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According to the literature, the need for surgical treatment of fractures of the lower extremity in patients with chronic spinal cord injury (SCI) is very limited. Conservative management is usually presented as the treatment of choice. We present the results of a retrospective review of 55 fractures in 44 patients from 1996 to 2000 which were managed surgically. Rating of the outcome was based on basic clinical and radiological criteria. The results of the radiological investigation on bone remodeling and bone positioning after healing were rated as good or excellent in 43 and fair in five limbs. In five cases, the treatment failed. For 53 of the 55 fractures, the patients regained their normal level of independence. Comparing our results to those presented in the literature, we clearly had fewer complications as well as better clinical and radiological results. We therefore advocate surgical treatment as an appropriate choice of treatment for lower extremity fractures of patients with chronic SCI.

The cost pressures in the German health care system continue to rise. In the context of the introduction of the DRG system, adequate treatment of paraplegic and tetraplegic patients within the financial limits will become even more difficult. In dispute with health care insurance companies, scientifically sound studies have been lacking to justify a treatment lasting up to six months as an in-patient of individuals with acute spinal cord injury or disease. The FIM (Functional Independence Measurement), established as a reliable tool in the evaluation of the functional development of patients presenting with acute spinal cord lesions, has been used as the basic tool in our study. Under the conditions of a specialized spinal cord injury centre the FIM showed a statistically highly significant increase of functional independence during the entire course of treatment. No therapeutic standstill could be detected in order to determine a point of discharge. Even in the last six weeks of treatment significant progress in functional independence can be observed.

There is a growing number of mobility-impaired and wheelchair-dependent patients caused by diseases and injuries of the central nervous system. The risk is high for pressure sores to develop due to disturbances of the motor, sensory, and autonomic nervous system. Numerous seating systems for prophylaxis and treatment of decubitus ulcer are available. To identify risk parameters, the literature on animal experiments regarding pressure ulcers was reviewed. A study on the reproducibility of the analysis method with capacitive sensors tested in ten paraplegics with 470 measurements is presented. It shows the reliability of the procedure.

The contents of the vitamins B1 (27 ng/ml), B2 (57 ng/ml), A (1.3 micrograms/ml), and E (9.7 micrograms/ml) as well as beta-carotene (0.2 microgram/ml) in transitional human milk were determined for up to 35 women aged between 19 and 31 years. Additionally, the vitamin content in maternal and cord plasma as well as the erythrocytic transketolase- and glutathione-reductase activities of the water soluble vitamins were measured. Dietary recalls were evaluated for the nutritional intake of vitamins. Concerning the fat soluble vitamins, the breast fed newborns received the recommended amounts of the German Society of Nutrition (DGE) for this group. In contrast to this, the supply of the water soluble vitamins (B1: 13.5 micrograms/500 ml; B2: 28.5 micrograms/500 ml) attained only 5 to 10% of the recommendations for newborns during the first two weeks after parturition with breast feeding. Vitamin content of maternal plasma (B1: 6.1 +/- 2.8 ng/ml) and erythrocytic enzyme activities (alpha ETK: 0.86-1.62; alpha EGR: 1.08-1.75) indicated a low or sufficient intake, while the values in cord blood (B1: 19.8 +/- 6.5 ng/ml; alpha ETK: 0.62-1.62; alpha EGR: 1.01-1.47) were in accordance with a satisfactory supply.