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Background: Intravenous thrombolysis for ischaemic stroke remains underused worldwide. We aimed to assess whether our statewide comprehensive stroke management programme would improve thrombolysis use and clinical outcome in patients., Methods: In 2008-09, we designed the Tyrol Stroke Pathway, which provided information campaigns for the public and standardised the entire treatment pathway from stroke onset to outpatient rehabilitation. It was commenced in Tyrol, Austria, as a long-term routine-care programme and aimed to include all patients with stroke in the survey area. We focused on thrombolysis use and outcome in the first full 4 years of implementation (2010-13)., Findings: We enrolled 4947 (99%) of 4992 patients with ischaemic stroke who were admitted to hospitals in Tyrol; 675 (14%) of the enrollees were treated with alteplase. Thrombolysis administration in Tyrol increased after programme implementation, from 160 of 1238 patients (12·9%, 95% CI 11·1-14·9) in 2010 to 213 of 1266 patients (16·8%, 14·8-19·0) in 2013 (ptrend 2010-13<0·0001). Differences in use of thrombolysis in the nine counties of Tyrol in 2010 (range, 2·2-22·6%) were reduced by 2013 (12·1-22·5%). Median statewide door-to-needle time decreased from 49 min (IQR 35-60) in 2010 to 44 min (29-60) in 2013; symptomatic post-thrombolysis intracerebral haemorrhages occurred in 28 of 675 patients (4·1%, 95% CI 2·8-5·9) during 2010-13. In four Austrian states without similar stroke programmes, thrombolysis administration remained stable or declined between 2010 and 2013 (mean reduction 14·4%, 95% CI 10·9-17·9). Although the 3-month mortality was not affected by our programme (137 [13%] of 1060 patients in 2010 vs 143 [13%] of 1069 patients in 2013), 3-month functional outcome significantly improved (modified Rankin Scale score 0-1 in 375 [40%] of 944 patients in 2010 vs 493 [53%] of 939 in 2013; score 0-2 in 531 [56%] patients in 2010 and 615 [65%] in 2013; ptrend 2010-13<0·0001)., Interpretation: During the period of implementation of our comprehensive stroke management programme, thrombolysis administration increased and clinical outcome significantly improved, although mortality did not change. We hope that these results will guide health authorities and stroke physicians elsewhere when implementing similar programmes for patients with stroke., Funding: Reformpool of the Tyrolean Health Care Fund., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: There are no data on the association between acute inflammation during critical illness and long-term mortality in ICU patients., Methods: Nonsurgical patients with an ICU length of stay > 24 h surviving until ICU discharge were included into this prospective, observational, follow-up study. Demographics, chronic diseases, admission diagnosis, the Simplified Acute Physiology Score (SAPS) II, length of ICU stay, maximum C-reactive protein (CRP) levels during the ICU stay (CRPmax), and CRP levels at ICU discharge (CRPdis) were documented. After a follow-up time of 1.88 ± 1.16 years (range, 0.5-4 years), the survival status was determined., Results: Seven hundred sixty-five patients were enrolled into the study protocol. One hundred fifty-eight patients (20.7%) died within 0.62 ± 0.88 years after ICU discharge. Cumulative survival rates differed between patients grouped into the CRPmax and CRPdis quartiles. Patients in the first and second CRPmax quartiles had better cumulative survival rates than those in higher CRPmax quartiles (all P < .001). Patients in the first CRPdis quartile had better cumulative survival rates than those in higher CRPdis quartiles (all P < .001). Using adjusted Cox proportional hazards models, both CRPmax and CRPdis were independently associated with post-ICU mortality (both P < .001). Furthermore, the number of chronic diseases (P < .001), age (P < .001), and the SAPS II (P = .03) were associated with post-ICU mortality in both Cox models., Conclusions: CRP levels during critical illness seem independently associated with post-ICU survival in nonsurgical ICU patients. Future research focusing on the association between acute systemic inflammation and post-ICU outcome is warranted in order to improve long-term survival of critically ill patients.

With a collective of 46 patients we show the details and kinds of accidents caused by paragliding. The base for the casuistry of the accidents was a questionnaire which was answered by most of the injured persons. These were questions about the theoretical and practical training, the course of the flight during the different phases, and the subjective point of view of the course of the accident. The patterns of the injuries showed a high incidence of injuries of the spinal column and high risks for the ankles. At the end, we give some advice how to prevent these accidents.

186 lower leg torsional fractures treated via percutaneous cerclage wiring (Götze's method) yielded good to very good final results. There were no intraoperative complications such as lesions of the vessels and nerves. The number of refractures (1.61%), the incidence of delayed healing (4.3%), infections (3.23%) and misalignments (6.9%) are all comparable with data that can be found in the literature. No pseudoarthroses were seen. Besides low rate of complications and the rapidity of the procedure, the simplicity and low cost of the required instrumentarium are also very attractive. The fact that the patients remain in the hospital for a short while only, is yet another contribution to keeping the cost of general health care low in these times of exploding expenditure for medical attendance.

A follow-up series of 324 lower leg fractures treated between 1980 and 1985 in a regional hospital showed overall good results. Besides a non-union-rate of 0% there were also low values for infection (3.7%), re-fracture (2.16%), delayed healing (4.63%) and thrombosis (3.42%). Many reasons are dealing with that. First of all, most of our patients were young, active people, who sustained their injuries during ski-accidents with a high amount of torsional-type lesions (A1, B1, C1; Johner/Wruhs-scheme). The second important point was, to use a simple, quick and safe method with the possibility of a short hospital stay and good final outcome, managing the high frequency of victims, admitting the trauma unit in the late afternoon after closure of ski-lifts. Finally, one has to realize, that most of our patients had been treated by one surgeon, who has a lot of experience with the aforementioned methods. We can state finally, that percutaneous cerclage-wires (Götzes method) will be used for spiral fractures, occurring in the second to fourthfifth, in future, too. Bending-type fractures with one or more butterfly-fragments (B2, B3) and segmental fractures (C2), should be treated by interlocking nailing. Only fractures with severe closed soft tissue injuries or open fractures (grade II-III-Tscherne), will be managed by an external frame. Compression plates should only be used for fractures in the first or fifth fifth with articular lesions.