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The diagnosis and treatment of patients with chronic wounds is an enormous challenge in various disciplines of medicine. These very complex processes usually involve several experts of different medical specialties with varying educational backgrounds. A necessary basis for consistent communication and documentation is the use of unambiguous nomenclature. Therefore, the board of the German wound association, Initiative for Chronic Wounds (ICW) e.V., has started to define various terms and procedures. An easy to remember algorithm, in the form of the ABCDE rule, has been developed for the structured diagnosis of chronic wounds. The successful therapy of chronic wounds is then based on the causal treatment of the underlying, pathophysiological relevant diseases. M.O.I.S.T. a concept which helps health professionals in the systematic approach to the local treatment of patients with chronic wounds, in conforming to the most up-to-date scientific knowledge. By using consistent definitions and standards in wound care, it is possible to optimise current diagnostic and treatment strategies as well as to make them more easily understandable.

Background: The Society for Vascular Surgery Lower Extremity Guidelines Committee developed the Wound, Ischemia, foot Infection (WIfI) a classification system to predict the amputation risk in patients with critical limb ischemia (CLI). A number of published studies have already evaluated its prognostic value. However, most of the included patients were diabetic, and the validation was done independent of the revascularization procedure. This single-center study evaluated the prognostic value of WIfI stages in nondiabetic patients treated by endovascular means., Methods: A retrospective analysis was performed of prospectively collected data of nondiabetic patients treated by endovascular means between January 2013 and September 2014. All patients were classified according to their wound status, ischemia index, and extent of foot infection to four classes: very low risk, low risk, moderate risk, and high risk. Comorbidities and vascular lesions for each group were analyzed. The prognostic value of WIfI was analyzed based on the amputation-free survival, overall survival rate, and freedom from amputation at 12 months., Results: Data from 302 CLI patients treated in the study period were reviewed. A total of 219 patients (73%) underwent an endovascular intervention, and among them, 126 nondiabetic patients (58%) were enrolled in this study. Most patients were classified as low risk (33%), and the prevalence of very low-risk, moderate-risk, and very high-risk patients was 23%, 23%, and 21%, respectively. The modified Edifoligide for the Prevention of Infrainguinal Vein Graft Failure (PREVENT III) score was statistically significantly higher in the high-risk group (5.2 ± 2.4) than in the very low-risk, low-risk, and moderate-risk groups (4.3 ± 2.5, 3.5 ± 2.3, 4.5 ± 2.2, respectively; P = .048). One major amputation (1%) was performed during the hospital stay in a high-risk patient. Mean follow-up was 14 ± 8 months. The amputation-free survival at 12 months was 87%, 81%, 81%, and 62%, in the very low-risk, low-risk, moderate risk, and very high-risk groups, respectively (P = .106). The difference was statistically significant between the very low-risk and high-risk groups (hazard ratio, 3.4; 95% confidence interval, 1.1-10.3; P = .029). A similar trend was also observed for 1-year survival between the very low-risk and the high-risk groups (87%, 84%, 81%, 65%; P = .166). The amputation rate during the follow-up time was 0%, 2% (n = 6), 3% (n = 5), and 12% (n = 9) for the very low-risk, low-risk, moderate-risk, and very high-risk groups, respectively (P = .033)., Conclusions: The WIfI classification system predicted the amputation risk and survival in this highly selected group of nondiabetic CLI patients treated by endovascular means, with a statistically significant difference between very low-risk and high-risk patients already at 1 year., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

History and Admission Findings: 5 heroin addicts (aged 31-44 years; 1 female, 4 men) presented with a history of blurred vision and diplopia followed by dysarthria. 3 of the patients also developed respiratory failure requiring long-term ventilatory support. Physical examination revealed cranial nerve deficits and abscesses at injection sites in 3 of them., Diagnosis: In 4 patients wound botulism was diagnosed on the basis of symptoms, course of the illness and response to specific treatment. Clostridium botulinum was grown from wound swab in one patient., Treatment and Course: Two of the patients, having been injected with antitoxin immediately after admission, were discharged almost symptom-free after only a few days. Adjuvant antibiotics and, in 3 patients, surgical débridement of the abscesses were needed., Conclusions: Progressive cranial nerve pareses in addicts who inject drugs intravenously or intramuscularly should raise the suspicion of wound botulism and require hospitalization. While indirect demonstration of toxin supports the diagnosis, false-negative results are common.

Access to health care always has been one of the most critical issues for offshore crews. Therefore, telemedicine has a long and outstanding tradition in the maritime environment. Since 1931 Cuxhaven medical center (Medico Cuxhaven) operates as a hospital-based radio medical advice center (RMA) for ships worldwide providing one of the first routine telemedical services worldwide. For a long time this task was performed on a honorary basis by the hospital's physicians. In 1994 Germany accepted the IMO/ILO (International Maritime Organisation and International Labour Organisation) solution 164. Therefore, in 1998 a formal contract of the German Ministry of Transport officially installed Medico Cuxhaven as the TMAS Center for Germany. According to IMO/ILO solution 164, the RMA provides an expert level of care 24 h/day, 365 days/year. Cuxhaven hospital is a busy general hospital with departments of anesthesia and intensive care, internal medicine, surgery, gynecology and obstetrics, urology, pediatrics, ENT, radiology, and pain medicine. All physicians directly responding to TMAS calls have practical experience in maritime routine and emergency medicine. All incoming emergency calls are primarily handled by board-certified anesthesiologists, experienced in martime emergency medicine (e. g., staffing coastal SAR helicopters, working on rescue boats, carrying out repatriation services for sailors worldwide). If needed, other medical specialists are included. Today, Medico Cuxhaven takes an average workload of one to two emergency calls (response time < 20 s), two to three follow-up calls and approximately one informative call per day. Since 2000 transmission of digital photos has been used for routine RMA. Recently, a system for online and trenddata telemetry of twelve-lead ECG, NIBP (noninvasive blood pressure measurement), CO(2), SaO(2), pulse and respiration rates including the transmission of video images was developed. This system allows worldwide communications as it is capable of all possible means of telecommunication such as GSM, Inmarsat-ISDN or Iridium-Satellite-Transmission. So far, this system has been installed on board several German SAR rescue boats.However, radio telephone and the simple transmission of digital photography remain the basis of maritime radio medical advice service.