erstarrungsmodus von primaer ferritsch zu primaer austenitisch nachgewiesen. Die kritische Erstarrungsgeschwindigkeit kann in guter Naeherung mit einem neu entwickelten Modell durch eine geometrische Analyse der Erstarrungsstrukturen ermittelt werden. Die von der Zusammensetzung der Werkstoffe abhaengige kritische Erstarrungsgeschwindigkeit fuer den Wechsel der Primaererstarrung betraegt fuer diese Werkstoffe groessenordnungsmaessig etwa 1 m/min. Als ein wesentliches Ergebnis wird fuer die zu primaer austenitisch gewechselten Erstarrungsmorphologien die zunaechst vermutete Beeintraechtigung der

Efficient turbine control. Advantages through controlling internal turbine power in place of turbo generator output; Effektive Turbinenregelung. Vorteile durch die Regelung der inneren Turbinenleistung anstelle der Turbogeneratorleistung

Energy Technology Data Exchange (ETDEWEB)

Sindelar, R.

1999-07-01

Hitherto, the electrical output of turbo generators has generally been controlled by means of power output controllers. Load changes caused, for example, by changeovers to isolated unit operation where the load requirements are unknown at first, often resulted in `wrong way control` effects that sometimes even caused entire turbine generator sets to fail. Controlling the internal turbine power makes it possible to avoid such consequences. (orig.) [Deutsch] Die elektrische Leistung eines Turbogenerators wurde bislang durch Leistungsregler geregelt. Im Falle einer Lastaenderung, wie sie beispielsweise beim Uebergang in den Betrieb auf ein Teilnetz (Insel-) mit vorher unbekannter Last vorkommt, trat ein Falschregeleffekt auf. Auf diesen wurden bereits Turbosatzausfaelle zurueckgefuehrt. Wird anstelle der elektrischen Leistung allerdings die innere Turbinenleistung geregelt, so tritt der Falschregeleffekt nicht ein. (orig.)

Extraprostatische Expansion des Prostatakarzinoms und seine Beziehung zu den Resektionsrändern bei der radikalen Prostatektomie aus Sicht des Pathologen

Directory of Open Access Journals (Sweden)

Noll P

2008-01-01

Full Text Available Das Prostatakarzinom stellt heute in der westlichen Welt das am häufigsten diagnostizierte Karzinom beim Mann dar. Entsprechend dieser Häufigkeit werden zunehmend radikale Prostatektomien durchgeführt. Die histologische Aufarbeitung des Operationspräparates liefert dem Urologen die wichtigsten Prognosefaktoren des Prostatakarzinoms. Hierbei besteht ein enger Zusammenhang zwischen der extraprostatischen Ausdehnung des Tumors und seiner Beziehung zu den Resektionsrändern. Anhand einer eigenen Untersuchung an 200 radikal operierten Prostatakarzinomen konnte gezeigt werden, dass hierbei die Lokalisation, der Malignitätsgrad und die Größe des Tumors entscheidende Bedeutung haben. Die Ermittlung dieser Parameter ist abhängig von einer standardisierten Untersuchungstechnik auf der Grundlage einer vollständigen histologischen Aufarbeitung der Prostata.

Measurements of the beam background in ALEPH

CERN Document Server

Lutters, Gerd Rudolf

2001-01-01

Die vorliegende Arbeit fa t die in den Jahren gewonnenen Erkenntnisse uber strahl induzierten Untergrund in dem ALEPHExperimentdetektor des LEPSpeicherringes GeV Strahlenergie zusammen Die selbstentwickelte AnkunftszeitAnalysetechnik erlaubt aufgrund der Daten des eigens entwickelten SAMBA Untergrundmonitors eine Prognose der Strahluntergrund raten beim Betrieb des LEPIISpeicherringes GeV Strahlenergie mit verdoppelter Schwer punktsenergie Am LEPISpeicherring ist die maximale Luminositat nicht durch die Parameter der Lumino sitatsbeziehung sondern durch die maximal vertraglichen Dunkelstrome in den Spurdetektoren und damit durch die Strahluntergrundraten begrenzt Die Strahluntergrundrate deren dominie render Beitrag Synchrotronstrahlung in den Quadrupolen der Experimentzone ist erhoht sich linear mit dem Strahlstrom Die Synchrotronstrahlung wird in LEP durch Kollimatoren abgeblen det so da neben direkten Photonen an den Kollimatoren oder strahlabwarts liegenden Elemen ten der Vakuumkammer comptongestreute Pho...

Ecological construction methods are energy saving construction methods - experiences with the low-energy standard; Oekologisches Bauen ist energiesparendes Bauen - Erfahrungen mit dem Niedrigenergiestandard

Energy Technology Data Exchange (ETDEWEB)

Feist, W. [Inst. Wohnen und Umwelt, Darmstadt (Germany)

1995-09-01

Efficient energy utilisation (intelligent energy saving techniques) is characterised by the following features. When realised in new buildings using currently available techniques it can help save up to 90% of what has hitherto been considered normal energy consumption. It becomes economically efficient for reductions in energy consumption of 50% or more. In terms of cost it outcompetes all non-fossil energy carriers (i.e., excluding oil, natural gas, and coal) of the future. (orig./HW) [Deutsch] Die rationelle Energienutzung (`intelligente Einspartechnik`) - kann mit heute verfuegbarer Technik beim Neubau bis ca. 90% der bisher verwendeten Energie einsparen helfen; - ist bei Energieeinsparungen von ueber 50% bereits heute wirtschaftlich vertretbar; - ist gegenueber allen Zukunftsenergietraegern, die nicht auf fossilen Brennstoffen (also Oel, Erdgas und Kohle) basieren, konkurrenzlos kostenguenstig. (orig./HW)

Zur didaktischen Konzeption von «Sozialen Lernplattformen» für das Lernen in Gemeinschaften

Directory of Open Access Journals (Sweden)

Michael Kerres

2011-12-01

Full Text Available Mit der aktuellen Diskussion über Web 2.0 stellt sich die Frage nach der Zukunft von traditionellen Lernplattformen. Der Beitrag stellt verschiedene Entwicklungsoptionen vor und beschreibt die Perspektiven «sozialer Lernplattformen». Bei diesen stehen die Aktivitäten der Akteure und ihre Interaktion im Vordergrund und nicht Dokumente und Lernmaterialien. Sie sind durchlässig für Informationen aus dem und in das Internet, woraus sich unterschiedliche Optionen für die Privatheit von Informationen ergeben. Schliesslich unterstützen sie die Zusammenarbeit, die Entwicklung von Bekanntschaften und den Aufbau sozialer Gruppen. Dabei stellt sich die Frage, wie diese sozialen Strukturen auf einer Plattform zu konzipieren sind, um Gemeinschaftsbildung beim Lernen zu fördern.

Optimal matching of energy supply and demand; Optimale Anpassung der Energiebereitstellung an den Bedarf

Energy Technology Data Exchange (ETDEWEB)

Baumgarth, S. [Competence Center for Building Networks in Wolfenbuettel (Germany); Boggasch, E.; Heiser, M.; Schernus, G.P. [Fachhochschule Braunschweig/Wolfenbuettel (Germany)

2004-06-01

New strategies are presented for matching heat supply and demand on the basis of a bus technology. Investment costs are at a minimum as the automation stations are activated by introducing new programs. (orig.) [German] Seit einiger Zeit wird ueber verschiedene Regelungsstrategien versucht, die Energiebereitstellung so an den Bedarf (Verbraucher) anzupassen, dass die Waermeverluste beim Transport auf den Zuleitungen sowie in der Energiezentrale minimiert werden. Fuer mehrere Anwendungen aus dem Bereich der Heizungs-, Lueftungs- und Klimatechnik sollen hier neue Strategien vorgestellt werden, die erst mit dem Einsatz der Bus-Technologien in der Gebaeudeautomation moeglich sind. Fuer die Betrachtungen ist es auch von Wichtigkeit, dass zu deren Umsetzung moeglichst keine zusaetzlichen Investitionskosten erforderlich sind, sondern dass die in den Automationsstationen durch Einfuegen neuer Programme zu aktivieren sind. (orig.)

Intelligent buildings. Living and working in a high-tech building; Das intelligente Haus. Wohnen und Arbeiten mit zukunftsweisender Technik

Energy Technology Data Exchange (ETDEWEB)

Traenkler, H.R. [Universitaet der Bundeswehr Muenchen (Germany). Inst. fuer Sensoren und Messsysteme; Schneider, F. [Technische Univ. Muenchen (Germany). Lehrstuhl fuer Messsystem- und Sensortechnik

2001-07-01

Intelligent buildings (smart home, home automation, intelligent living) are characterised by technical facilities with high comfort, flexible use of rooms, central and decentralised control, communication options, environmental compatibility, low energy cost and low operating cost. This book discusses technologies, components, subsystems and general aspects of smart homes. Sensors and sensor systems are discussed in particular as they are key components. Target groups of the publication are planning authorities, architects and constructional engineers, component producers, suppliers, tradesmen and private builder-owners. [German] Die interdisziplinaere Thematik des Intelligenten Hauses bzw. der Intelligenten Hausinstrumentarisierung (Smart Home, Home Automation, Intelligent Living) gewinnt zunehmend an Interesse. Waehrend die konventionelle Elektroinstallation im privaten Haus seit Jahrzehnten lediglich auf die Verteilung und das Schalten der elektrischen Energie ausgerichtet war, haben sich die Anforderungen an eine moderne Haustechnik hinsichtlich Komfort, Moeglichkeiten flexibler Raumnutzungen, zentraler und dezentraler Steuerungen, Kommunikationsmoeglichkeiten, Umweltvertraeglichkeit sowie Energie- und Betriebskostenminimierung geaendert und erweitert.Das vorliegende Werk behandelt Technologien, Komponenten, Subsysteme und Gesamtsystemaspekte fuer das intelligente Haus. Eine Schluesselrolle nehmen dabei Sensoren und Sensorsysteme ein, da nur solche Informationen verarbeitet werden koennen, die zuverlaessig erfasst worden sind. Neue Anwendungen ermoeglichen die Schaffung von Wohnraum, der den Bewohnern angepasst werden kann (kindgerecht, seniorengerecht), der im Einklang mit der Natur steht (Passivhaus, Nullheizenergiehaus), der vorteilhaft geplant werden kann (Gebaeudegeometrie, Gebaeudeausrichtung, Baumaterial, Landschaftsbezogenheit), der die mitdenkende Haut besitzt (lichtlenkende Fassade, transluzente Waermedaemmung) und der mit selbstregulierenden Systemen

AN ANALYSIS ON HOLLOW VISCERAL INJURY AND ITS MANAGEMENT FOLLOWING BLUNT TRAUMA ABDOMEN AT A TERTIARY HEALTHCARE CENTRE

Directory of Open Access Journals (Sweden)

Niranjan Sahoo

2017-10-01

Full Text Available BACKGROUND Trauma is “the neglected disease of modern developing nations.” Hollow viscous injury following blunt trauma to abdomen is not common. The incidence of hollow viscous injuries following abdominal trauma varies from 2 to 15%. The following study was conducted at Department of General Surgery, MKCG Medical College and Hospital, Berhampur, a tertiary care hospital. MATERIALS AND METHODS All the patients admitted to MKCG Medical College and Hospital, Berhampur, with history of blunt trauma to abdomen were examined carefully. Those patients with symptoms and signs suggestive of visceral injury were identified and subjected to xray chest and abdomen erect view and ultrasound abdomen/CT scan. Those with features of pneumoperitoneum are subjected to laparotomy and treated according to location of perforation. Duration of study was from January 2016 to July 2017. RESULTS This study included people of different age groups from 13 to 65 years. Majority of the patients were men (83.5% and most common mode was found to be road traffic accident (69.6%. Most of the patients injured were young and belonged to earning group (81.44%. Most common viscera injured was ileum (37.85% Most common type of injury encountered in our study was isolated perforation and the common surgical procedure was primary closure. CONCLUSION In cases of polytrauma, blunt abdominal trauma contributes significantly to morbidity and mortality. Both the sexes were affected with a male preponderance. The most common mode of blunt trauma was found to be Road Traffic Accident (RTA. Adequate knowledge regarding suspecting intra-abdominal injuries and timely management at tertiary care centre can definitely bring a marked difference in the prognosis of polytrauma patients with history of blunt trauma to abdomen.

A missed injury leading to delayed diagnosis and postoperative infection of an unstable thoracic spine fracture - case report of a potentially preventable complication

Directory of Open Access Journals (Sweden)

Stahel Philip F

2011-10-01

Full Text Available Abstract Background Patients suffering from polytrauma often present with altered mental status and have varying levels of examinability. This makes evaluation difficult. Physicians are often required to rely on advanced imaging techniques to make prompt and accurate diagnoses. Occasionally, injury detection on advanced imaging studies can be challenging given the subtle findings associated with certain conditions, such as diffuse idiopathic skeletal hyperostosis (DISH. Delayed or missed diagnoses in the setting of spinal fracture can lead to catastrophic neurological injury. Case presentation A man struck by a motor vehicle suffered multiple traumatic injuries including numerous rib fractures, a mechanically unstable pelvic fracture, and also had suspicion for an aortic injury. Unfortunately, the upper thoracic segment (T1-5 was only visualized with axial images based on the electronic data. Several days later, a contrast CT scan obtained to check the status of suspected aortic injury revealed T3-T4 subluxation indicative of an unstable extension-type fracture in the setting of DISH. Due to the missed injury and delay in diagnosis, surgery was not performed until eight days after the injury. At surgery, the patient was found to have left T3-T4 facet joint infection as well as infected hematoma surrounding a left T4 transverse process fracture and a traumatic T4 costo-transverse joint fracture-subluxation. Despite presence of infection, an instrumented posterior spinal fusion from T1-T6 was performed and the patient recovered well after antibiotic treatment. Conclusion A T3-T4 unstable DISH extension-type fracture was initially missed in a polytrauma patient due to inadequate imaging acquisition, which caused a delay in treatment and bacterial seeding of fracture hematoma. Complete imaging is especially needed in obtunded patients that cannot be thoroughly examined.

Treatment of traumatic rupture of the thoracic aorta

Directory of Open Access Journals (Sweden)

Davidović Lazar

2008-01-01

Full Text Available INTRODUCTION Interest for traumatic thoracic aorta rupture stems from the fact that its number continually increases, and it can be rapidly lethal. OBJECTIVE The aim of this study is to present early and long term results as well as experiences of our team in surgical treatment of traumatic thoracic aorta rupture. METHOD Our retrospective study includes 12 patients with traumatic thoracic aorta rupture treated between 1985 and 2007. There were 10 male and two female patients of average age 30.75 years (18-74. RESULTS In six cases, primary diagnosis was established during the first seven days days after trauma, while in 6 more than one month later. In 11 cases, classical open surgical procedure was performed, while endovascular treatment was used in one patient. Three (25% patients died, while two (16.6% had paraplegia. Nine patients (75% were treated without complications, and are in good condition after a mean follow-up period of 9.7 years (from one month to 22 years. CONCLUSION Surgical treatment requires spinal cord protection to prevent paraplegia, using cardiopulmonary by-pass (three of our cases or external heparin-bonded shunts (five of our cases. Cardiopulmonary by-pass is followed with lower incidence of paraplegia, however it is not such a good solution for patients with polytrauma because of hemorrhage. The endovascular repair is a safe and feasible procedure in the acute phase, especially because of traumatic shock and polytrauma which contributes to higher mortality rate after open surgery. On the other hand, in chronic postrauamatic aortic rupture, open surgical treatment is connected with a lower mortality rate and good long-term results. There have been no published data about long-term results of endovascular treatment in the chronic phase.

Rapid release of tissue enzymes into blood after blast exposure: potential use as biological dosimeters.

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Peethambaran Arun

Full Text Available Explosive blast results in multiple organ injury and polytrauma, the intensity of which varies with the nature of the exposure, orientation, environment and individual resilience. Blast overpressure alone may not precisely indicate the level of body or brain injury after blast exposure. Assessment of the extent of body injury after blast exposure is important, since polytrauma and systemic factors significantly contribute to blast-induced traumatic brain injury. We evaluated the activity of plasma enzymes including aspartate aminotransferase (AST, alanine aminotransferase (ALT, lactate dehydrogenase (LDH and creatine kinase (CK at different time points after blast exposure using a mouse model of single and repeated blast exposures to assess the severity of injury. Our data show that activities of all the enzymes in the plasma were significantly increased as early as 1 h after blast exposure. The elevated enzyme activity remained up to 6 h in an overpressure dose-dependent manner and returned close to normal levels at 24 h. Head-only blast exposure with body protection showed no increase in the enzyme activities suggesting that brain injury alone does not contribute to the systemic increase. In contrast to plasma increase, AST, ALT and LDH activity in the liver and CK in the skeletal muscle showed drastic decrease at 6 h after blast exposures. Histopathology showed mild necrosis at 6 h and severe necrosis at 24 h after blast exposures in liver and no changes in the skeletal muscle suggesting that the enzyme release from the tissue to plasma is probably triggered by transient cell membrane disruption from shockwave and not due to necrosis. Overpressure dependent transient release of tissue enzymes and elevation in the plasma after blast exposure suggest that elevated enzyme activities in the blood can be potentially used as a biological dosimeter to assess the severity of blast injury.

Trauma dos ossos temporais e suas complicações: aspectos na tomografia computadorizada Temporal bone trauma and complications: computed tomography findings

Directory of Open Access Journals (Sweden)

Ana Maria Doffémond Costa

2013-04-01

Full Text Available A maioria das fraturas dos ossos temporais resulta de traumas cranianos bruscos, de alta energia, estando muitas vezes relacionadas a outras fraturas cranianas ou a politraumatismo. As fraturas e os deslocamentos da cadeia ossicular, na orelha média, representam umas das principais complicações das injúrias nos ossos temporais e, por isso, serão abordadas de maneira mais profunda neste artigo. Os outros tipos de injúrias englobam as fraturas labirínticas, fístula dural, paralisia facial e extensão da linha de fratura ao canal carotídeo. A tomografia computadorizada tem papel fundamental na avaliação inicial dos pacientes politraumatizados, pois é capaz de identificar injúrias em importantes estruturas que podem causar graves complicações, como perda auditiva de condução ou neurossensorial, tonturas e disfunções do equilíbrio, fístulas perilinfáticas, paralisia do nervo facial, lesões vasculares, entre outras.Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others.

Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database.

Science.gov (United States)

Sammy, Ian Ayenga; Chatha, Hridesh; Lecky, Fiona; Bouamra, Omar; Fragoso-Iñiguez, Marisol; Sattout, Abdo; Hickey, Michael; Edwards, John E

2017-04-01

First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) [year]. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Empirically derived lifespan polytraumatization typologies: A systematic review.

Science.gov (United States)

Contractor, Ateka A; Caldas, Stephanie; Fletcher, Shelley; Shea, M Tracie; Armour, Cherie

2018-07-01

Polytraumatization classes based on trauma endorsement patterns relate to distinct clinical outcomes. Person-centered approaches robustly evaluate the nature, and construct validity of polytraumatization classes. Our review examined evidence for the nature and construct validity of lifespan polytraumatization typologies. In September 2016, we searched Pubmed, PSYCINFO, PSYC ARTICLES, Academic Search Complete, PILPTS, Web of Science, CINAHL, Medline, PsycEXTRA, and PBSC. Search terms included "latent profile," "latent class," "latent analysis," "person-centered," "polytrauma," "polyvictimization," "traumatization," "lifetime," "cooccurring," "complex," "typology," "multidimensional," "sequential," "multiple," "subtype," "(re)victimization," "cumulative," "maltreatment," "abuse," and "stressor." Inclusionary criteria included: peer-reviewed; latent class/latent profile analyses (LCA/LPA) of lifespan polytrauma classes; adult samples of size greater than 200; only trauma types as LCA/LPA indicators; mental health correlates of typologies; and individual-level trauma assessment. Of 1,397 articles, nine met inclusion criteria. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, research assistants completed a secondary reference search, and independently extracted data with standardized coding forms. Three-class (n = 5) or four-class (n = 4) solutions were found. Seven studies found a class characterized by higher trauma endorsement (high-trauma). All studies found a class characterized by lower trauma endorsement (low-trauma), and predominance of specific traumas (specific-trauma; e.g., childhood maltreatment). High-trauma versus low-trauma classes and specific-trauma versus low-trauma classes differed on mental health correlates. Evidence supports the prevalence of a high-trauma class experiencing poorer mental health, and the detrimental impact of aggregated interpersonal and other traumas. We highlight the clinical

Difficult weaning in delayed onset diaphragmatic hernia

Directory of Open Access Journals (Sweden)

Ahmed Syed

2009-01-01

Full Text Available Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.

Management of the Morel-Lavallée Lesion.

Science.gov (United States)

Greenhill, Dustin; Haydel, Christopher; Rehman, Saqib

2016-01-01

Morel-Lavallée lesions are closed degloving injuries sustained during violent soft tissue shear that separate the subdermal fat from its strong underlying fascia. Lesions most often occur in the peritrochanteric region, and patients may have concomitant polytrauma. As a result, a hematoma develops that has a high rate of acute bacterial colonization and chronic recurrence. Conservative treatment outcomes are best for those managed acutely. However, diagnosis is often delayed or missed. Furthermore, there is no universally accepted treatment algorithm. Diagnosis and treatment depend on a surgeon's thorough understanding of the cause, pathophysiology, imaging characteristics, and treatment options of Morel-Lavallée lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

The CURE project as an example of international and interdisciplinary cooperation; Das CURE-Projekt als Beispiel internationaler und interdisziplinaerer Zusammenarbeit

Energy Technology Data Exchange (ETDEWEB)

Giussani, Augusto [Bundesamt fuer Strahlenschutz, Oberschleissheim (Germany). Arbeitsgruppe Externe und Interne Dosimetrie, Biokinetik

2017-10-01

The CURE project was a European activity of biologists, epidemiologists, statisticians, mathematicians and dosimetry experts from 9 institutions in 6 European countries. The contribution summarizes the success of the project the focus of the work, the importance of European cooperative research in the field of radiation protection. Advantages and problems arising in the team work of persons from different countries and different scientific background are discussed.

Bone graft substitutes for the treatment of traumatic fractures of the extremities [Knochenersatzmaterialien zur Behandlung von traumatischen Frakturen der Extremitäten

Directory of Open Access Journals (Sweden)

Hagen, Anja

2012-06-01

Knochenersatzmaterialien eingesetzt.Es stellt sich die Frage nach der Wirksamkeit, Kostenwirksamkeit sowie nach ethischen, sozialen und juristischen Implikationen beim Einsatz von Knochenersatzmaterialien bei traumatischen Frakturen.Eine systematische Literaturrecherche wird in den medizinischen elektronischen Datenbanken MEDLINE, EMBASE etc. im Dezember 2009 durchgeführt. In die Bewertung werden randomisierte kontrollierte Studien (RCT ggf. mit gesundheitsökonomischen Analysen sowie Publikationen zu ethischen, sozialen sowie juristischen Aspekten einbezogen. Die medizinische Informationssynthese erfolgt nach Bewertung der Studienqualität u.a. in Form von Metaanalysen, die gesundheitsökonomische Informationssynthese deskriptiv.14 RCT werden in die medizinische und zwei Analysen in die gesundheitsökonomische Bewertung einbezogen, zu ethischen, sozialen und juristischen Aspekten werden keine Publikationen identifiziert. Beim Vergleich Bone morphogenetic protein (BMP-2 gegenüber Standardtherapie ohne Knochentransplantat bei Frakturen ergeben sich in einem RCT (mit erhöhtem Verzerrungspotenzial signifikante Unterschiede zugunsten BMP-2 bezüglich mehrerer Endpunkte. Bei Calciumphosphat (CaP-Zementen und knochenmarkhaltigen Kompositmaterialien zeigen sich beim Vergleich gegenüber Knochentransplantaten in den RCT (alle mit hohem Verzerrungspotenzial signifikante Unterschiede zugunsten der Knochenersatzmaterialien bezüglich einzelner Endpunkte. Bei allen anderen Materialien finden sich in fast allen Vergleichen keine signifikanten Unterschiede.Die BMP-2-Anwendung zusätzlich zur Standardbehandlung ohne Knochentransplantation führt bei Betrachtung aller Patienten mit traumatischen offenen Frakturen zur Kostenerhöhung. Einsparungen durch zusätzlichen BMP-2-Einsatz lassen sich allerdings bei der Patientensubgruppe mit hochgradig offenen Frakturen (Gustilo-Anderson-Grad-IIIB errechnen. Die Kostenwirksamkeit beim BMP-2-Einsatz vs. Standardbehandlung mit Knochentransplantation sowie beim

Die trinitarische Spekulation und göttliche Freiheit beim späten Schelling

Czech Academy of Sciences Publication Activity Database

Landa, Ivan

-, č. 3 (2011), s. 74-86 ISSN 0010-3713 R&D Projects: GA AV ČR(CZ) KJB900090902 Institutional research plan: CEZ:AV0Z90090514 Keywords : trinity * freedom * God * Schelling * Hegel Subject RIV: AA - Philosophy ; Religion

Neues Punktionsinstrumentarium: Provox-Vega®-Punktionsset: Anwendung beim Einbringen einer Stimmprothese nach Laryngektomie

NARCIS (Netherlands)

Lorenz, K.J.; Hilgers, F.M.; Maier, H.

2013-01-01

Background The use of voice prostheses has been considered the gold standard in voice rehabilitation following laryngectomy for the last 20 years. Insertion is generally performed as a primary procedure during laryngectomy or as a secondary procedure with a re-usable trocar or rigid esophagoscope, a

Safety requirements to the operation of hydropower plants; Sicherheit beim Betrieb von Wasserkraftwerken

Energy Technology Data Exchange (ETDEWEB)

Lux, Reinhard [Berufsgenossenschaft Energie Textil Elektro Medienerzeugnisse (BG ETEM), Koeln (Germany)

2011-07-01

Employers have to take into account various safety and health requirements relating to the design, construction, operation and maintenance of hydropower plants. Especially the diversity of the hydropower plant components requires the consideration of different safety and health aspects. In 2011 the ''Fachausschuss Elektrotechnik'' (expert committee electro-technics) of the institution for statutory accident insurance and prevention presented a new ''BG-Information'' dealing with ''Safe methods operating hydropower plants''. The following article gives an introduction into the conception and the essential requirements of this new BG-Information. (orig.)

Radiological interventional procedures for the acute abdomen; Radiologisch-interventionelle Massnahmen beim akuten Abdomen

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Trumm, C.; Hoffmann, R.T.; Reiser, M.F. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

2010-03-15

In patients with acute thrombo-embolic occlusion of the superior mesenteric artery, catheter-assisted thrombolytic therapy represents a procedure of increasing importance in addition to surgery and intensive care treatment. The thrombolytic drugs utilized for this purpose are urokinase, streptokinase and recombinant tissue plasminogen activator (rtPA). Therapeutic embolization is predominantly used in the treatment of arterial bleeding from the gastro-intestinal tract, the liver, the intestines (due to an aneurysm or vascular malformation) and in bleeding from intestinal anastomoses. Polyvinyl alcohol particles, embospheres, gelfoam and microcoils can be utilized as embolic agents. Percutaneous transhepatic cholangiodrainage and stent implantation are applied in patients with biliary obstructions caused by inoperable tumors of the gall bladder or bile ducts, of the pancreatic head or duodenum and by metastases located in the liver parenchyma or hepatic hilum. Image-guided percutaneous drainage is a valuable option in the management of abscesses in the peritoneal cavity; less common indications are lymphoceles, biliomas, urinomas, hematomas, necrosis and pseudocysts. (orig.) [German] Die kathetergestuetzte thrombolytische Therapie stellt im Kontext einer chirurgischen und intensivmedizinischen Versorgung von Patienten mit thrombembolisch bedingter mesenterialer Ischaemie ein unterstuetzendes Behandlungsverfahren von zunehmender Bedeutung dar. Als thrombolytische Agenzien werden Urokinase, Streptokinase und der rekombinante Gewebeplasminogenaktivator (rtPA) verwendet. Die therapeutische Embolisation kommt neben der endoskopischen und chirurgischen Blutungsstillung bei arteriellen Blutungen im Gastrointestinaltrakt, aus der Leber, im Darm (als Folge eines Aneurysmas oder einer vaskulaeren Malformation) sowie bei blutenden intestinalen Anastomosen zum Einsatz. Zur Embolisation koennen Polyvinylalkoholpartikel, Embosphaeren, Gelfoam oder Mikrocoils verwendet werden. Die perkutane transhepatische Cholangiodrainage und die biliaere Stentimplantation bei malignem Ikterus kommen bei inoperablen Tumoren der Gallenblase oder Gallenwege, Tumoren des Pankreaskopfs oder Duodenums sowie Metastasen im Bereich von Leber oder Leberpforte zum Einsatz. Indikationen fuer die bildgesteuerte perkutane Drainage sind abdominelle Abszesse, weniger haeufig Lymphozelen, Biliome, Urinome, Haematome, Nekrosen sowie Pseudozysten. (orig.)

Modern imaging techniques in patients with multiple myeloma; Moderne Bildgebungsverfahren beim Multiplen Myelom

Energy Technology Data Exchange (ETDEWEB)

Bannas, Peter; Adam, G.; Derlin, T. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie; Kroeger, N. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Stammzelltransplantation

2013-01-15

Imaging studies are essential for both diagnosis and initial staging of multiple myeloma, as well as for differentiation from other monoclonal plasma cell diseases. Apart from conventional radiography, a variety of newer imaging modalities including whole-body low-dose-CT, whole-body MRI and 18F-FDG PET/CT may be used for detection of osseous and extraosseous myeloma manifestations. Despite of known limitations such as limited sensitivity and specificity and the inability to detect extraosseous lesions, conventional radiography still remains the gold standard for staging newly diagnosed myeloma, partly due to its wide availability and low costs. Whole-body low-dose CT is increasingly used due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions, and is replacing conventional radiography at selected centres. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI or 18F-FDG PET/CT. Diffuse bone marrow infiltration may be visualized by whole-body MRI with high sensitivity. Whole-body MRI is at least recommended in all patients with normal conventional radiography and in all patients with an apparently solitary plasmacytoma of bone. To obtain the most precise readings, optimized examination protocols and dedicated radiologists and nuclear medicine physicians familiar with the complex and variable morphologies of myeloma lesions are required. (orig.)

Lebensdauer von Stahlseilen beim kombinierten Lauf über Treib- und Ablenkscheiben unterschiedlicher Rillenform

OpenAIRE

Berner, Oliver Roger

2011-01-01

Die Lebensdauer von Stahldrahtseilen in Treibscheibenaufzügen wird von unterschiedlichen Faktoren beeinflusst. Bei allen Anwendungen, bei denen Seile über Rollen laufen, erfahren die Seile eine Zug- und Biegebeanspruchung, die zu einer Materialermüdung und zu einem Verschleiß der Drähte an der Seiloberfläche und im Inneren der Seile führt. Darüber hinaus findet man bei Treibscheibenaufzügen systembedingt weitere anwendungsspezifische Beanspruchungen, die zu einer zusätzlichen Lebensdauerminde...

Status reports on the development and application of acoustic emission analysis. Proceedings; Statusberichte zur Entwicklung und Anwendung der Schallemissionsanalyse. Beitraege

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-07-01

. Schallemissionsanalyse beim Gesamtermuedungstest eines Windkraftrotorblattes; 6. Methoden zur Ueberpruefung der Messempfindlichkeit von Schallemissionssensoren im Labor; 7. Schallemissionsanalyse beim Berstversuch an Aluminiumgussgehaeusen; 8. Visualisierung von Schallemissionslokalisierungen; 9. Schwellenunabhaengige und lueckenlose Aufzeichnung von Merkmalen und Wellenformen transienter und kontinuierlicher Schallemission; 10. Charakterisierung von breitbandigen Schallemissionsaufnehmern; 11. Handling grosser Datenmengen in der Schallemissionsanalyse - ein Beitrag zur Algorithmenentwicklung; 12. Akustische Emission und Ultraschall zur Charakterisierung von Rissgeflechten im Salzgestein. Ein Vortrag wurde separat fuer diese Datenbank aufgenommen.

Acute injury of the ankle joint; Akutes Trauma des Sprunggelenks

Energy Technology Data Exchange (ETDEWEB)

Breitenseher, M.J. [Univ. Klinik fuer Radiodiagnostik, Abt. fuer Osteologie und Besondere Klinische Einrichtung Magnet Resonanz, AKH, Wien (Austria)]|[Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)

1999-01-01

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and clinical stress tests. If the clinical stress test is positive, stress radiography could be performed. There is no consensus about the usefulness of stress radiography in acute ankle sprain, particularly about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today MRI is not used for this indication, although it allows, with controlled positioning of the foot and with defined sections, visualization of injured lateral collateral ankle ligaments. In ankle injuries, plain radiographs form the established basis of diagnostic imaging and can provide definitive answers in most cases. CT is used in complex fractures for complete visualization. MRI is the method of choice for several diagnostic problem cases, including occult fractures and post-traumatic avascular necrosis. In tendon injuries, MRI is important if ultrasound is not diagnostic. Generally, for the evaluation of acute ankle injuries, MRI is the most important second-step procedure when radiographs are nondiagnostic. (orig.) [Deutsch] Die Diagnose einer lateralen Bandverletzung beim frischen Sprunggelenkstrauma fusst auf der Anamnese, der klinischen Untersuchung und klinischen Stresstests. Bei positiven klinischen Stresstests kann eine Stressradiographie durchgefuehrt werden. Es gibt keine Uebereinstimmung fuer den Wert der Stressradiographie beim frischen Supinationstrauma des Sprunggelenks, insbesonders fuer den Winkel der Aufklappbarkeit bei einer Zweibandverletzung, der von 5 -30 reicht. Die MRT wird zur Zeit bei dieser Indikation nur in Einzelfaellen benutzt, obwohl sie mit definierter Fusspositionierung und Ausrichtung der Untersuchungsebene eine ausgezeichnete Beurteilung der Sprunggelenksbaende erlaubt. Bei knoecherner Sprunggelenksverletzungen ist die Verwendung des konventionellen Roentgen die etablierte Methode und meist

Reduction of energy consumption and reduction of galvanisation fluid loss by means of innovative galvanisation drums made of novel materials and with novel geomentries. Final report; Senkung des Energieverbrauches und Verringerung der Galvanisierbadverschleppung durch die Entwicklung von innovativen Galvanisiertrommeln aus neuen Werkstoffen mit neuer Geometrie. Abschlussbericht

Energy Technology Data Exchange (ETDEWEB)

Tscherwitschke, R.

2003-09-01

The project intended to develop a galvanizing drum with higher efficiency (30 percent) without inducing limitations, either by reducing the exposure time at identical energy consumption or by permitting a higher coating rate at higher energy consumption. Developments during the last 50 years have been unsatisfactory in this field. (orig.) [German] Ziel des Projektes war, eine Galvanisiertrommel zu entwickeln, die ohne sonstige Einschraenkung eine signifikante Leistungssteigerung erbringt, konkret bei gleichem Energie-Einsatz (V x A) die Expositionszeit beim Galvanisierprozess reduziert oder bei gleichem Energie-Einsatz ein groesseres Warenvolumen mit der gleichen Schichtdicke, galvanisch beschichtet. Angestrebte Effizienzsteierung war 30%. In der gleichen Groessenordnung sollte eine Energieeinsparung einhergehen. In den letzten 50 Jahren gab es nur eine Entwicklung in diese Richtung, die sich aus einer Reihe von Gruenden nicht dauerhaft durchgesetzt hat. (orig.)

La nécropole mérovingienne d’Erstein (Bas-Rhin) : étude des textiles minéralisés au contact des fibules

OpenAIRE

Médard, Fabienne; Rohmer, Pascal; Moulherat, Christophe; Guillaume, Jacques

2008-01-01

Au cours des années 1999 et 2000, des fouilles de sauvetage ont été menées au lieu dit « Beim Limersheimerweg », non loin de la ville d’Erstein (France, Bas-Rhin). Une importante nécropole datée entre le début du VIe et la fin du VIIe siècle après J.-C. a été mise au jour. 239 sépultures au mobilier funéraire très riche ont été découvertes. Alors que les matières organiques d’origine végétale et animale ont été peu préservées, les nombreuses pièces d’armement (épées longues, scramasaxes, cout...

Was ein Wort bedeutet, kann ein Satz nicht sagen: Zur Bedeutung der Terminologiearbeit für die Technische Kommunikation und das Fachtextübersetzen

Directory of Open Access Journals (Sweden)

Klaus-Dirk Schmitz

2010-05-01

Full Text Available Einleitung: Dieser Beitrag geht von einem Zitat des österreichisch-britischen Philosophen Ludwig Wittgenstein aus und bezeiht sich auf seine Aussagen über Wörter und Sätze. Zielsetzung: Analyse und Diskussion der Relevanz von WittgensteinsAussage für die Terminologiearbeit in der Technischen Kommunikation und beim Fachübersetzen. Methode: Kritische Analyse und Betrachtung. Ergebnis: Neben den terminologischen Grundbegriffen Begriff, Benennung und Gegenstand werden vor allem die Definition als Begriffsbeschreibung sowie die Kriterien zur Bildung von Benennungen untersucht. Schlussfolgerung: Das Zitat von Wittgenstein lässt viele Interpretationen zu. Für die Technische Kommunikation und das Fachübersetzen muss aber die Definition (Satz den Begriff hinter der Benennung (Wort erklären. Idealerweise ist aber die Benennung so transparent, dass dadurch schon die Begriffsklärung erfolgt.

The Neustadt-Glewe geothermal project - problems and experience during operation; Das Geothermieprojekt Neustadt-Glewe - Probleme und Erfahrungen mit einer laufenden Anlage

Energy Technology Data Exchange (ETDEWEB)

Menzel, H [Erdwaerme Neustadt-Glewe GmbH (Germany)

1997-12-01

The scope and goals of the project and the principle of the Neustadt-Glewe geothermal system are presented. The system was commissioned in February 1995, so that sufficient performance data and availability information are now available. Problems that occurred are described and analyzed. Preliminary analyses of the consumption-dependent cost and cost distribution provide a basis for statements on the economic efficiency of geothermal projects. (orig.) [Deutsch] Es werden Inhalt und Ziel des Projektes, sowie das Prinzip der Geothermienutzung in Neustadt-Glewe kurz dargestellt. Nachdem die Anlage im Februar 1995 in Betrieb ging, koennen erste Betriebsergebnisse und Zuverlaessigkeitsaussagen gegeben werden. Es werden Probleme beim Betrieb der Anlagen geschildert und analysiert. Erste Analysen fuer die verbrauchsabhaengigen Kosten und die Kostenverteilung bilden die Grundlage fuer Aussagen zur Wirtschaftlichkeit derartiger Projekte. (orig.)

Aspects of numerical modelling in expert practice; Aspekte der numerischen Modellierung in der gutachterlichen Praxis

Energy Technology Data Exchange (ETDEWEB)

Schaedler, G.

1998-01-01

Referring to a relatively restricted field, namely the preparation of expertises in small-scale climatology and air hygiene, the paper wants to give insight into the methods of, and the problems associated with, the numerical modellings used. Frequently occurring tasks are described, the numerical models used are briefly outlined, and some of the problems are discussed which are encountered when using these models. (orig./KW) [Deutsch] Der vorliegende Aufsatz soll am Beispiel eines relativ eng umgrenzten Themenkreises, naemlich der gutachterlichen Taetigkeit im Bereich der kleinraeumigen Klimatologie und Lufthygiene, einen Einblick in die Methoden und Probleme der dabei eingesetzten numerischen Modellierung geben. Zunaechst werden haeufig auftretende Aufgabenstellungen dargestellt, dann die verwendeten numerischen Modelle kurz vorgestellt und schliesslich einige der Probleme angesprochen, die sich beim praktischen Einsatz dieser Modelle stellen. (orig./KW)

Basics of acute stroke treatment; Grundzuege der akuten Schlaganfalltherapie

Energy Technology Data Exchange (ETDEWEB)

Haass, A. [Neurologische Universitaetsklinik Homburg/Saar (Germany)

2005-05-01

Therapie auf einer Normalstation, selbst wenn dort ein spezialisiertes Team taetig ist. In der Akutphase sollen der haeufig angestiegene Blutdruck bis zu systolischen Werten von 200-220 mmHg toleriert und auf keinen Fall zu rasch gesenkt werden. Weitere evidenzbasierte Richtlinien fuer die Basistherapie sind optimale O{sub 2}-Versorgung, Blutzucker nicht hoeher als 100-150 mg% und Koerpertemperaturen ueber 37,5 C mit physikalischen Massnahmen oder medikamentoes senken. Die Therapie des erhoehten intrakraniellen Druckes besteht in der Hochlagerung des Oberkoerpers, der Gabe von Glyzerin, Mannit und/oder Sorbit, mechanischer Beatmung und unter entsprechender Ueberwachung von Trispuffer. Die dekompressive Kraniektomie kommt beim malignen Mediainfarkt und stark raumfordernden Kleinhirninfarkt in Frage. Die Fibrinolyse ist die effektivste Therapie des Hirninfarkts und doppelt so wirksam wie beim Myokardinfarkt. Sie ist im vorderen Kreislauf im 3-h-Zeitfenster zugelassen. Solange noch eine Penumbra durch ein PWI-DWI-Mismatch im MRT nachweisbar ist, kann in spezialisierten Zentren die intraarterielle Lyse bis zu 6 h nach Symptombeginn durchgefuehrt werden. Beim Hirninfarkt im Basilarisstromgebiet ist das Lysezeitfenster deutlich laenger. Die intraarterielle Lyse erfolgt in ueberregionalen Stroke Units mit rtPA oder Urokinase. Die Behandlung der Post-Stroke-Depression und neuropsychologischer Defizite gehoert genauso zur Weiterbehandlung wie die Bekaempfung der Risikofaktoren und Begleiterkrankungen wie Hypertonus, Diabetes mellitus und Herzrythmusstoerungen. (orig.)

Radiological diagnostics of multiple myeloma; Radiologische Diagnostik des multiplen Myeloms

Energy Technology Data Exchange (ETDEWEB)

D' Anastasi, M.; Grandl, S.; Reiser, M.F.; Baur-Melnyk, A. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

2014-06-15

Robust and reliable imaging methods are required to estimate the skeletal tumor load in multiple myeloma, as well as for the diagnosis of extraskeletal manifestations. Imaging also plays an essential role in the assessment of fracture risk and of vertebral fractures. The conventional skeletal survey has been the gold standard in the imaging of multiple myeloma for many years. Other modalities which have been investigated and are in use are whole-body computed tomography (WBCT), 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET-CT) and whole-body magnetic resonance imaging (WBMRI). These techniques are able to depict both mineralized bone and the bone marrow with a high sensitivity for myeloma lesions. Several studies have shown that cross-sectional imaging is superior to the skeletal survey in the detection of myeloma lesions and WBMRI has been shown to be significantly more sensitive than WBCT for the detection of focal myeloma lesions as well as for diffuse infiltration. The FDG PET-CT technique has a sensitivity comparable to WBMRI. Due to the higher sensitivity in the detection of myeloma lesions WBCT and WBMRI should replace the skeletal survey. A WBCT should be performed if there is suspicion of multiple myeloma. If no focal lesions are found WBMRI or at least MRI of the spine and pelvis should be additionally performed if available. If WBMRI has been initially performed and focal lesions are present, an additional WBCT may be performed to assess the extent of bone destruction and fracture risk. In cases of monoclonal gammopathy of undetermined significance (MGUS), solitary and smoldering myeloma, a WBMRI, if available, should be performed in addition to WBCT. (orig.) [German] Die Aufgabe der bildgebenden Diagnostik beim multiplen Myelom (MM) ist die zuverlaessige Erfassung der Tumorlast im Skelett sowie auch der extraskelettalen Manifestationen und der assoziierten Komplikationen (z. B. Wirbelkoerperfrakturen, Frakturgefahr

Radiation-induced liver injury mimicking liver metastases on FDG-PET-CT after chemoradiotherapy for esophageal cancer. A retrospective study and literature review

Energy Technology Data Exchange (ETDEWEB)

Voncken, Francine E.M.; Aleman, Berthe M.P. [The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Radiation Oncology, Amsterdam (Netherlands); Dieren, Jolanda M. van [The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Gastroenterology, Amsterdam (Netherlands); Grootscholten, Cecile [The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Internal Medicine, Amsterdam (Netherlands); Lalezari, Ferry [The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Radiology, Amsterdam (Netherlands); Sandick, Johanna W. van [The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Surgery, Amsterdam (Netherlands); Steinberg, Jeffrey D.; Vegt, Erik [The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Nuclear Medicine, Amsterdam (Netherlands)

2018-02-15

For esophageal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT), restaging using F-18-fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET-CT) following nCRT can detect interval metastases, including liver metastases, in almost 10% of patients. However, in clinical practice, focal FDG liver uptake, unrelated to liver metastases, is observed after chemoradiotherapy. This radiation-induced liver injury (RILI) can potentially lead to overstaging. A systematic search for potential cases of RILI after (chemo)radiotherapy for esophageal cancer was performed in the electronic reports from all PET-CT scans made between 2006 and 2015 in our hospital. Additional data about potential cases were obtained from the electronic medical records. A literature review of RILI was also performed. Of 205 patients undergoing nCRT, 6 cases with localized increased FDG uptake in the caudate or left liver lobe following nCRT for esophageal cancer were identified. None of these patients had signs of liver metastases with additional imaging, during surgery, on biopsy, or during follow-up (range 11-46 months). At our institute, the incidence of RILI after neoadjuvant chemoradiotherapy for esophageal cancer was 3%. In the literature, RILI is described in about 8% of patients at the time of restaging. FDG-avid lesions occur in the high radiation dose area, usually corresponding to the caudate or left liver lobe. FDG accumulation in the caudate or left liver lobe after CRT in the area that received a high radiation dose may be caused by metastases or RILI. Awareness of the pitfall of high FDG uptake in RILI is crucial to avoid misinterpretation and overstaging. (orig.) [German] Nach neoadjuvanter Radiochemotherapie (nCRT) findet man bei ungefaehr 10 % der Patienten mit Oesophaguskarzinom beim Restaging in der F-18-Fluorodeoxyglukose-Positronenemissionscomputertomographie (FDG-PET-CT) Intervallmetastasen, einschliesslich Lebermetastasen. In der klinischen

Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer

Energy Technology Data Exchange (ETDEWEB)

Pinkawa, Michael; Berneking, Vanessa; Koenig, Liane; Frank, Dilini; Bretgeld, Marilou; Eble, Michael J. [RWTH Aachen University, Department of Radiation Oncology, Aachen (Germany)

2017-01-15

) erhalten hatten, wurde eingeschlossen. Die Anzahl der wegen Beschwerden beim Stuhlgang resultierenden Interventionen in den ersten 2 Jahren nach RT wurde verglichen. Die Patienten wurden prospektiv vor RT, am letzten Tag der RT sowie im Median 2 Monate und 17 Monate nach RT mit einem validierten Fragebogen befragt (Expanded Prostate Cancer Index Composite). Die Basischarakteristika waren in beiden Gruppen vergleichbar. Die Behandlung von Beschwerden beim Stuhlgang (0 vs. 11 %; p < 0,01) und endoskopische Untersuchungen (3 vs. 19 %; p < 0,01) wurden bei Patienten mit Abstandhalter seltener durchgefuehrt. Ueber ein Jahr nach RT aenderten sich die durchschnittlichen Punktwerte fuer die Darmfunktion bei Patienten mit Abstandhalter verglichen mit den Ausgangswerten nicht, im Gegensatz dazu fand sich bei Patienten ohne Abstandhalter ein durchschnittlicher Abfall von 5 Punkten. Bei 0 vs. 12 % trat ein maessiges/grosses Problem durch Beschwerden beim Stuhlgang neu auf (p < 0,01). Statistisch signifikante Unterschiede fanden sich bei den Items ''weicher Stuhlgang'', ''blutiger Stuhlgang'', ''schmerzhafter Stuhlgang'' und ''Haeufigkeit des Stuhlgangs''. Die Injektion eines Abstandhalters ist mit einem signifikanten Vorteil fuer Patienten nach RT des Prostatakarzinoms assoziiert. (orig.)

Polytrauma in the elderly: predictors of the cause and time of death

Directory of Open Access Journals (Sweden)

Muwanga Cyrus

2010-05-01

Full Text Available Abstract Background Increasing age and significant pre-existing medical conditions (PMCs are independent risk factors associated with increased mortality after trauma. Our aim was to review all trauma deaths, identifying the cause and the relation to time from injury, ISS, age and PMCs. Methods A retrospective analysis of trauma deaths over a 6-year period at the study centre was conducted. Information was obtained from the Trauma Audit and Research Network (TARN dataset, hospital records, death certificates and post-mortem reports. The time and cause of death, ISS, PMCs were analysed for two age groups ( Results Patients ≥ 65 years old were at an increased risk of death (OR 6.4, 95% CI 5.2-7.8, p 15 and died within the first 24 hours of admission, irrespective of age, from causes directly related to their injuries. Twelve patients with an ISS of Conclusion Elderly patients with minor injuries and PMCs have an increased risk of death relative to their younger counterparts and are more likely to die of medical complications late in their hospital admission.

Physical rehabilitation following polytrauma. The Canadian Forces Physical Rehabilitation Program 2008-2011.

Science.gov (United States)

Besemann, Markus

2011-12-01

As a consequence of Canada's involvement in the war in Afghanistan, many members of the Canadian Forces have experienced debilitating injuries. Despite the Canadian Forces Health Services (CFHS) having outstanding relationships with many civilian care providers for the rehabilitation of injured soldiers, it became apparent early on that the high-level goals and aspirations of these returning soldiers were sometimes beyond the capability of these centres to facilitate. From this reality grew the need to develop a Physical Rehabilitation Program within the CFHS. This article describes the lessons learned since the creation of the program and outlines the future vision in terms of unique challenges and opportunities. The primary purpose of this article is to describe a hybrid model of civilian-military rehabilitation for injured soldiers and discuss the benefits and challenges of such a model of care.

[Terrorist attack trauma - an individual entity of polytrauma : A 10-year update].

Science.gov (United States)

Güsgen, C; Franke, A; Hentsch, S; Kollig, E; Schwab, R

2017-10-01

The incidence of terrorist attacks is increasing worldwide, and they have also become a permanent threat in European cities. Due to its complexity, terrorist attack trauma places high demands on the strategy of surgical treatment. The combination of various mechanisms, explosions and gunshot injuries, with the characteristic pressure (blast) damage and a high proportion of penetrating trauma with simultaneous burns are characteristic features. Unlike in military conflicts, injuries to people of all ages and without ballistic body protection (body armor) are to be expected. The mechanism of the attack and its local conditions are of relevance for the assessment of the situation and the expected injury patterns. Thus, suicide attacks result in several times higher numbers of fatalities and casualties. Explosions on free ground lead to different types of injury than those in closed or semi-enclosed spaces. The treatment principles of the Advanced Trauma Life Support (ATLS®) are based on the intrahospital care of casualties as well as damage control strategies with trigger factors. In order to prepare and educate clinics and surgeons in Germany for such scenarios, various course formats of the professional societies, the German Society for General and Visceral Surgery (DGAV) and the German Society for Trauma Surgery (DGU) have now been established.

Early clinical phase of patient's management after polytrauma using 1- and 4-slice helical CT; Fruehes klinisches Management nach Polytrauma mit 1- und 4-Schicht-Spiral-CT

Energy Technology Data Exchange (ETDEWEB)

Kloeppel, R.; Kahn, T. [Klinik und Poliklinik fuer Diagnostische Radiologie, Universitaetsklinikum Leipzig (Germany); Schreiter, D. [Chirurgische Intensivtherapieabteilung, Zentrum fuer Chirurgie, Universitaetsklinikum Leipzig (Germany); Dietrich, J. [Abt. Neuroradiologie der Klinik und Poliklinik fuer Diagnostische Radiologie, Universitaetsklinikum Leipzig (Germany); Josten, C. [Klinik und Poliklinik fuer Unfall- und Wiederherstellungschirurgie, Zentrum fuer Chirurgie, Universitaetsklinikum Leipzig (Germany)

2002-07-01

In the early clinical phase the comprehensive imaging of patients with multiple trauma using helical CT is already established. Aim of this study was to assess whether MSCT may improve the patient management and the diagnostic results.The procedure is designed as follows: after life-thretening treatment x-ray of chest and ultrasound are carried out in the emergency room. Then the patient is moved to CT. From 1998 to december 2000 241 patients were examined using a single slice helical CT (Somatom plus 4), in 2001 79 patients using a 4-slice helical CT (Somatom VZ, Siemens Med.Sol.). After CT selected radiograms of the extremities were taken.359 of 360 procedures were carried out successfully. Excluding 1 case (death during 1-sl. h CT) all relevant lesions of head, neck, and body were diagnosed. Although the patients had an injury severity score of {approx}30. The change from 1slice-helical CT to 4 slice-helical CT allowed us to reduce the stay in the CT room from 28 to 16 min. The total lethality decreased by {approx}4%.Advantages for the patient arose from the standardized examination protocol using multislice CT. If integrated in an interdisciplinary management concept, it is a good compromise between examination time, comprehensive diagnostic imaging, life-saving therapeutic procedures, and therapy planning. (orig.) [German] Die klinische Erstversorgung Polytraumatisierter schliesst inzwischen in vielen Unfallkliniken den fruehzeitigen Einsatz der Spiral-CT ein. Kann die neuerlich eingefuehrte Mehrschicht-Spiral-CT Ergebnisse und Patientenmanagement weiter verbessern?Nach lebensrettenden Sofortmassnahmen, Thoraxroentgen und Notsonographie im Schockraum erfolgte die CT: Von 1998-2000 wurden 241 Patienten mit einem 1-Schicht-Spiral-CT (Somatom plus 4) und in 2001 79 Patienten mit einem 4-Schicht-Spiral-CT (Somatom VZ, beide Siemens Med. Sol.) untersucht. Klinisch ausgewaehlte Extremitaetenaufnahmen wurden ergaenzt.359 von 360 Untersuchungen verliefen erfolgreich, ein Patient verstarb im 1-Schicht-Spiral-CT. Alle relevanten Verletzungen von Kopf, Hals und Koerperstamm wurden erkannt. Der Injury severity score (ISS) betrug durchschnittlich ueber 30. Mit dem Wechsel vom 1- auf das 4-Schicht-Spiral-CT konnte der Aufenthalt im CT-Raum von durchschnittlich 28 auf 16 min gesenkt werden. Die Gesamtletalitaet sank um ca. 4%.Vorteile fuer polytraumatisierte Patienten resultierten aus einem standardisierten Untersuchungsprotokoll mit Mehrschicht-Spiral-CT. Es stellte einen guten Kompromiss zwischen Untersuchungszeit, Umfang an diagnostischer Information, lebensrettenden Massnahmen und notwendiger Therapieplanung dar. (orig.)

Ecology of the Baia da Babitonga landscape. A cooperative model project of Bavaria and Brazil. Contributions of Erlangen University; Zur Landschaftsoekologie der Baia da Babitonga. Ein brasilianisch-bayerisches Modellprojekt. Beitraege aus Erlanger Fakultaeten

Energy Technology Data Exchange (ETDEWEB)

NONE

2004-07-01

Brazil, with its sensitive ecology and large rainforests, has a key role in the global environmental problem. Bavaria and Brazil have a long tradition of economic and scientific cooperation. For this reason, it appears logical that the 'Babitonga 2000' project was initiated by the Universities of Erlangen-Nuremberg and Univille, Joinville, in the southern province of Santa Catarina. There was also a regular exchange of scientists and students. Two research stations are operated in the bay of Baia da Babitonga and in the rainforest of Sao Bento do Sul. (orig.) [German] Im vorliegenden Band der Erlanger Forschungen wird ueber das interdisziplinaere bayerisch-brasilianische Umweltprojekt ''Babitonga 2000'' berichtet. Brasilien kommt mit seiner sensiblen Umwelt und den grossen Regenwaldarealen im Rahmen der globalen Umweltproblematik eine besondere Bedeutung zu. Bayern und Brasilien verbindet eine lange Tradition wirtschaftlicher und wissenschaftlicher Zusammenarbeit, die heute auf vielfaeltige Weise gefoerdert wird. Somit lag die vor einigen Jahren angebahnte Partnerschaft zwischen den Universitaeten Erlangen-Nuernberg und der brasilianischen Universitaet Univille in Joinville (in der Suedprovinz Santa Catarina) im beiderseitigen Interesse einer Forschungskooperation. Ueber das Projekt ''Babitonga 2000'' hinaus ist es zu einem regen Austausch von Wissenschaftlern und Studenten gekommen. Brasilianische Studenten nutzen die neu geschaffenen MSc- und PhD-Studiengaenge in Erlangen zu ihrer Qualifizierung. Umgekehrt finden deutsche Wissenschaftler und Studenten im Rahmen von Promotionen und Diplomarbeiten interessante Betaetigungsfelder und ausgezeichnete Rahmenbedingungen im Raum Joinville. Besondere Bedeutung kommt dabei den beiden Forschungsstationen der Univille an der Baia da Babitonga und im Regenwald von Sao Bento do Sul zu. (orig.)

Analytische Betrachtung des Quantisierungsfehlers bei grundlegenden Rechenoperationen der digitalen Signalverarbeitung

Directory of Open Access Journals (Sweden)

W. Schlecker

2005-01-01

Full Text Available Bei der Realisierung digitaler Schaltungen mit einem ASIC oder FPGA kann die Wortbreite der Berechnungen frei gewählt werden. Um die Fläche bzw. die benötigte Hardware zu minimieren, wird versucht, die Berechnungen mit minimaler Wortbreite zu implementieren. Dabei muss jedoch das Quantisierungsrauschen, das durch das Beschränken der Wortbreite entsteht, berücksichtigt werden. Häufig wird hierzu eine worst-case Abschätzung des Fehlers gemacht oder mit Simulationen die benötigte Wortbreite bestimmt. Der vorliegende Beitrag betrachtet die Auswirkungen der Quantisierung analytisch. Dabei wird von gleichverteilten Eingangssignalen ausgegangen. Es wird das Quantisierungsrauschen in Abhängigkeit von der Eingangs- und Ausgangswortbreite bei der Multiplikation und beim Skalarprodukt betrachtet. Die Untersuchungen wurden für Runden und für Abschneiden analytisch durchgeführt und durch Simulation bestätigt.

Monitoring `Renewable resources`. Vegetable oils and other fuels from plants. Third status report; Monitoring `Nachwachsende Rohstoffe`. Pflanzliche Oele und andere Kraftstoffe aus Pflanzen. Dritter Sachstandsbericht

Energy Technology Data Exchange (ETDEWEB)

Roesch, C.

1997-11-01

The present status report `vegetable oils and other fuels from plants` deals with important developments on the utilization of biofuels in spark ignition engines and diesel engines since presentation of the report `growing raw materials` of the Enquete comission `Technikfolgenabschaetzung und -bewertung`. The report deals mainly with rapeseed oil and rape seed oil fatty acid methyl ester produced from this (mentioned short of biodiesel) as well as with bioethanol made from sugar beet and grain. (orig./SR) [Deutsch] Der vorliegende Sachstandsbericht `Pflanzliche Oele und andere Kraftstoffe aus Pflanzen` beschaeftigt sich mit den wichtigsten Entwicklungen beim Einsatz von Biokraftstoffen in Otto- und Dieselmotoren seit Vorlage des Berichts `Nachwachsende Rohstoffe` der Enquete-Kommission `Technikfolgenabschaetzung und -bewertung`. Der Bericht befasst sich schwerpunktmaessig mit Rapsoel und daraus hergestelltem Rapsoelfettsaeuremethylester (kurz Biodiesel genannt) sowie mit aus Zuckerrueben und Getreide erzeugtem Bioethanol. (orig./SR)

Review: Gerald Beck (2013. Sichtbare Soziologie. Visualisierung und soziologische Wissenschaftskommunikation in der Zweiten Moderne

Directory of Open Access Journals (Sweden)

Axel Philipps

2014-01-01

Full Text Available Visualisierungen von Wissen hatten und haben im Kern des Faches Soziologie einen schweren Stand. Gerald BECK nimmt sich daher in seinem Buch "Sichtbare Soziologie" der Thematik an, um die Stellung von Visualisierungen in der Soziologie zu verstehen, damit verbundene Problemfelder zu identifizieren und für visuelle Umsetzungen zu sensibilisieren. Er setzt dazu beim Übergang zur Zweiten Moderne an und betrachtet anhand von neun Fallbeispielen gelungene und weniger gelungene Visualisierungen. Durch die verkürzte Aufarbeitung des Verhältnisses der Soziologie zum Bild bleiben jedoch wichtige Einsichten unberücksichtigt, sodass BECKs Empfehlungen, die Zahl der Visualisierungen und die visuelle Kompetenz zu erhöhen, kaum geeignet sind, die Skepsis in der Soziologie gegenüber Visualisierungen zu überwinden. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1401228

Mykotische Infektionen des Penis

Directory of Open Access Journals (Sweden)

Mayser P

1999-01-01

Full Text Available Die häufigste mykotische Infektion des Penis stellt die Balanitis/Balonoposthitis durch Candida albicans dar. Sie weist eine steigende Inzidenz auf und scheint vornehmlich durch Genitalverkehr übertragen zu werden. Penile Infektionen durch Dermatophyten sind sehr selten, obwohl die Tinea inguinalis zu den häufigeren Erkrankungen zählt. Eine Mitbeteiligung des Penis im Rahmen von Systemmykosen kennzeichnet zumeist ein schwer verlaufende Erkrankung. Ursächlich kann beim immunoinkompetenten Patienten nahezu jeder Erreger in Frage kommen. Biopsie sowie Gewebekultur aus den meist ulzerativen Veränderungen können die Diagnose sichern. Die meisten superfiziellen Infektionen sprechen zufriedenstellend auf eine topische antimykotische Behandlung an, insbesondere wenn Provokationsfaktoren und die Möglichkeit der sexuellen Transmission berücksichtigt werden. Ausgedehnte Infektionen durch Dermatophyten, Hefen und natürlich systemische Infektionen erfordern eine systemische antimykotische Therapie.

Waiting for the Barbarians: Conrad, Kafka, Coetzee

Directory of Open Access Journals (Sweden)

Simona Micali

2017-12-01

Full Text Available The threat of the “Barbarians at the gates”, who bring chaos and death upon civilization, has gradually become one of the thematic obsessions of contemporary imagination. Along the course of the 20th century, the Enemy became less and less the bearer of another culture, and more and more the carrier of a Nonculture or an Anticulture. Such evolution is particularly evident in popular imagination, in all the comics and blockbuster films which stage the final battle between the heros of (white, Western civilization against a dreadful army of barbarian enemies. The article focus on three works – Heart of Darkness by Joseph Conrad, Beim Bau der chinesischen Mauer by Franz Kafka, Waiting for the Barbarians by J.M. Coetzee – which investigate on this mechanism from within, highlighting its ideological implications and its tragic potential.

The Ecology of Urban Tectonics

DEFF Research Database (Denmark)

Beim, Anne; Hvejsel, Marie Frier

2016-01-01

This paper is related to previous research by the authors that examine the phenomenon of tectonics as architectural design theory and method. These studies have shown that the notion of tectonics at large is associated with exclusive architecture, and that, as a profession architects have...... to develop methods for applying tectonic knowledge extracted from significant existing examples for developing future practical methods (Frampton 2002: 81). The specific intention of this paper is to push the understanding of tectonics further, into the scale of the urban context and thereby to discuss...... using Hansen’s work as a case study. (Beim & Madsen (ed.) 2014) Methodologically this has been done by applying the notion of ‘urban tectonics’ inspired by the work of Eduard F. Sekler, as a critical lens. (Sekler 1964, Sekler 1965) Through this lens we study how Hansen was able to treat culture...

Defecography - analysis of qualitative findings; Evakuationsproktographie - Analyse qualitativer Befunde

Energy Technology Data Exchange (ETDEWEB)

Schott, U. [Tuebingen Univ. (Germany). Abt. Radiologische Diagnostik; Braunschweig, R. [Tuebingen Univ. (Germany). Abt. Radiologische Diagnostik; Claussen, C.D. [Tuebingen Univ. (Germany). Abt. Radiologische Diagnostik

1994-12-31

The defectography is an examination of the anorectal function in defecatory disorder. The defecography has a diagnostic impact on disease, which only emerge during defecation as intussusception, enterocele, prolapse or sphincter dysfunction. Other findings as rectocele or descending pelvic floor are ambiguous concerning clinical relevance. The interpretation of defecography should include patient`s history and clinical findings and - if available - endoscopic and manometric findings. (orig.) [Deutsch] Die Evakuationsproktographie ist eine Funktionsuntersuchung des Anorektums beim Symptomenkreis der Defaekationsbeschwerden. Die Domaene der Evakuationsproktographie sind Erkrankungen, die sich nur unter den Provokationsbedingungen der Defaekation manifestieren, wie die Intussuzeption, Enterocele, temporaerer Wandprolaps oder Anismus. Andere Befunde wie eine Rektocele oder Beckenbodenschwaeche sind in ihrer klinischen Relevanz umstritten. Die Bewertung der Evakuationsproktographie im Rahmen des Beschwerdebildes des Patienten sollte in Zusammenschau von vollstaendiger anamnestischer und klinischer Information und - sofern vorhanden - Befunden von Rektoskopie und Rektummanometrie erfolgen. (orig.)

Methods for safe and economical design of components of ABS/ABR braking systems in terms of operating stability; Methodik zur sicheren und wirtschaftlichen betriebsfesten Auslegung von Komponenten in ABS/ASR-Bremssystemen

Energy Technology Data Exchange (ETDEWEB)

Bacher-Hoechst, M. [Robert Bosch GmbH, Technisches Zentrum Schwieberdingen (Germany); Sonsino, C.M. [Fraunhofer-Institut fuer Betriebsfestigkeit (LBF), Darmstadt (Germany)

1997-05-01

The combination of hardware-in-the-loop simulators with stress calculation in terms of operating stability at Robert Bosch GmbH, as well as experience gathered at LBF Darmstadt with component in terms of operating stability, result in optimized design of hydraulic units for antilock systems (ABS) and acceleration skid control systems (ASC). Thus, both safety demands and economic demands are met. (orig./AKF) [Deutsch] Die kombinierte Anwendung von Hardware-In-The-Loop-Simulatoren mit betriebsfestigkeitsgerechter Belastungserfassung bei der Robert Bosch GmbH und die beim LBF Darmstadt vorliegenden Erfahrungen bei der betriebsfesten Bauteilauslegung fuehren zu einer optimierten Auslegung und Absicherung von Hydraulikaggregaten fuer Antiblockier- und Antriebsschlupfregelungssyteme (ABS,ASR). Die wesentlichen Schritte dieses Vorgehens wurden gezeigt. Auf diese Weise ist es moeglich, den Sicherheitsanforderungen derartiger Bauteile einerseits und den wirtschaftlich-technischen Rahmenbedingungen andererseits zu entsprechen. (orig./AKF)

Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre

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Pape Hans-Christoph

2009-10-01

Full Text Available Abstract Background Symptomatic heterotopic ossification (HO in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the effect of surgical treatment on formation of symptomatic heterotopic ossification in polytrauma is sparse. Therefore, we test the effects of surgical treatment (plate osteosynthesis or intramedullary nailing on the formation of heterotopic ossification in the multiple trauma patient. Methods We retrospectively analysed prospectively documented data of blunt multiple trauma patients with long bone fractures which were treated at our level-1 trauma centre between 1997 and 2005. Patients were distributed to 2 groups: Patients treated by intramedullary nails (group IMN or plate osteosynthesis (group PLATE were compared. The expression and extension of symptomatic heterotopic ossifications on 3-6 months follow-up x-rays in antero-posterior (ap and lateral views were classified radiologically and the maximum expansion was measured in millimeter (mm. Additionally, ventilation time, prophylactic medication like indomethacine and incidence and correlation of head injuries were analysed. Results 101 patients were included in our study, 79 men and 22 women. The fractures were treated by intramedullary nails (group IMN n = 50 or plate osteosynthesis (group PLATE n = 51. Significantly higher radiologic ossification classes were detected in group PLATE (2.9 ± 1.3 as compared to IMN (2.2 ± 1.1; p = 0.013. HO size in mm ap and lateral showed a tendency towards larger HOs in the PLATE group. Additionally PLATE group showed a higher rate of articular fractures (63% vs. 28% in IMN while IMN demonstrated a higher rate of diaphyseal fractures (72% vs. 37% in PLATE; p = 0.003. Ventilation time, indomethacine and incidence of head injuries showed no significant difference between groups. Conclusion Fracture care with plate osteosynthesis in polytrauma patients is associated with

Serum IL-6: a candidate biomarker for intracranial pressure elevation following isolated traumatic brain injury

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Ward Norman H

2010-03-01

Full Text Available Abstract Background Increased intracranial pressure (ICP is a serious, life-threatening, secondary event following traumatic brain injury (TBI. In many cases, ICP rises in a delayed fashion, reaching a maximal level 48-96 hours after the initial insult. While pressure catheters can be implanted to monitor ICP, there is no clinically proven method for determining a patient's risk for developing this pathology. Methods In the present study, we employed antibody array and Luminex-based screening methods to interrogate the levels of inflammatory cytokines in the serum of healthy volunteers and in severe TBI patients (GCS≤8 with or without incidence of elevated intracranial pressure (ICP. De-identified samples and ELISAs were used to confirm the sensitivity and specificity of IL-6 as a prognostic marker of elevated ICP in both isolated TBI patients, and polytrauma patients with TBI. Results Consistent with previous reports, we observed sustained increases in IL-6 levels in TBI patients irrespective of their ICP status. However, the group of patients who subsequently experienced ICP ≥ 25 mm Hg had significantly higher IL-6 levels within the first 17 hours of injury as compared to the patients whose ICP remained ≤20 mm Hg. When blinded samples (n = 22 were assessed, a serum IL-6 cut-off of 128 pg/ml correctly identified 85% of isolated TBI patients who subsequently developed elevated ICP, and values between these cut-off values correctly identified 75% of all patients whose ICP remained ≤20 mm Hg throughout the study period. In contrast, the marker had no prognostic value in predicting elevated ICP in polytrauma patients with TBI. When the levels of serum IL-6 were assessed in patients with orthopedic injury (n = 7 in the absence of TBI, a significant increase was found in these patients compared to healthy volunteers, albeit lower than that observed in TBI patients. Conclusions Our results suggest that serum IL-6 can be used for the

Pediatric Injuries at an Annual Motocross Competition: Rates and Severity.

Science.gov (United States)

Williams, Brendan A; McFadden, James P; Teurlings, Tyler L; Blakemore, Laurel C

Pediatric motocross injuries occur frequently and with significant associated morbidity; however, data are limited regarding injury occurring during competition. North Central Florida hosts an annual motocross competition with numerous pediatric competitors. We sought to evaluate the rate and severity of injuries sustained at this event over a multiyear period. Our primary hypothesis was that motocross injury rates and severity in competition exceed that of other competitive sports in this age group. A retrospective review was performed to identify pediatric patients (17 and younger) presenting to a single Level 1 Trauma Center as a result of injury sustained at an annual motocross competition from 2009 to 2012. Demographic, diagnostic, and treatment data were collected including injuries, procedural interventions, and length of hospital stay. Rate, type, and severity of injury were evaluated and compared with established norms of other competitive sports in a similar age group. Over a 4-year period, 51 pediatric motocross competitors sustained 75 injuries. Injured riders were 14.2±2.51 years (range, 8 to 17 y) old and 92% (47/51) male. Forty (78%) patients sustained at least 1 orthopaedic injury and 17 (33%) patients suffered polytrauma. The majority of injuries occurred in the upper extremity (36%). Twenty-four (47%) patients required procedural intervention, 15 of which were operative. Thirty-nine (76%) patients necessitated surgical specialty care. Average injury severity score was 6.5 (1 to 75) and 1 death occurred. The injury rate for pediatric motocross riders in this study was 19.9 injuries per 1000 competitors. High rates of injury occur among pediatric patients in competitive motocross, exceeding those seen in other competitive sports in a comparable age group. Significant morbidity and at least 1 fatality were demonstrated in the group studied. The majority of patients suffer at least 1 orthopaedic injury and nearly all patients require pediatric

MRI for troubleshooting detection of prostate cancer; MRT zur Problemloesung beim Nachweis des Prostatakarzinoms

Energy Technology Data Exchange (ETDEWEB)

Beyersdorff, D.; Hamm, B. [Universitaetsmedizin Berlin, Charite Mitte (Germany)

2005-06-01

Prostate cancer is the most common malignancy in males. Men aged 50 and older are recommended to undergo an annual digital rectal examination (DRE) and determination of prostate-specific antigen (PSA) in serum for early detection. However, prostate biopsies guided by transrectal ultrasound (TRUS) come up negative for cancer in many patients despite having PSA levels above 4 ng/ml. T2-weighted Magnetic Resonance Imaging (MRI) is able to represent the prostate including the surrounding anatomy and depict suspicious areas of low intensity within a high-intensity peripheral zone. MRI has a higher sensitivity for detecting prostate carcinomas than DRE and TRUS in patients having an elevated PSA value and a negative core biopsy. However, its specificity is poor since other abnormalities such as prostatic intraepithelial neoplasia (PIN), prostatitis, scars, or haemmorrhage have a similar MRI appearance. The use of additional techniques such as MR spectroscopy and contrast-enhanced dynamic MRI improves sensitivity, but in particular it improves the specificity of tumor detection. Newly developed biopsy devices enable the performance of targeted biopsies in areas that appear suspicious in the MRI. (orig.)

Neuro-MRI-findings in patients with primary panhypopituitarism; Neuro-MR-Befunde beim primaeren Panhypopituitarismus

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Fellner, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie]|[Oberoesterreichische Landesnervenklinik Wagner Jauregg, Linz (Austria). Inst. fuer Neuroradiologie; Triebe, S.; Baum, U.; Schmitt, R.; Flottemesch, J.; Bautz, W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie; Hensen, J. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Endokrinologie und Stoffwechsel

1998-12-31

We report a case of congenital panhypopituitarism. MR imaging of the brain revealed a hypoplastic adenohypophysis and a hypoplastic pituitary stalk which was interrupted in its superior segment. An ectopic neurohypophysis was found located in the area of the hypothalamus (``hypothalamic hot spot``). The ectopic neurohypophysis showed strong enhancement after intravenous application of Gd-DTPA. MR imaging of the hypothalamic-hypophyseal axis is well suited for the differentiation between congenital and acquired forms of panhypopituitarism in clinically uncertain cases. (orig.) [Deutsch] Wir berichten ueber einen Patienten mit kongenitalem Panhypopituitarismus. Die MRT des Zerebrums zeigte eine hypoplastische Adenohypophyse sowie ein hypoplastisches Infundibulum hypophysis. Es fand sich eine ektope Neurohypophyse im Areal des Hypothalamus (`hypothalamic hot spot`). Die ektope Neurohypophyse zeigte nach Gadoliniumgabe eine kraeftige Kontrastmittelanreicherung. Die MRT der hypothalamisch-hypophysaeren Achse eignet sich somit in klinisch unklaren Faellen fuer die Differentialdiagnostik zwischen angeborenen und erworbenen Formen des Panhypopituitarismus. (orig.)

The clinical use of mammography in the male; Klinische Relevanz der Mammographie beim Mann

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Merkle, E [Ulm Univ. (Germany). Abt. Radiologie; Mueller, M [Ulm Univ. (Germany). Abt. Radiologie; Vogel, J [Ulm Univ. (Germany). Abt. Radiologie; Klatt, S [Ulm Univ. (Germany). Abt. Innere Medizin I; Goerich, J [Ulm Univ. (Germany). Abt. Radiologie; Berger, H G [Ulm Univ. (Germany). Allgemeinchirurgische Abt.; Brambs, H J [Ulm Univ. (Germany). Abt. Radiologie

1996-01-01

During a period of four years 104 mammograms were performed in 89 men. Mastectomies were carried out on 23 men (group 1). 66 patients (group 2) were followed up clinically and in 15 patients serial mammograms were obtained. In group 1 there were 5 patients with bilateral gynaecomastia, 9 with unilateral gynaecomastia and two with pseudogynaecomastia and there were 7 patients with malignancies. In group 2 there were 46 patients with bilateral gynaecomastia and 10 patients with unilateral gynaecomastia. Pseudogynaecomastia was found in 25 patients. There were 7 malignancies, of which 5 had been suspected clinically and one had been diagnosed as gynaecomastia by mammography. Two carcinomas in situ were missed clinically and also by mammography. When malignancy is not suspected on clinical grounds the first examination should be sonography. Where, however, malignancy is suspected, and for follow-up, mammography retains its primary position. (orig./MG) [Deutsch] In einem 4-Jahres-Zeitraum wurden bei 89 Maennern insgesamt 104 Mammogramme angefertigt. 23 Maenner (=Gruppe 1) wurden mastektomiert. 66 Patienten (=Gruppe 2) wurden klinisch und zum Teil mammographisch kontrolliert. Alle Mammogramme wurden in Unkenntnis des klinischen Befundes retrospektiv ausgewertet und, wenn moeglich, dem histologischen Ergebnis gegenuebergestellt. In der Gruppe 1 fand sich eine beidseitige Gynaekomastie in 5/23 Faellen, eine einseitige Form in 9/23 Faellen, eine Pseudogynaekomastie in 2/23 Faellen und ein Malignom in 7/23 Faellen. In Gruppe 2 ergab sich eine beidseitige Gynaekomastie in 46/81 Faellen gegenueber einer einseitigen Form in 10/81 Faellen. Eine Pseudogynaekomastie fand sich in 25/81 Faellen. Von 7 Malignomen waren 5 klinisch suspekt, wobei eines mammographisch als Gynaekomastie imponierte. Zwei In-situ-Karzinome waren sowohl mammographisch als auch klinisch okkult. Klinisch nicht malignomsuspekte Befunde sollten primaer der Mammasonographie zugefuehrt werden. Bei Malignomverdacht und in der Tumornachsorge hingegen hat die Mammographie auch weiterhin ihren festen Platz. (orig./MG)

Rekonstruktion mit Netz beim komplexen Prolaps der Frau: Was hilft es der Patientin wirklich?

Directory of Open Access Journals (Sweden)

Hierl J

2010-01-01

Full Text Available Einleitung: Der komplexe Genitaldeszensus der Frau geht oftmals mit einer deutlichen Einschränkung der Lebensqualität (LQ einher. Dennoch ist der Endpunkt der meisten klinischen Analysen rein anatomischer und funktioneller Natur. In der vorliegenden Untersuchung wurden die Einflüsse der operativen Rekonstruktion mit einem Netz prospektiv auf die LQ evaluiert. Patienten und Methoden: Bei insgesamt 111 Patientinnen mit Deszensus erfolgte zwischen 08/2005 und 12/2007 eine operative Versorgung mittels vaginaler Netzeinlage (anteriorer bzw. kompletter Mesh-Repair. Die LQ wurde prospektiv prä- und postoperativ anhand standardisierter LQ-Fragebögen erfasst. Ergebnisse: Präoperativ zeigte sich bei den Patientinnen eine signifikant reduzierte LQ gegenüber einem Normalkollektiv (p 0,01. Bei 7 % der Patientinnen mit anteriorem, und bei 11 % mit komplettem Mesh-Repair lag postoperativ kein adäquates klinisches Ergebnis vor. In diesem Kollektiv zeigte sich kein signifikanter Unterschied in den LQ-Tests prä- und postoperativ. Bei gutem postoperativem Ergebnis zeigte sich in der Gruppe mit anteriorer Netzeinlage lediglich bei 45 % (p = 0,021, bei kompletter Netzeinlage nur bei 31 % (p = 0,041 eine signifikant verbesserte LQ. Bei kleiner Fallzahl und kurzem Nachbeobachtungszeitraum kann eine gültige Aussage bezüglich der LQ nach Deszensuschirurgie mit Netzeinlage jedoch noch nicht getroffen werden.

Procedure and accuracy in the Eurotunnel breakthrough. Vorgehensweise und Genauigkeit beim Durchschlag des Eurotunnels

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Korittke, N. (DMT-Gesellschaft fuer Forschung und Pruefung mbH, Essen (Germany, F.R.). Inst. fuer Lagerstaette und Vermessung (ILV))

1991-02-14

After a construction time of about 2.5 years the first link was made in the Eurotunnel between France and England, viz. the service tunnel, on 1 December 1990. Thanks to the accurate Gyromat measurements of the Institute for Mineral Deposits and Surveying of the Deutsche Montan Technologie (DMT) a transverse deviation of only 361 mm, a longitudinal deviation of 69 mm and a vertical deviation of 58 mm were determined in the breakthrough of the 22.3 and 15.6 km long tunnel sections. (orig.).

Cardiac computed tomography in patients with acute coronary syndrome; Kardiale CT beim akuten Koronarsyndrom

Energy Technology Data Exchange (ETDEWEB)

Schlett, C.L. [Universitaetsklinikum, Heidelberg (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Alkadhi, H. [Universitaetsspital, Zuerich (Switzerland); Bamberg, F. [Universitaetsklinikum, Tuebingen (Germany). Diagnostische und Interventionelle Radiologie

2014-09-15

Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

Gefuge und Eigenschaften - Modellierung der Keimbildungs- und Wachstumskinetik der Verbindungsschicht beim Nitrieren von Reineisen

DEFF Research Database (Denmark)

Somers, Marcel A.J.; Friehling, Peter B.

2002-01-01

to explain the accellerating effect of an oxidizing pretreatment on the nucleation on iron nitrides. A model was developed for describing growth of a double layer, which consists of epsilon-Fe2N1-z at the surface und gamma’-Fe4N1-x at the substrate. The model takes the dynamic state at the surface...... into account, and was fitted to experimental data for double layer growth....

Whole-body multislice computed tomography as the primary and sole diagnostic tool in patients with blunt trauma: searching for its appropriate indication.

Science.gov (United States)

Wurmb, Thomas Erik; Frühwald, Peter; Hopfner, Wittiko; Roewer, Norbert; Brederlau, Jörg

2007-11-01

In our hospital, whole-body multislice computed tomography is used as the primary diagnostic tool in patients with suspected multiple trauma. A triage rule is used for its indication. We have retrospectively analyzed data of sedated, intubated and ventilated patients consecutively admitted to our trauma center to assess whether the triage rule can help identify patients with severe trauma (injury severity score > or = 16). We have found that overtriage (injury severity score < 16) occurs in 30%, and undertriage occurs in 6% of patients. Although we have found the triage rule to be highly sensitive, this results in a high rate of overtriage. Until we know more about the most relevant and independent predictive factors, sole reliance upon multislice computed tomography in triaging suspected polytrauma victims will imply the risk to overscan many patients.

Fair in the face: modern diagnostics of midfacial trauma

International Nuclear Information System (INIS)

Zajaczek, J.E.W.; Rodt, T.; Keberle, M.

2007-01-01

Modern diagnostics of midfacial trauma are embedded in a diagnostic concept that is oriented to the therapeutic relevance for the individual. Critical analysis of the indicated and efficient radiological method in the acute phase shows that MSCT is currently the method of choice in the diagnosis of midfacial trauma. Besides extensive acquisition of data in the shortest time the possibilities of modern post-processing provide a three-dimensional picture of the often complex injuries in real time. Other perilous injuries are often more important especially for the polytrauma patient. With modern scan protocols intracranial injuries as well as injuries of bone and soft tissue of the head and neck region can be diagnosed during a single examination. Radiology plays a key role for the economically oriented strategy of patient care. (orig.)

Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures

Directory of Open Access Journals (Sweden)

Roberto Bini

2013-01-01

Full Text Available The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations.

A Rare Early Complication of Tracheostomy

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Manjeet Singh Pawar

2011-01-01

Full Text Available A polytrauma patient on ventilator was admitted to ICU with open tracheostomy, GCS 8/15 and unequal pupils. After 10 days, he was weaned from the ventilator. The patient had respiratory problems i.e. expiratory stridor, shortness of breath, dysphonia and dyspnea on closing tracheostomy. It was diagnosed as a case of asthma, and the patient responded to salbutamol nebulization and intravenous steroid therapy. However, after some time, he desaturated and a plan for rapid sequence intubation was made. Endotracheal tube could not be negotiated beyond vocal cords, so an unprepared tracheostomy without proper equipment had to be immediately done by an anesthetist to save the patient’s life. CT scan revealed tracheal stenosis. This case demonstrates that patients with a short 15-days history of previous tracheostomy may have tracheal stenosis.

Combined duodenal and pancreatic major trauma in high risk patients: can a partial reconstruction be safe?

Science.gov (United States)

Toro, A; Li Destri, G; Mannino, M; Arcerito, M C; Ardiri, A; Politi, A; Bertino, G; Di Carlo, I

2014-04-01

Pancreatic trauma is an uncommon injury, occurring in only about 0.2% of blunt abdominal injuries, while duodenal injuries represent approximately 4% of all blunt abdominal injuries. When trauma of the pancreas and duodenum do not permit reparation, pancreatoduodenectomy (PD) is mandatory. In the reconstructive phase, the use of ductal ligation as an alternative to standard pancreaticojejunostomy has been reported by some authors. We report a case of polytrauma with pancreatic and duodenal injury in which the initial diagnosis failed to recognize the catastrophic duodenal and pancreatic situation. The patient was submitted for PD and the pancreatic stump was abandoned in the abdominal cavity after main pancreatic ductal ligation. This technique can minimize the morbidity and mortality of PD in patients with other organs or apparatus involved severely and extensively in trauma.

Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims

International Nuclear Information System (INIS)

Shannon, L.; Peachey, T.; Skipper, N.; Adiotomre, E.; Chopra, A.; Marappan, B.; Kotnis, N.

2015-01-01

Aim: To assess the accuracy of the trauma team leader's clinical suspicion of injury in patients who have undergone whole-body computed tomography (WBCT) for suspected polytrauma, and to assess the frequency of unsuspected injuries and specific patterns of injury at WBCT. Materials and methods: Requests for patients who underwent WBCT for suspected polytrauma from April 2011 to March 2014 were reviewed and each body area that was clinically suspected to be injured was recorded. Body areas were divided into the following groups based on anatomical regions covered in each segment of the WBCT examination: head (including facial bones); neck (including cervical spine); chest (including thoracic spine); and abdomen/pelvis (including lumbar spine). The formal radiology report for each study was reviewed and injuries found at CT were grouped into the same body areas. For each patient, the number of clinically suspected injured areas was compared to the number of confirmed injured areas at WBCT. Results: Five hundred and eighty-eight patients were included in the study. Thirty-two percent (186/588) had a normal scan. Ninety-three percent (546/588) had fewer injured body areas at WBCT than suspected. Four percent (27/588) had the equivalent number of injured areas at WBCT as suspected. Three percent (15/588) had more injured areas at WBCT than suspected. Fifty percent (263/527) with clinically suspected chest injuries were confirmed to have chest injuries at WBCT. This was lower for other areas: abdomen/pelvis 31% (165/535); head 29% (155/533); neck 13% (66/513). Four percent of (24/588) patients had unsuspected injuries found at WBCT. Seventy-five percent (18/24) of unsuspected injuries were considered as serious, where failure to treat would have the potential for significant morbidity. Most of these patients had severe injuries to other body areas that were correctly suspected. Of the 165 with abdominal/pelvic region injuries, there were associated injuries in the

Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer. Results of the first prospective randomized phase II trial

Energy Technology Data Exchange (ETDEWEB)

Golcher, Henriette; Merkel, Susanne; Hohenberger, Werner [University Hospital Erlangen, Department of Surgery, Erlangen (Germany); Brunner, Thomas B. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); University Hospital Freiburg, Department of Radiation Oncology, Freiburg (Germany); Witzigmann, Helmut [University Hospital Leipzig, Department of Surgery, Leipzig (Germany); Hospital Dresden-Friedrichstadt, General Surgery, Dresden (Germany); Marti, Lukas [Hospital of Kanton St. Gallen, General Surgery, St. Gallen (Switzerland); Bechstein, Wolf-Otto [University Hospital Frankfurt, Department of Surgery, Frankfurt/Main (Germany); Bruns, Christiane [University Hospital Munich, Department of Surgery - Hospital Campus Grosshadern, Munich (Germany); University Hospital Magdeburg, Department of Surgery, Magdeburg (Germany); Jungnickel, Henry [Hospital Dresden-Friedrichstadt, General Surgery, Dresden (Germany); Schreiber, Stefan [University Hospital Leipzig, Department of Surgery, Leipzig (Germany); Grabenbauer, Gerhard G. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Hospital Coburg, Department of Radiation Oncology, Coburg (Germany); Meyer, Thomas [University Hospital Erlangen, Department of Surgery, Erlangen (Germany); Hospital Ansbach, General Surgery, Ansbach (Germany); Fietkau, Rainer [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany)

2014-09-25

In nonrandomized trials, neoadjuvant treatment was reported to prolong survival in patients with pancreatic cancer. As neoadjuvant chemoradiation is established for the treatment of rectal cancer we examined the value of neoadjuvant chemoradiotherapy in pancreatic cancer in a randomized phase II trial. Radiological staging defining resectability was basic information prior to randomization in contrast to adjuvant therapy trials resting on pathological staging. Patients with resectable adenocarcinoma of the pancreatic head were randomized to primary surgery (Arm A) or neoadjuvant chemoradiotherapy followed by surgery (Arm B), which was followed by adjuvant chemotherapy in both arms. A total of 254 patients were required to detect a 4.33-month improvement in median overall survival (mOS). The trial was stopped after 73 patients; 66 patients were eligible for analysis. Twenty nine of 33 allocated patients received chemoradiotherapy. Radiotherapy was completed in all patients. Chemotherapy was changed in 3 patients due to toxicity. Tumor resection was performed in 23 vs. 19 patients (A vs. B). The R0 resection rate was 48 % (A) and 52 % (B, P = 0.81) and (y)pN0 was 30 % (A) vs. 39 % (B, P = 0.44), respectively. Postoperative complications were comparable in both groups. mOS was 14.4 vs. 17.4 months (A vs. B; intention-to-treat analysis; P = 0.96). After tumor resection, mOS was 18.9 vs. 25.0 months (A vs. B; P = 0.79). This worldwide first randomized trial for neoadjuvant chemoradiotherapy in pancreatic cancer showed that neoadjuvant chemoradiation is safe with respect to toxicity, perioperative morbidity, and mortality. Nevertheless, the trial was terminated early due to slow recruiting and the results were not significant. ISRCTN78805636; NCT00335543. (orig.) [German] Mehrere nichtrandomisierte Studien zeigten, dass eine neoadjuvante Therapie das Ueberleben bei Patienten mit Pankreaskarzinom verlaengert. Beim lokal fortgeschrittenen Rektumkarzinom gehoert die

Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre.

Science.gov (United States)

Naqvi, G; Johansson, G; Yip, G; Rehm, A; Carrothers, A; Stöhr, K

2017-01-01

Introduction Paediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK. Methods This retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region. Results A total of 213 patients were included in the study, with a mean age of 7.8 years (standard deviation [SD]: 5.2 years). The most common cause of injury was vehicle related incidents (46%). The median length of hospital stay was 5 days (interquartile range [IQR]: 4-10 days). Approximately half (52%) of the patients had to stay in the intensive care unit, for a median of 1 day (IQR: 0-2 days). The mortality rate was 6.6%. The mean injury severity score was 19 (SD: 10). Pearson's correlation coefficient showed a positive correlation for injury severity score with length of stay in hospital (p<0.001). Conclusions There is significant variation in mechanism of injury, severity and pattern of paediatric trauma across age groups. A multidisciplinary team approach is imperative, and patients should be managed in specialist centres to optimise their care and eventual functional recovery. Head injury remained the most common, with significant mortality in all age groups. Rib fractures and pelvic fractures should be considered a marker for the severity of injury, and should alert doctors to look for other associated injuries.

Injúria Renal Aguda no paciente politraumatizado Acute Renal Injury in polytrauma patients

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Thiago Gomes Romano

2013-03-01

Full Text Available A Injúria Renal Aguda (IRA no contexto do paciente politraumatizado ocorre, na maioria das vezes, por uma conjuntura de fatores que passam por eventos correlacionados à ressuscitação volêmica inicial, ao grau de resposta inflamatória sistêmica associada ao trauma, ao uso de contraste iodado para procedimentos diagnósticos, à rabdomiólise e à síndrome compartimental abdominal. Atualmente, passamos por uma fase de uniformização dos critérios diagnósticos da IRA com o Acute Kidney Injury Network (AKIN, sendo a referência mais aceita. Consequentemente, o estudo da IRA no politraumatismo também passa por uma fase de reformulação. Esta revisão da literatura médica visa trazer dados epidemiológicos, fisiológicos e de implicação clínica para o manuseio destes pacientes, bem como expor os riscos do uso indiscriminado de expansores volêmicos e particularidades sobre a instituição de terapia renal substitutiva em indivíduos sob risco de hipertensão intracraniana.Acute Kidney Injury (AKI in trauma is, in most cases, multifactorial. Factors related to the initial ressuscitation protocol, degree of the systemic inflamatory response to trauma, contrast nephropathy in diagnostic procedures, rhabdomyolysis and abdominal compartment syndrome are some of those factors. Nowadays a uniformization in diagnostic criteria for AKI has been proposed by the Acute Kidney Injury Network (AKIN and as a result the incidence of AKI and its impact in outcomes in trauma patients also needs to be reconsider. In this review we aim to approach epidemiologic, physiologic and clinical relevant data in the critical care of patients victims of trauma and also to expose the risks of indiscriminate use of volume expanders and the interaction between renal replacement theraphy and intracranial hypertension.

Complex pelvic ring injuries associated with floating knee in a poly-trauma patient

OpenAIRE

Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

2017-01-01

Abstract Rationale: Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage ...

Functional-anatomic evaluation of dilated uropathies in children using combined MR-nephrography and MR-urography compared to renal scintigraphy; Funktionell-anatomische Diagnostik dilatierter Uropathien bei Kindern mit kombinierter MR-Nephrographie und MR-Urographie im Vergleich zur renalen Isotopennephrographie

Energy Technology Data Exchange (ETDEWEB)

Reither, M. [Abt. fuer bildgebende Diagnostik am Kinderkrankenhaus Park Schoenfeld, Kassel (Germany); Tuerkay, S. [GE Medical Systems Deutschland GmbH, Solingen (Germany)

2004-02-01

Purpose: to evaluate MR-tomographic assessment of split renal function and degree of obstruction compared to diuretic renal scintigraphy, and pathoanatomic imaging of the urinary tract as all in one exam. Patients and methods: in a prospective study 62 children, aged 1 month to 9.5 years, mean 2.8 years, underwent diuretic renal scintigraphy and dynamic MR-nephrography at the same day except for 7 patients with a time interval of 1 day. In all patients we did T2w (water-technique) MR-urography additionally. Results: comparing spilt renal function we found a very close correlation in 54 out of 62 patients (correlation coefficient = 0.95). Due to technical failures 8 cases couldn't be calculated. Comparing degrees of obstruction there was an agreement in 57 out of 62 patients, 3 studies were gradually over-, 2 underestimated. All but one morphologic diagnoses in advance obtained by ultrasound and completed by other imaging modalities later on were confirmed MR-urographically. Though correctly imaged the functionless upper moiety in a renal duplication with ureterocele was misinterpreted at a first glance. (orig.) [German] Ziel: Es sollte geprueft werden, ob die Berechnung der seitengetrennten Nierenfunktion, die Bestimmung des Obstruktionsgrades und die pathoanatomische Darstellung des Harntraktes im Vergleich zur Diurese-Szintigraphie in einem Untersuchungsgang MR-tomographisch zuverlaessig moeglich ist. Patienten und Methode: In einer prospektiven Studie wurden bei 62 Kindern im Alter von 1 Monat bis 9,5 Jahren, Mittelwert 2,8 Jahre, ein Diurese-Szintigramm und eine dynamische MR-Nephrographie am gleichen Tag durchgefuehrt; lediglich bei 7 Patienten lag 1 Tag zwischen beiden Untersuchungen. Alle Patienten erhielten zusaetzlich eine T2w-MR-Urographie in ''Wasserbild''-Technik. Ergebnisse: Beim Vergleich der seitengetrennten Nierenfunktion fand sich eine sehr enge Korrelation bei 54 von insgesamt 62 Patienten (Korrelationskoeffizient = 0

Microbial reactions in coal and coal relevant structures. Part project: fungal and enzymatic depolarisation of brown coal for the production of low-molecular compounds. Interim report; Mikrobielle Umsetzung an Kohle und kohlenrelevanten Strukturen. Teilvorhaben: Pilzliche und enzymatische Depolymerisation von Braunkohle zur Gewinnung niedermolekularer Verbindungen. Zwischenbericht (Berichtszeitraum 01.01.1998 - 31.12.1998)

Energy Technology Data Exchange (ETDEWEB)

Ziegenhagen, D.; Bublitz, F.; Sorge, S.; Ullrich, R.; Hofrichter, M.; Fritsche, W.

1999-04-29

optimiert, dass maximale Ausbeuten an niedermolekularen Produkten erzielt werden. Im Mittelpunkt der im Berichtzeitraum durchgefuehrten Versuche standen die Suche nach neuartigen, ligninolytisch wirkenden Organismen, die Gewinnung ligninolytischer Enzyme, deren Immobilisierung an natuerlichen Traegersubstanzen sowie die weitere Untersuchung des Wirkspektrums der MnP. Der Einsatz unterschiedlicher Modellsubstrate sollte Aufschluss ueber die durch MnP spaltbaren Bindungstypen und moegliche Reaktionsprodukte geben. Hierbei wurden sowohl freie als auch an Kieselgel als Traeger fixierte Substrate eingesetzt. Ausgangspunkt beim Einsatz traegerfixierter Modellsubstrate waren Ueberlegungen, beim Umsaetzungen mit dem Pilzmycel zwischen intra- und extrazellulaeren Reaktionen unterscheiden zu koennen. (orig.)

Smart Metering. Between technical challenge and societal acceptance - Interdisciplinary status quo; Smart Metering. Zwischen technischer Herausforderung und gesellschaftlicher Akzeptanz - Interdisziplinaerer Status Quo

Energy Technology Data Exchange (ETDEWEB)

Westermann, Dirk; Doering, Nicola; Bretschneider, Peter (eds.)

2013-04-01

The international research project RESIDENS (more efficient energy utilization by means of system technical integration of the private ultimate consumer) investigates the technology of smart metering that is the utilization of intelligent smart meters in private households. The interdisciplinary character of the RESIDENS project becomes visible by different sub-projects examining different formulations of a question from perspectives of different scientific disciplines: First of all, chapter 2 of the contribution under consideration follows up the question, what impact the media coverage on smart metering has on the perception of this technology in the population at large. Chapter 3 reports on the state of the art of the smart metering. Chapter 4 illustrates how a load control of private consumers can be performed by means of the smart meter technology. Chapter 5 reports on the impacts of the smart metering on the procurement of energy in the liberalised energy market. Chapter 6 investigates the smart metering from the customer's point of view. Concretely, the user-friendliness of an internet portal is evaluated by which the customers may follow up their consumption of electricity by means of an intelligent smart meter continuously. Chapter 7 illustrates legal aspects of smart metering from the perspective of the customer, electricity suppliers and distribution system operators. Chapter 8 presents the conception and implementation of an online gaming operation for the promotion of competency of private power customers: In line with this game, the participants may learn to handle smart metering and flexible electricity tariffs in an entertaining manner. Finally, chapter 9 reports on an expert interview in which the smart metering technology is evaluated by public utilities being involved in this project.

Possible emissions from electricity generation from geothermal energy; Moegliche Emissionen bei der Stromerzeugung aus Geothermie

Energy Technology Data Exchange (ETDEWEB)

Heberle, Florian; Bruggemann, Dieter [Bayreuth Univ. (Germany). Lehrstuhl fuer Technische Thermodynamik und Transportprozesse (LTTT)

2013-03-15

Electricity from geothermal energy in the low temperature range can be efficiently recovered if power plant processes are used with organic working fluids. It is inevitable that a small part of the sometimes harmful fluids leaking from the plant - a conflict in the development of climate-friendly renewable energy actually. A short report of the Centre for Energy Technology at the University of Bayreuth, on behalf of UBA quantifies the emissions of fluorinated hydrocarbons for different development scenarios and emission rates. [German] Strom aus Erdwaerme im Niedertemperaturbereich kann effizient gewonnen werden, wenn Kraftwerksprozesse mit organischen Arbeitsmedien einsetzt werden. Dabei ist es nicht zu vermeiden, dass ein kleiner Teil der mitunter klimaschaedlichen Fluide, aus den Anlagen entweicht - ein Zielkonflikt beim Ausbau der eigentlich klimaschonenden erneuerbaren Energie. Ein Kurzgutachten des Zentrums fuer Energietechnik der Universitaet Bayreuth im Auftrag des UBA quantifiziert die Emissionen fluorierter Kohlenwasserstoffe fuer verschiedene Ausbauszenarien und Emissionsraten.

Cooperative project for energy-oriented modernisation of industrial buildings - coordination results; Projektverbund zur energiegerechten Sanierung industriell errichteter Gebaeude - Ergebnisse der Koordination

Energy Technology Data Exchange (ETDEWEB)

Kerschberger, A. [Assmann Beraten und Planen GmbH, Stuttgart (Germany)

1997-12-31

The cooperative project concept of the federal ministry of science and technology is discussed. Coordination activities as well as pilot projects and comparative projects are described. Results obtained so far are reported in detail; heat energy conservation potentials as substantiated by means of measurements are shown in tabulated form. Further indicated in tabulated form are the redevelopment costs per residential unit, the payback period of the entire project, and a comparison of reduced heating costs with increased basic rent for apportioning the costs of modernization. (MSK) [Deutsch] Die Konzeption des Projektverbundes des BMBF wird naeher erlaeutert. Die Aktivitaeten der Koordination und die Versuchs-und Vergleichsbauvorhaben werden beschrieben. Die bisherigen Ergebnisse werden detailliert geschildert und die messbeim Heizenergieverbrauch sind tabellarisch aufgezeigt. Ebenfalls in Tabellen dargestellt sind die Sanierungskosten pro Wohnung, die Amortisationszeiten der Gesamtmass

Die Gralssuche als Sauftour: mittelalterliche Erzählstrukturen in Bernard Leonettis parodistischem Fantasy-Thriller "La Quête brestoise" (2007

Directory of Open Access Journals (Sweden)

Anna Isabell Wörsdörfer

2016-06-01

Full Text Available Der Artikel untersucht die narrativen Parallelen zwischen roman courtois und phantastischem Thriller anhand von Bernard Leonettis „polar arthurien“ La Quête brestoise. Dabei rückt das Hauptmotiv der (Grals-Queste in den Vordergrund, das im mittelalterlichen Roman als ritterliche aventure und im Kriminalroman als actiongeladene Suche jeweils den strukturgebenden Handlungsrahmen darstellt und aufgrund des Kontrasts zwischen der früheren Lebenswelt des Protagonisten Chevalier und dem modernen Brest zahlreiche parodistische Züge erhält. Eine wichtige Rolle in der Analyse spielt ferner die Raum-Zeit-Struktur, die mit Bachtin als wunderbare Welt, in der die Zeit des Abenteuers vorherrscht, beschrieben werden kann und demnach derjenigen des höfischen Romans ähnelt: Beim letzten Gefecht, welches auf einer Yacht ausgetragen wird, die im Inneren eine Steingrotte birgt, scheint die Zeit stillzustehen und eigenen – phantastischen – Gesetzen zu unterliegen.

Threshold limit values, test values and sanitation values for soil sanitation; Richt-, Pruef- und Sanierungswerte fuer den Bodenschutz

Energy Technology Data Exchange (ETDEWEB)

Karlaganis, G.; Dettwiler, J. [Bundesamt fuer Umwelt, Wald und Landschaft (BUWAL), Bern (Switzerland). Abt. Stoffe, Boden, Biotechnologie

1998-09-01

Soils, the basis for human, plant and animal life, are exposed to quantitative and qualitative deterioration. Quantitative deterioration refers to paving of ground but also to erosion and soil destruction. There are new regulations for physical protection of soil which refer to soil erosion, compacting and handling of soil during building construction. (orig.) [Deutsch] Boden als natuerliche Lebensgrundlage fuer Mensch, Tiere und Pflanzen ist quantitativen und qualitativen Beeintraechtigungen ausgesetzt. Als quantitative Beeintraechtigung gilt jede Art von Verminderungen der Boeden durch Bauten und Anlagen, aber auch durch Erosion oder Bodenschwund. Erlassen worden sind nun neue Bestimmungen fuer drei Bereiche des physikalischen Bodenschutzes, naemlich fuer die Bodenerosion, die Bodenverdichtung und fuer den Umgang mit dem Boden vor allem beim Bauen. Die Verordnung vom 1. Juli 1998 ueber Belastungen des Bodens (VBBo`98) erhaelt neu drei Arten von Beurteilungs- bzw. Massnahmewerten, naemlich Richtwerte, Sanierungswerte und Pruefwerte. (orig./ABI)

Die Bedeutung der aktuellen Nierentumorklassifikation für Diagnostik und Therapie

Directory of Open Access Journals (Sweden)

Moch H

2008-01-01

Full Text Available In den letzten Jahren erweiterte sich das Verständnis zur Histogenese von Nierentumoren durch neue molekulare Erkenntnisse erheblich. Damit wurde es möglich, eine Klassifikation der Nierentumoren auf der Basis von molekularen Veränderungen vorzunehmen. Daneben wurden neue Tumortypen identifiziert, deren Kenntnis erheblichen Einfluss auf die Auswahl der Behandlungsstrategien haben kann. Bei zystischen Nierentumoren gibt es zum Beispiel neben Tumoren mit sehr guter Prognose auch hochmaligne Tumoren. Die charakteristischen molekularen Veränderungen sind einerseits für die Klassifikation der verschiedenen Nierentumoren relevant, andererseits können sie auch innerhalb der klarzelligen Nierenzellkarzinome ein potenzielles Ansprechen auf neue Medikamente vorhersagen. Die Kenntnis der molekularen Zielstrukturen bei Nierenkarzinomen ist die Grundlage für neue Therapien, die gegen spezifische Strukturen gerichtet sind. HIF- α-responsive Gene, z. B. VEGF, PDGF, TGFα, EGFR und Ca IX spielen dabei eine zentrale Rolle beim klarzelligen Nierenkarzinom.

Small water courses for electric power generation; Mit wenig Wasser zum Fliessen bringen

Energy Technology Data Exchange (ETDEWEB)

Ossberger, K.F.; Wirth, D. [Ossberger Turbinenfabrik GmbH und Co, Weissenburg (Germany)

1997-12-31

In principle, no one nowadays doubts the usefulness of small hydroelectric installations. Hydro power is a renewable energy source. Contrary to oil, gas or coal, the energy source is not consumed. Hydroelectric power generation neither gives rise to atmospheric pollution nor does it cause residual products; it is environment-friendly. Moreover, the energy used is a native one. These arguments no doubt advocate the broadest possible use of hydro power, especially also in the form of small hydroelectric installations. (orig.) [Deutsch] Grundsaetzlich gibt es heutzutage keinen Zweifel am Nutzen von Kleinkraftwerken. Die Wasserkraft ist eine regenerierbare Energiequelle. Im Gegensatz etwa zu Oel, Gas oder Kohle wird der Energietraeger Wasser beim Nutzungsvorgang nicht aufgebraucht. Die Stromerzeugung aus Wasserkraft belastet die Umwelt weder durch Luftschadstoffe noch Rueckstaende, sie ist umweltfreundlich. Und man nutzt damit einheimische Energie. Gewichtige Argumente zweifellos, die fuer eine moeglichst weitgehende Wasserkraftnutzung, gerade auch in Kleinkraftwerken, sprechen. (orig.)

Pollutants from road traffic and breathing problems in children; Schadstoffe aus dem Strassenverkehr und Atemwegsbeschwerden bei Kindern

Energy Technology Data Exchange (ETDEWEB)

Mutius, E. von [Muenchen Univ. (Germany). Dr. von Haunersche Kinderklinik

1996-06-01

So far, there ave been few studies on measurable health effects of emissions from road traffic. An analysis of the available studies yields no clear indication of a relationship between road traffic emissions and the incidence of asthma and allergies in infants. On the other hand, there are no valid data on individual pollutant exposure of infants in the framework of epidemiological studies which take account of other influencing factors.(orig./MG) [Deutsch] Der Frag, ob eine Schadstoffbelastung durch den Strassenverkehr einen messbaren schaedigenden Effekt auf die menschliche Gesundheit hat, ist bislang in wenigen Studien nachgegangen worden. Analysiert man die vorliegenden Studien, ergibt sich derzeit kein eindeutiger Hinweis auf einen starken Zusammenhang zwischen der Strassenverkehrsbelastung und dem Auftreten von Asthma und Allergien beim Kind. Allerdings fehlt es an validen Daten zur individuellen Schadstoffexposition bei Kindern im Rahmen epidemiologischer Studien, ie eine Beruecksichtigung anderer Einfluss- und Stoervariablen erlauben. (orig/MG)

Deregulation of the electric power market and chances of ecopolicy-based regulatory action. Report on the symposium organised by Forschungsstelle Umweltrecht at Hamburg University on June 2, 1994; Liberalisierung des Strommarktes und die Chancen fuer umweltpolitische Steuerungen. Bericht ueber das Symposium der Forschungsstelle Umweltrecht an der Universitaet Hamburg am 2. Juni 1994

Energy Technology Data Exchange (ETDEWEB)

Krebs, A [Freiherr-vom-Stein-Institut, Muenster (Germany)

1994-08-01

The report briefly discusses each paper presented at the symposium. Eleven experts from academia, administration and the power industry have been ventilating the various models of reform for deregulation of the electric power market currently under debate at national and international level, and the possibilities available under these models for ecopolicy-based regulatory activities for avoiding adverse effects on the environment. Other topics discussed addressed framework conditions to be defined for the reform models on the basis of constitutional laws, and rules of competition. (orig.) [Deutsch] Elf Experten aus Wissenschaft, Verwaltung und Energiewirtschaft eroertern die zur Zeit auf nationaler und internationaler Ebene diskutierten Reformmodelle fuer eine Liberalisierung des Strommarktes sowie die mit diesen jeweils verbundenen Moeglichkeiten der umweltpolitischen Steuerung von oekologischen Folgewirkungen. Weitere Themen des Symposions waren die wettbewerbs- und verfassungsrechtlichen Rahmenbedingungen einer Deregulierung des Strommarktes. Der Bericht behandelt in kurzer Form alle beim Symposion gehaltenen Referate. (orig.)

Symposium Ecological construction - from half-timbered- to passive house: living yesterday - today - tomorrow; Symposium Oekologische Bauweisen - vom Umgebinde- zum Passivhaus: Wohnen Gestern - Heute - Morgen

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-07-01

While the first part of the symposium was dedicated to half-timbered buildings in the traditional style of Lausitz, Bohemia and Silesia, the second part discussed passive buildings. [German] Das Umgebindehaus ist ein weltweit einmaliger Haustyp und zum anderen ist es ein traditionelles Haus unserer Region der Oberlausitz und angrenzender Teile von Boehmen und Schlesien. Das Symposium behandelt das Umgebindehaus in Vergangenheit und Gegenwart und will Motivation und Ansaetze geben, dieses wunderschoene Baukulturgut zu erhalten und unter modernen Wohn-, Arbeits- und Lebensbedingungen zu nutzen. Der zweite Teil der Tagung ist nicht minder wichtig. Beim Passivhaus geht es im wesentlichen darum, Heizwaermeverluste im Winter so klein zu halten, dass sie von den Gewinnen (Sonnenenergie, inneres Waermeaufkommen u.a.) gedeckt werden koennen. Damit wird der Waermeschutz des Gebaeudes vielleicht bis an die Grenzen getrieben und es entstehen neue Anforderungen an das Energiemanagement und die Qualitaet der technischen Gebaeudeausruestung. (orig.)

Complete freedom; Voellig losgeloest

Energy Technology Data Exchange (ETDEWEB)

Baun, R.

2000-10-01

The first two places in the list of technology trends went to engine technology - while the bronze medal was won by X-by-wire systems. The possibility of accelerating, braking, steering and gear shifting without mechanical links or connections creates new degrees of packaging freedom and allows for more comfort and safety. Some systems - for example the electronic accelerator - are already state-of-the-art technology. Steering and braking systems, however, still have a number of bureaucratic - and other - hurdles to overcome. (orig.) [German] Die beiden ersten Plaetze bei den Techniktrends gingen an die Motorentechnik - die Bronze-Medaille konnten sich die X-by-Wire-Systeme erobern. Beschleunigen, bremsen, lenken und schalten ohne mechanische Gestaenge oder Verbindungen schaffen neue Freiheitsgrade beim Package und ermoeglichen mehr Komfort und Sicherheit. Einige Systeme - etwa E-Gas - sind schon Stand der Technik. Bei den Lenk- und Bremssystemen stehen - unter anderem - noch buerokratische Sicherheitshuerden im Weg. (orig.)

Les particules illocutoires, variable d’ajustement de la traduction sous-titrante au cinéma

Directory of Open Access Journals (Sweden)

Ève Vayssière

2010-12-01

Full Text Available Die illokutiven Partikel fungieren als Anpassungsvariable, die beim Übersetzungsakt zur Untertitelung von Filmen entweder weggelassen werden oder erscheinen. Wenn sie einfach gelöscht werden, ergeben sich weder grammatikalische Störungen noch Informationsverlust. Das Auftauchen dieser Partikel in den deutschen Untertiteln zeigt jedoch, wie wichtig sie sind: Als Partikel der Oralität tragen sie zur Idiomatizität bei.Les particules illocutoires sont des variables d’ajustement lors de l’acte de traduction sous-titrante au cinéma, elles peuvent être supprimées sans que cela occasionne de dysfonctionnement grammatical et elles disparaissent lors de la traduction en français sans que cela occasionne une perte d’informations. Leur apparition dans les sous-titres allemands montre néanmoins leur importance : particules de l’oralité, elles sont vecteur d’« idiomaticité ».

Effects of the preparation process on the quality of refuse-derived fuels: The example of chlorine; Einfluss der Aufbereitung auf die Qualitaet der Ersatzbrennstoffe am Beispiel von Chlor

Energy Technology Data Exchange (ETDEWEB)

Kost, T.; Roetter, S.; Bilitewski, B. [Technische Univ. Dresden (Germany)

2000-07-01

The different interest groups (environmental authorities, licensing authorities, producers and users of refuse-derived fuels) have different guidelines, proposals and product specifications for quality assurance. While the limiting values for heavy metals reflect the controversial positions of the parties concerned, limiting values for chlorine are generally set at less than 1 percent by weight. This is not an ecological consideration but derives from the technical aspects of safe operation in the industries concerned. [German] Fuer die Guetesicherung von Ersatzbrennstoffen liegen von den beteiligten Interessengruppen (Umweltaemter, Genehmigungsbehoerden, Hersteller und Anwender von Ersatzbrennstoffen) verschiedene Grenzwerte als Richtlinien, Vorschlaege und Produktspezifikationen vor. Waehrend die Werte fuer Schwermetalle die teilweise kontraere Positionen der Beteiligten widerspiegeln, besteht fuer den Parameter Chlor dagegen eine einheitliche Spezifikation von <1 Gew.-% (wf). Dieser Wert ergibt sich nicht in erster Linie aus oekologischen Anforderungen, sondern ist vielmehr an technischen Aspekten der Betriebssicherheit beim Einsatz in den Anwenderindustrien orientiert. (orig.)

Absorbers for combined heating and cooling permit new concepts; Absorber zum Kuehlen und Heizen gestatten neue Konzepte

Energy Technology Data Exchange (ETDEWEB)

Stadelmann, M. [Verband der Schweizerischen Gasindustrie, Zurich (Switzerland)

1998-05-01

Direct-fuelled absorption-type refrigerators are recently being used not only for cold generation but also for heat generation with a flow temperature of 80 C. They can cool, heat, or cool and heat simultaneously, eah with a 50% share. This opens up new fields of application, either as a stand-alone system or combined with a gas engine cogeneration unit and absorber for cold generation. Two examples are presented, i.e. a hotel and a shopping mall. (orig.) [Deutsch] Direktbefeuerte Absorptionskaeltemaschinen erzeugen neuerdings nicht nur Kaelte, sondern auch Heizungswaerme mit 80 C Vorlauftemperatur. Sie koennen kuehlen, heizen oder - bis je 50% der Leistung - beides gleichzeitig. Der Teillastwirkungsgrad beim Kuehlbetrieb ist hoeher als bekannt. Das eroeffnet neue Moeglichkeiten des Einsatzes solcher Geraete, sei es allein oder zusammen mit Gasmotor-BHKW und Absorber zur Kaelteerzeugung. Zwei Beispiele - ein Hotel und ein Einkaufszentrum - werden vorgestellt. (orig.)

Rehabilitation of extremity war injuries with lesion of peripheral nerves in "PRAXIS" Centre for Physical Medicine and Rehabilitation, Sarajevo

Directory of Open Access Journals (Sweden)

Džemal Pecar

2003-08-01

Full Text Available Polytrauma with significant lesion of peripheral nerves is a specific war injury. It is also one of the most delicate problems in rehabilitation treatment because it requires a close cooperation with surgeon and timely surgical interventions. Based on our experience, the best results in the treatment of injured persons with lesion of peripheralnerves have been accomplished after the surgical treatment. Results in the neurolysis were better than those accomplished in neurorrhaphy. Total of 436 patients with lesion of peripheral nerves were recorded and 56 patients with plexus lesion. Out of this number, 78 patients (about 15% had surgical treatment (41 neurorrhaphy and 37 neurolysis. Due to lack of adequate ENMG diagnostics, the objective valorisation of treatment outcome was not possible.

Interdisciplinary shock-room care: tasks for the radiologist from the viewpoint of the trauma surgeon

International Nuclear Information System (INIS)

Mutschler, W.; Kanz, K.G.

2002-01-01

Efficient resuscitation of major trauma requests an interdisciplinary communication between trauma surgeons, anaesthesiologists and radiologists. Trauma outcome is significantly influenced by horizontal trauma team organisation and coherence to clinical algorithms, which allow fast diagnosis and intervention. A radiologist present on patients arrival in the trauma room provides a major impact on trauma care. Nevertheless optimal integration in the trauma team implies profound knowledge of the priorities of advanced trauma life support and trauma algorithms. His or her involvement is not limited to patient care only, also active participation in trauma room design, interdisciplinary algorithm development and trauma research are essential tasks for radiologists devoted to emergency radiology. Based on the pathophysiology of polytrauma and the structure of German trauma system, current concepts and proven clinical algorithms with special regard to the radiologist and his duties and tasks will are presented. (orig.) [de

OK-432 as a sclerosing agent to treat wound-healing impairment.

Science.gov (United States)

Fasching, G; Sinzig, M

2007-12-01

We report on the application of OK-432 (picibanil) in a patient with prolonged wound healing impairment. A 13-year-old girl had suffered a polytrauma with a displaced fracture of the sacrum which required neurosurgical decompression of the sacral plexus. Postoperatively, a seroma with recurrent fistulation was seen. Excision of the wound, prolonged suction drainage and the instillation of hypertonic glucose solution did not have any effect over a period of four months postoperatively. Relying on our personal experience of the treatment of lymphangiomas using OK-432 we instilled OK-432 into the wound. Leakage stopped immediately, there was a regression of fluid accumulation and four weeks later the ultrasound examination was normal. The patient is still asymptomatic four years after treatment. OK-432 can be used effectively for the treatment of chronic wound healing impairment.