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Background: Today, humerus nails have become the surgical method of choice in the treatment of humerus shaft fractures. Whether or not the radial nerve should be intraoperatively examined by default in case of primary paresis is currently under discussion. Patients and Methods: Clinical findings from 38 patients with humeral shaft fractures surgically treated with unreamed humerus nail (UHN) at the Department of Accident Surgery, University Clinics Bonn, Germany, between 2000 and 2003 were retrospectively assessed. Constant Score was applied for evaluation of functional results. Results: In 40% of patients, primary radial nerve paresis was present. This was especially common after high energy trauma (e.g. traffic accident) and significantly increased in fractures of the middle third. In 93% of cases, spontaneous remission of motor and sensory loss was observed. No iatrogenic radial nerve impairment occurred. Conclusion: Due to the high rates of spontaneous remissions of radial nerve palsy after treatment with UHN in humerus shaft fractures, primar exploration of the radial nerve does not appear to be necessary.

Nicht dislozierte unkomplizierte Bruche ohne Gelenkbeteiligung konnen zum Teil konservativ versorgt werden. Doch der Vorteil einer operativen Behandlung nach einer Fraktur ist, dass der Patient nicht wochenlang mit dem Gips liegt, sondern ohne ausere Fixation rasch wieder mobil ist. Gerade bei alteren Patienten lassen sich so das Thromboembolie risiko und der Pflegeaufwand erheblich reduzieren.

Main task of diffusion experiments in liquids is to avoid additional transport induced by convection. Even under microgravity conditions aboard a space vehicle, diffusion measurements can be disturbed. Additional transport due to residual accelerations and vibrations can only be analysed under low gravity conditions. For the 28th ESA Parabolic flight campaign (May 2000), modified for the 31st ESA Parabolic flight campaign (October 2001) and for the 34th ESA Parabolic flight campaign (April 2003), a model experiment using water as liquid was developed. Because of the short term of a parabola, the analogy between diffusive mass transport and the faster heat transport was used. The angle between the 4mm or 10mm thin capillary and the direction of acceleration ranged between 0∘ and 90∘. For an oscillation amplitude of 100mm, the increase of the frequency up to 1 Hz led to a slight increase of the additional transport. Experiments with 1.7 Hz showed an additional transport of maximum 50%. An effect of the angle between the capillary and the acceleration vector was in the order of the error.

Diffusion and convection in melts play an important role in most technological processes involving the liquid state. Many diffusion experiments in liquids suffer from additional transport induced by gravity-driven flow. Therefore, different research groups performed experiments under microgravity conditions aboard a space vehicle. But even there, diffusion measurements can be disturbed by residual accelerations and vibrations. To analyse this additional transport, model experiments using water as liquid were performed inside an airplane performing zero gravity flight manoeuvres. Because of the short duration of low gravity, the analogy between diffusive mass transport and the faster heat transport was used. The angle between the capillary and the direction of acceleration ranged between 0° and 90°. For an oscillation amplitude of 100 mm, the increase of the frequency up to 1 Hz led to a slight increase of the additional transport. Experiments with 1.7 Hz showed an additional transport of a 50% maximum. The effect of the angle between the capillary and the acceleration vector was within the experimental error limits.

This paper presents results of the measurement of solute diffusivities in the Al–Ni and Sn–Bi–In systems. These experiments were conducted in microgravity and may therefore be assigned as reference values. A dedicated facility, which can be used for processing of four identical samples in parallel, was developed for the experiments under consideration. In addition, a rather thorough analysis of possible error sources in shear cell type experiments is carried out. Comparison with work carried out using magnetic fields to control convective flows, and with previous indirect measurements results, is also provided. A coherent picture emerges from the overall agreement between various measurements, and the data from the current work can thus be considered as reference benchmarks for future experiments. Another conclusion of the present study is that the shear cell technique is well suited for the measurement of solute diffusivities.

The effect of acetyl - tyrosyl-valyl-alanyl-aspartyl - chloromethylketone (ac-YVAD-cmk), an irreversible caspase-1 (IL-1beta converting enzyme, ICE) inhibitor on mortality, leukocyte and platelet counts and cytokine levels was investigated in a double-blind rat model of endotoxaemia. Intravenous (i.v.) bolus administration of lipopolysaccharide (LPS) (25-75 mg kg(-1), n=12 per group) to anaesthetized rats induced a dose dependent increase in mortality over 8 h (LD(50)=48 mg kg(-1)). During this period, animals became leukopenic and thrombocytopenic. Serum levels of IL-beta, IL-6, and TNF-alpha were highly elevated. Pretreatment of rats with ac-YVAD-cmk at a dose of 12.5 micromol kg(-1) significantly reduced mortality from 83 to 33% using Log Rank analysis. However, ac-YVAD-cmk did not modify blood cell counts or cytokine profiles as compared with the LPS-drug vehicle group. These data lay credence to the potential importance of caspase-1-inhibition in modifying the inflammatory response to endotoxin. Further investigations are warranted in understanding the relationship between caspase-1 inhibition, cytokine production and animal survival in different experimental paradigms of sepsis.

By doing experiments in space, it was possible to avoid convection in liquid diffusion experiments for the first time. Due to the improved accuracy it was possible to check experimentally different diffusion theories. Spacelab experiments revealed a square dependence of the self-diffusion coefficient on temperature for different metals (Sn, In, Pb, Sb) and for impurity diffusion and interdiffusion in the In-Sn system. For future microgravity experiments a new shear cell was developed, and shearing was investigated during parabolic flights in model experiments. The method of hydromagnetic damping of convection for ground-based liquid metal diffusion experiments was also tested.

Im Verlauf von 19 Jahren wurden 21 Kinder aufgrund einer vorderen oder hinteren Kreuzbandruptur in der Abteilung fur Unfall- und Wiederherstellungschirurgie des Universitatskrankenhauses Hamburg-Eppendorf operiert. Eine Ergebnisuberprufung, gestutzt auf poliklinische Daten sowie eine Nachuntersuchung von zwolf der 21 Patienten, erfolgte im Mittel 5,5 Jahre nach der operativen Versorgung. Die Nachuntersuchung beinhaltete die klinische Untersuchung, eine Untersuchung mit dem Kniearthrometer KT-1000, Rontgenaufnahmen und eine Kniegelenksonographie. Die anschliesende Ergebnisauswertung mit Hilfe von Scores bestatigte die uberwiegend guten bis sehr guten Ergebnisse. Langfristig ist eine prospektive Multicenterstudie zu initiieren, um statistisch fundierte, effiziente Behandlungsmethoden fur diese Verletzung im Kindesalter zu etablieren.

In the trauma emergency room 212 patients were asked--according to German law--for a blood sample for HIV-testing. Nine (4.2%) victims rejected the test, another 3 (1,4%) did not meet the study criteria since they were previously known to be HIV-positive or suffering from AIDS disease. None of the finally tested 200 patients was HIV-positive. On an anonymous questionnaire that was handed out additionally, 64% of the patients said they would accept HIV-testing without consent prior to operative treatment. 49% would reject HIV-testing without consent in non-operative treatment.

18 Patienten mit einer operativ versorgten Ruptur des hinteren Kreuzbandes wurden im Rahmen einer Nachuntersuchung zwei bis 13 Jahre nach der Operation vergleichend mit dem Kniearthrometer KT-1000 und radiologisch im Scheuba-Halteapparat untersucht. Die Messungen ergaben, das beide Methoden eine hohe Aussagekraft bezuglich hinterer Instabilitaten haben und sich in ihrer Aussage in 89% der Falle decken. In 11% der Falle fand sich eine Diskrepanz im Ubergangsbereich zwischen einer „+”-und „++”-Schulade in der Klassifikation nach Hughston et al. [5]. Da jedoch die Untersuchung im Scheuba-Halteapparat eine Strahlenbelastung mit sich bringt, stellt die Objektivierung einer hinteren Schublade mit dem KT-1000-Kniearthrometer eine in der Aussage sichere Alternative zur radiologischen Schubladenbestimmung dar.

The chemical short-range structure was studied in liquid Al–Ni alloys by x-ray absorption spectroscopy as a function of temperature and composition. A containerless technique, combining aerodynamic levitation and inductive heating, was used to position and melt the samples. The fluorescence yield x-ray absorption at the Ni K edge was measured by a multichannel solid-state Ge detector. The number of heteroatomic pairs around the scatterer is higher than for a homogeneous alloy.

The short-range order in liquid binary Al-rich alloys (Al-Fe, Al-Ti) was studied by x-ray diffraction. The measurements were performed using a novel containerless technique which combines aerodynamic levitation with inductive heating. The average structure factors, S(Q), have been determined for various temperatures and compositions in the stable liquid state. From S(Q), the pair correlation functions, g(r), have been calculated. The first interatomic distance is nearly temperature-independent, whereas the first-shell coordination number decreases with increasing temperature for all the alloys investigated. For the Al-Fe alloys, room-temperature scanning electron microscropy (SEM) studies show the formation of a microstructure, namely the existence of Al(13)Fe(4) inclusions in the Al matrix.

Today, early mobilization is recommended, irrespective of whether a patient with a fracture of the extremities has been treated conservatively or surgically. In this way, morbidity and mortality risks can be considerably reduced, in particular in the elderly patient. As a result of the continuing trend towards an ever shorter hospital stay, the general physician is faced with the task of providing aftercare to such patients at an early stage in the healing process of the fracture. This includes wound care, prevention of thromboembolism, the timely initiation of physiotherapeutic measures, and the requesting of x-ray follow-up.

When a fracture of an extremity has been established, the question immediately arises: should it be treated conservatively or surgically? For each of these options the three "R's" of fracture treatment apply "reduction, retention, rehabilitation". In humans, the most common fracture is that of the distal radius, which is usually amenable to conservative treatment. A fracture of the ankle is treated conservatively only when it is stable with no syndesmotic injury, and the fragments are in good alignment. Should surgical treatment be necessary, stabilization is accomplished with a plate and screws. The advantages and disadvantages of each of the options must be weighed up on an individual basis.

The initial care of a fractured bone provided by the general physician includes reduction followed by immobilization and the treatment of pain. Open fractures must be covered by a sterile dressing, prior to the transportation of the patient to a hospital. Depending upon the severity of the injury, further treatment is provided by an orthopedic surgeon or in an appropriate hospital.

The local short-to-intermediate range structure was studied in liquid Al-Ni and Al-Cu alloys by X-ray diffraction as a function of temperature and composition. A containerless technique, combining aerodynamic levitation and inductive heating, was used to position and melt the samples. The scattered intensity was recorded by an image plate. Liquid samples with compositions corresponding to an intermetallic solid phase show a pronounced prepeak in the structure function S(Q).

The aim of this prospective cohort study was to address the feasibility of measuring cytokines in serum and urine as early predictor tests for the identification of septic Intensive Care Unit (ICU) patients. The study group consisted of 10 septic and 5 non-septic patients at the onset of sepsis according to modified definitions by the American College of Chest Physicians (ACCP)/Society of Critical Care Medicine (SCCM). Serum and urine samples were taken from septic patients at the onset of sepsis and from non-septic patients, every 12 h for 3 days and thereafter every 24 h until day 10. Levels of TNF-alpha, IL-1beta, IL-6, IL-10, IL-18, IFN-gamma, MCP-1, and PCT (procalcitonin) were measured by ELISA. Apart from serum IL-18 and PCT levels, which were elevated in septic patients (p

The stimulatory effects of different purified lipopolysaccharide (LPS) preparations from E. coli, S. typhosa, P. aeruginosa, and K. pneumoniae on cytokine and chemokine production were measured in whole blood assays by ELISA. Incubation of 0.5 ml whole blood with 10 ng/ml E. coli and S. typhosa resulted in a time-dependent production of TNF-alpha, IL-1beta, IFN-gamma, IL-10 and MCP-1. K. pneumoniae, however, showed preferential effects on IL-1beta, IL-10 and MCP-1 production with less potent effects on TNF-alpha and IFN-gamma. LPS derived from P. aeruginosa showed a similar potency to other LPS preparations on MCP-1 production, yet completely failed to elicit the production of other cytokines. To further investigate potencies of the different LPS preparations, mediator production was determined following stimulation with agonist concentrations of 0.1 ng and 1000 ng per ml over a 24 h time period. Dose-response curves were obtained with LPS derived from E. coli, S. typhosa and K. pneumoniae on all mediators apart from IL-1beta and MCP-1. Most strikingly though, was the ability of LPS derived from P. aeruginosa to selectively elicit a significant dose-response effect on MCP-1 production, despite its very weak stimulatory effects on all other cytokines. These data imply that the bacterial origin of different LPS preparations can exhibit disparate effects on inflammatory mediator production. Furthermore, the potent, selective dose-response effect of P. aeruginosa LPS on MCP-1 production could help to explain the preponderance of a relentless inflammatory cellular infiltrate in diseases such as cystic fibrosis (CF).

Our objective was to investigate the levels of chemokines (MIP1-alpha, MCP-1, and Gro-alpha), Interleukin-18 (IL-18), and Interleukin (IL-6) in bronchoalveolar lavage (BAL) fluid and serum at the onset and ongoing states of sepsis as defined by the American College of Chest Physicians/Society of Critical Care Medicine in septic surgical ICU patients. Our summary background data was to understand the significance of compartmentalized inflammatory mediator production in an immunologically active organ (lung) in comparison with levels in the systemic circulation. The study group consisted of 20 septic patients and 10 non-septic patients on surgical ICU. At the onset of sepsis, both BAL fluid and serum samples were taken and levels of MIP-1alpha, MCP-1, GRO-alpha, IL-18, and IL-6 were measured by ELISA. Furthermore, over a subsequent 8-day period, levels of these mediators were determined in serum. In some experiments, IL-18 mRNA levels were determined in peripheral blood lymphocytes (PBL) of septic and non-septic patients. At the onset of sepsis, MIP-1alpha, MCP-1, GRO-alpha, IL-18, and IL-6 levels were significantly up-regulated in BAL fluid as compared with non-septic controls. In marked contrast, with the exception of IL-18 mRNA and IL-6 peptide, there was no increase in serum levels of inflammatory mediators determined both at the onset and during the ongoing states of sepsis. Based on the present data, monitoring levels of serum chemokines and IL-18 protein as markers of sepsis might be misleading since despite their non-detection in serum, they were highly up-regulated in the lung tissue compartment. These data might underscore the role of MIP-1alpha, MCP-1, GRO-alpha, and IL-18 in the mediation of local tissue damage. Furthermore, these findings raise the notion that mediator measurement in immunologically active organs might serve as pivotal indicators of sepsis prior to the actual fulfillment of specific clinical criteria that defines the patient as being septic.

We report a case of abdominal actinomycosis in a young woman wearing an intrauterine contraceptive device. The patient presented with right lower abdominal pain. A diagnostic laparoscopy was performed. Intraoperatively two perforations of the sigma were detected, a sigmoidectomy was performed. Postoperatively no problems occurred. Histology revealed an abdominal actinomycosis. In the literature only some case reports are published dealing with abdominal actinomycosis. Women wearing intrauterine contraceptive devices seem to have a higher risk of actinomycosis. In unproblematic cases antibiotic therapy is the treatment of choice. In cases of doubt as in our case surgery is recommended to confirm the diagnosis.

Hintergrund: Die Bedeutung von IL-18 im Mediatoren-Netzwerk der Sepsis ist unklar. Ziel der vorliegenden Studie war die Untersuchung, ob IL-18 bzw. IL-18-mRNA bei septischen Intensivpatienten in der broncho alveolaren Lavage und im Serum vermehrt nachweisbar sind.

Forty-one patients were analyzed after surgical treatment of Achilles tendon ruptures. The following parameters served as the outcome measure: (1) duration of wearing cast, (2) length of hospital stay, (3) outpatient treatment, (4) time of absence from work, (5) complications, (6) re-rupture rate, (7) subjective evaluation by patients, (8) scar condition, (9) ability to stand on tiptoes, (10) Thompson test, (11) movement of talocrural joint, (12) circumference data of lower extremity, (13) radiographs, (14) power measurement of the ankle (in kg), (15) ultrasound examination, (16) blood cholesterol levels, (17) scoring by Trillat's score. Surgical treatment achieved an excellent or good outcome in 91% of patients as evidenced by the Trillat score. Furthermore, cholesterol levels were found to be elevated in 83% of patients. Given the good results, surgical treatment of Achilles tendon ruptures is recommended, but patients of status post-Achilles tendon rupture should be checked for high cholesterol levels. In the future, controlled, prospective trials need to prove a correlation between Achilles tendon rupture and a pathological blood lipid status.

In liquid diffusion measurements, the main problem is the additional mass transport by convection. In the system indium-tin, convection caused by density gradients in horizontal and vertical capillaries was characterised, and the magnetohydrodynamic damping was investigated experimentally. While the magnetic field effect on diffusion experiments in vertical capillaries was relatively minor, the damping effect of the magnetic field could be clearly demonstrated in horizontal capillaries. Comparing these experiments with experiments in microgravity it can be seen that in the investigated system convection was practically completely suppressed by transversal magnetic fields higher than 3T. In electrically conducting crucibles, the sample was mixed by Lorentz forces on account of thermoelectric currents.

Die Erstversorgung eines Bruches ubernimmt meist der Hausarzt. Danach muss er abwagen, ob er den Patienten zu einem niedergelassenen Unfallchirurgen uberweisen oder gleich ins Krankenhaus schicken soll. Unsere Autoren haben fur Sie die typischen Frakturzeichen, ein Diagnoseschema sowie die wichtigsten Punkte bei der Erstversorgung eines Patienten mit einer Extremitatenfraktur zusammengefasst.

Hepatic masses are predominantly malignant, and whereas benign tumors are rare. We report the case of a 65-year-old man who presented with an anomalous hepatic mass. Following explorative laparotomy and left lateral segmentectomy (II/III), the patient was diagnosed as having an inflammatory pseudotumor of the liver. So far only 102 cases of "inflammatory pseudotumor of the liver" have been reported in the literature. Asia is a geographical center for this tumor entity, which mostly affects men. The major symptoms are nonspecific: fever, weight loss and general fatigue. The prognosis of "inflammatory pseudotumor of the liver" is very good. In 98% of the cases, a cure has been obtained after surgical therapy, but conservative therapy approaches also yield good results.

Hepatic masses are predominantly malignant, and whereas benign tumors are rare. We report the case of a 65-year-old man who presented with an anomalous hepatic mass. Following explorative laparotomy and left lateral segmentectomy (II/III), the patient was diagnosed as having an inflammatory pseudotumor of the liver. So far only 102 cases of "inflammatory pseudotumor of the liver" have been reported in the literature. Asia is a geographical center for this tumor entity, which mostly affects men. The major symptoms are nonspecific: fever, weight loss and general fatigue. The prognosis of "inflammatory pseudotumor of the liver" is very good. In 98% of the cases, a cure has been obtained after surgical therapy, but conservative therapy approaches also yield good results.

In 19 years 21 children were operated upon anterior or posterior ligament ruptures. Follow-up based on policlinical data and 12 out of 21 patients were tested on follow-up (average follow-up time: 5.5 years). We made notes of the clinical data of an examination with the knee-arthrometer KT-1000 as well as of radiologic and sonographic methods. The subsequent scoring revealed mostly good to very good results. Still, in the long run it would be desirable to perform a prospective multicenter study to obtain statistically relevant data to give advice for ideal surgical treatment of ligamentous knee injuries in children.

In the trauma emergency room 212 patients were asked--according to German law--for a blood sample for HIV-testing. Nine (4.2%) victims rejected the test, another 3 (1,4%) did not meet the study criteria since they were previously known to be HIV-positive or suffering from AIDS disease. None of the finally tested 200 patients was HIV-positive. On an anonymous questionnaire that was handed out additionally, 64% of the patients said they would accept HIV-testing without consent prior to operative treatment. 49% would reject HIV-testing without consent in non-operative treatment.

Eighteen patients with surgically treated ruptures of the posterior cruciate ligament were tested on follow-up 2 to 13 years with KT-1000 Kneearthrometer and radiologically according to Scheuba to objectify the clinical results and to compare the 2 methods. It could be shown that both methods are highly specific and do correspond in 89%. In 11% a borderline difference between a "+" posterior drawer and a "++" posterior drawer in the classification by Hughston et al. [5] was detected. Since the Scheuba test does involve radiation, the KT-1000 Knee-arthrometer testing device represents a safe alternative to objectify a posterior drawer.

We report a case of abdominal actinomycosis in a young woman wearing an intrauterine contraceptive device. The patient presented with right lower abdominal pain. A diagnostic laparoscopy was performed. Intraoperatively two perforations of the sigma were detected, a sigmoidectomy was performed. Postoperatively no problems occurred. Histology revealed an abdominal actinomycosis. In the literature only some case reports are published dealing with abdominal actinomycosis. Women wearing intrauterine contraceptive devices seem to have a higher risk of actinomycosis. In unproblematic cases antibiotic therapy is the treatment of choice. In cases of doubt as in our case surgery is recommended to confirm the diagnosis.