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Abstract Objective Thoracic outlet syndrome (TOS) is a clinical phenomenon resulting from compression of the neurovascular structures at the superior aperture of the thorax which presents with varying symptoms. Regarding to the varying symptoms, the diagnosis of TOS seems to be a challenge and predictors for the outcome are rare. The purpose of this study was therefore to analyze the different clinical examinations and tests relative to their prediction of the clinical outcome subsequent to surgery. Methods During a period of five years, 56 patients were diagnosed with TOS. Medical history, clinical tests, operative procedure and complications were recorded and analysed. Mean follow-up of the patients was 55.6 ± 45.5 months, median age of the patients was 36.4 ± 12.5 years. Results Different clinical tests for TOS showed an acceptable sensitivity overall, but a poor specificity. A positive test was not associated with a poor outcome. Analyses of the systolic blood pressure before and after exercise showed, that a distinct decrease in blood pressure of the affected side after exercises was associated with a poor outcome (p = 0.0027). Conclusions Clinical tests for TOS show a good sensitivity, but a poor specificity and cannot be used as predictors for the outcome. A distinct decrease in blood pressure of the affected side after exercises was associated with poor outcome and might be useful to predict the patients' outcome.

Objectives: Rat fracture models are extensively used to characterize normal and pathological bone healing. Despite, systematic research on inter- and intra-individual differences of common rat bones examined is surprisingly not available. Thus, we studied the biomechanical behaviour and radiological characteristics of the humerus, the tibia and the femur of the male Wistar rat-all of which are potentially available in the experimental situation-to identify useful or detrimental biomechanical properties of each bone and to facilitate sample size calculations., Methods: 40 paired femura, tibiae and humeri of male Wistar rats (10-38 weeks, weight between 240 and 720 g) were analysed by DXA, pQCT scan and three-point-bending. Bearing and loading bars of the biomechanical setup were adapted percentually to the bone's length. Subgroups of light (skeletal immature) rats under 400 g (N = 11, 22 specimens of each bone) and heavy (mature) rats over 400 g (N = 9, 18 specimens of each bone) were formed and evaluated separately., Results: Radiologically, neither significant differences between left and right bones, nor a specific side preference was evident. Mean side differences of the BMC were relatively small (1-3% measured by DXA and 2.5-5% by pQCT). Over all, bone mineral content (BMC) assessed by DXA and pQCT (TOT CNT, CORT CNT) showed high correlations between each other (BMC vs. TOT and CORT CNT: R 2  = 0.94-0.99). The load-displacement diagram showed a typical, reproducible curve for each type of bone. Tibiae were the longest bones (mean 41.8 ± 4.12 mm) followed by femurs (mean 38.9 ± 4.12 mm) and humeri (mean 29.88 ± 3.33 mm). Failure loads and stiffness ranged from 175.4 ± 45.23 N / 315.6 ± 63.00 N/mm for the femurs, 124.6 ± 41.13 N / 260.5 ± 59.97 N/mm for the humeri to 117.1 ± 33.94 N / 143.8 ± 36.99 N/mm for the tibiae. Smallest interindividual differences were observed in failure loads of the femurs (CV% 8.6) and tibiae (CV% 10.7) of heavy animals, light animals showed good consistency in failure loads of the humeri (CV% 7.7). Most consistent results of both sides (left vs. right) in failure loads were provided by the femurs of light animals (mean difference 4.0 ± 2.8%); concerning stiffness, humeri of heavy animals were most consistent (mean difference of 6.2 ± 5%). In general, the failure loads showed strong correlations to the BMC (R 2  = 0.85-0.88) whereas stiffness correlated only moderate, except for the humerus (BMC vs. stiffness: R 2  = 0.79)., Discussion: Altogether, the rat's femur of mature specimens showed the most accurate and consistent radiological and biomechanical results. In synopsis with the common experimental use enabling comparison among different studies, this bone offers ideal biomechanical conditions for three point bending experiments. This can be explained by the combination of a superior aspect ratio and a round and long, straight morphology, which satisfies the beam criteria more than other bones tested.

Introduction: In trauma patients, injury of solid abdominal organs secondary to blunt trauma is a major source of morbidity and mortality. Different diagnostic options such as FAST sonography or CT scan have been described., Methods: Our trauma registry was used to identify multiple injured patients with blunt abdominal trauma during 2001 to 2006. Patient demographics, diagnostic and operative findings, treatment, complications, length of stay and mortality were reviewed., Results: Of 438 multiple injured patients, 58 patients were diagnosed with blunt abdominal trauma. During examination, free fluid or organ injury could be seen in 72.4% during sonography and in 84.3% of the patients who received CT scan, giving a sensitivity of 92% for initial FAST Sonography. Nevertheless, CT scan showed a higher sensitivity in detecting bowel (84%) or mesenteric (75%) injuries, if compared to FAST. 30 (51.7%) of the 58 patients had to undergo laparotomy because of blunt abdominal trauma, giving a laparotomy rate of 6.8% because of blunt abdominal trauma in multiple injured patients., Conclusion: Sonography is the method of choice for initial screening and CT scan in detecting bowel or mesenteric injuries. A large intraperitoneal fluid accumulation during initial sonography in combination with unstable vital signs should lead to an immediate exploratory laparotomy.

Objective: Skin and soft tissue abscesses are common findings in injecting drug users (IDUs) who present to the surgical emergency department for evaluation and treatment. Although most cases can be managed by incision and drainage, they do require special considerations as compared to abscesses which are not caused by intravenous drug abuse., Methods: Skin and soft tissue abscesses treated in the emergency department between 2005 and 2007 were reviewed and a systematic literature search of skin and soft tissue abscesses in IDUs was conducted, including the etiology, occurrence, risk factors, and treatment options, thus providing the rationale for the treatment algorithm presented herein., Results: The drugs injected, the technique by which they were injected, the attendant circumstances, as well as the immunological status of the IDUs were major factors for the development of abscesses. Skin and soft tissue abscesses in IDUs should be incised and drained under local or general anesthesia depending on the size, location, and association with neurovascular structures. Different factors have been taken into account when treating soft tissue abscesses in this population which predict their specific risks and therefore further therapy needs. The incidence of tetanus is high among IDUs compared to the general population, giving rise to the recommendation for a strict booster policy if the vaccination status is unclear when the patient presents to the emergency department. The presence of fever requires hospitalisation and evaluation for the presence of endocarditis. Foreign bodies, such as broken needles, should be ruled out by radiography, and duplex sonography should be performed to identify the presence of vascular complications. Prior to incision and drainage, prophylactic antimicrobial agents should be administered to every patient and as therapy for high-risk patients, such as immunocompromised patients and patients with fevers and chills., Conclusions: IDUs presenting with skin and soft tissue abscesses can be managed safely if some special issues are taken in account. The presented algorithm may help facilitate the decision-making in this context.

Objective: The aim of this study was to evaluate the technique of prosthetic mesh fixation in laparoscopic intraperitoneal incisional and ventral hernia repair using cyanoacrylat glue (Glubran GEM, Viareggio, Italy) in comparison with fixation methods using spiral tacks (Protack 5mm, Tyco) or transabdominal Prolene 4/0 sutures respectively., Method: Through a midline laparotomy 3 pieces (3 x 3cm) of mesh (n = 60) where fixed onto the intact peritoneum on either side of a midline laparotomy in 10 New Zealand White rabbits. Two types of meshes where compared: ePTFE meshes (Gore-Tex Dual Mesh W.L. Gore and Associates, Inc. Medical Products Division, Flagstaff, Arizona, USA) and polypropylene/ polyvinylfluorid meshes (Dyna Mesh - IPOM P.J. Dahlhausen and Co. GmbH, Germany). All animals were killed after 12 weeks. Upon scoring of the adhesions the prosthetic materials were excised en bloc with the anterior abdominal wall for tensile strength analysis and histologic evaluation., Results: In contrast to ePTFE meshes fixed with cyanoacrylat glue, PP meshes fixed with transabdominal sutures as well as with spiral tacks showed the highest percentage and tenacity of adhesions (p<0.033). Independent of the method of fixation, ePTFE meshes revealed a significantly higher shrinkage than PP prosthesis (41% vs 17% related to original mesh surface; p<0.033). The strength of the mesh incorporation was significantly higher in PP meshes (p<0.033). Fixation of PP meshes with cyanoacrylat glue showed an equivalent tensile strength as ePTFE meshes fixed with spiral tacks (6.6 +/- 2.7 N vs 6.6 +/- 3.1N)., Conclusion: In this rabbit model, intraabdominal fixation of PP composite meshes with cyanoacrylat glue was equivalent to ePTFE mesh fixation with spiral tacks concerning tensile strength analysis. Adhesions between mesh and abdominal wall were found more frequently after PP fixation. In contrast, mesh shrinkage was more evident after ePTFE mesh implantation.