Medical Library

[Relevance of Different Sequences in MRI-detected Subchondral Bone Damage of the Knee Joint and Possible Therapeutic Options.]

With the advent of magnetic resonance imaging (MRI) after knee injuries interest has focussed on the clinical relevance of different concomitant osseous damage. Different MRI- sequences reveal varying characteristics of such lesions. Prospective data of 69 patients with MRI-detected sub-acute subchondral fractures or bone bruises according to the classification of Mink was recorded. Function, symptoms (Noyes) and activity (Tegner) were assessed at the time of first MRI and 7,4 months later including a follow-up MRI using T 2-weighted fat saturated (fs) fast-spin-echo-sequences (FSE), T 1-weighted spin echo (SE) sequences, Proton-density-weighted spin echo-sequences (SE) and T 2-weighted (fs) gradient-echo-sequences. The patients were divided in 4 groups: patients with subchondral fracture and patients with pure bone bruise subdivided in patients with and without intraarticular knee lesions. Bone bruises were diagnosed in 44 cases, subchondral fractures in 25 patients. Patients without intra-articular pathology had significantly poorer function at the time of MRI with subchondral fractures, but not in the sub-group with intra-articular damage. Symptoms were not significantly different in both groups at this time. At 7,4 months both sub-groups with fractures had a lower level of function compared to patients with bone bruises, activity score and symptoms showed poorer results in the group without intraarticular lesion (p = 0,01 for all scores). T 1- weighted spin echo (SE) sequences revealed to be the most important tool to differentiate the various lesions. Hints for a modification of rehabilitation avoiding axial forces in case of subchondral fractures might be the use of isokinetics using open kinetic chain instead of closed kinetic chain or orthosis with relief of the affected compartment.

Lahm A, Spank H, Mrosek E, Frauendorf H, Merk H.

Universitätsklinik Greifswald, Klinik für Orthopädie und Orthopädische Chirurgie, Greifswald.

[\”Basketball Foot\” - Long-time Prognosis after Peritalar Dislocation.]

Subtalar dislocation is considered a severe injury but occurs rarely and studies generally refer to relatively small patient collectives. We investigated the functional outcome in 22 cases to determine the long-term prognosis. Since associated foot injury is common, we compared the outcome for 12 cases of isolated subtalar luxation with 10 cases of collateral fractures of the adjacent bones of the hind foot and Talus. 19 cases of complex, partially open injuries after high energy trauma have got excluded because of the apparently poor long-term results . The Kitaoka-hind-foot-Score (AOFAS) after mean follow up of 8.3 years indicated a significantly better outcome for isolated luxation. Nearly 50 % of isolated luxations had a excellent outcome (73 %, mean score 89), luxations with associated fractures had mainly good and fair results (73 %, mean score 74). Analysis of the gait pattern by dynamic plantar pressure measurement demonstrated lower pressures in the isolated luxation group and higher pressures in the group with associated fractures in the lateral region of the forefoot with shorter phases of weight bearing.

Simon LC, Schulz AP, Faschingbauer M, Morlock M, Jürgens C.

BG Unfallkrankenhaus Hamburg, Unfall- und Wiederherstellungschirurgie, Hamburg.

[Ski sport.]

Skiing is one of the most favoured winter sports, supported by the introduction of carving skies ten years ago. There\’s a close correlation between the design of the carving ski and a new skiing technique. Only a small number of persons is able to carve correctly. A special fitness program is necessary to be prepared adequately to the skills of carving. As proven by the latest injury statistics, the number of injuries has been declining over the last years. Due to the new skiing technique, injury patterns have changed. The most frequently affected injured region is still the knee joint. Prevention can be done by fitness training, watching instructional ski videos, and usage of well-fitting sports equipment. A new trend is the Telemark-technique, which shows different injury patterns than carving.

Bambach S, Kelm J, Hopp S.

Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar.

The European Perspective of Type 2 Diabetes Prevention: Diabetes in Europe - Prevention Using Lifestyle, Physical Activity and Nutritional Intervention (DE-PLAN) Project.

BACKGROUND: The prevalence of type 2 diabetes (T2D) has dramatically increased in Europe, and the age-at-diagnosis has become younger. Action is needed now to develop targeted prevention management program for T2D. The DE-PLAN (\”Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional intervention\”) project, led by the University of Helsinki is currently addressing this major public health concern in Europe. METHODS: The DE-PLAN project aims at developing and testing models of efficient identification and intervention of individuals at high risk of type 2 diabetes in the community. It conducts a lifestyle modification intervention in people at high risk for T2D. Furthermore, it tests the feasibility and cost-effectiveness of the translation of the current research evidence about preventive intervention program into clinical settings within existing health care systems in 17 European countries. RESULTS: This 3-year project spanning has commenced mid-2005. By now, 25 institutions from 17 countries are involved. CONCLUSION: The development of efficient screening strategies for type 2 diabetes risk as well as the development of core intervention strategies for the primary prevention of type 2 diabetes should significantly enhance the ability of health care professionals to respond swiftly to the drastic increase of T2D and its burden to the society.

Schwarz PE, Lindström J, Kissimova-Scarbeck K, Szybinski Z, Barengo NC, Peltonen M, Tuomilehto J.

1Department of Medicine III, Medical Faculty Carl Gustav Carus of the Technical University Dresden, Dresden, Germany.

Thrombin-Activatable Fibrinolysis Inhibitor and Cardiovascular Risk Factors in Polycystic Ovary Syndrome.

OBJECTIVE: We aimed to assess circulating thrombin activatable fibrinolysis inhibitor (TAFI) levels and carotid intima-media thickness (CIMT) in PCOS patients and control sujects. In this study we aimed to evaluate the relation between the levels of TAFI and homocysteine, high sensitive CRP (hsCRP), fibrinogen and CIMT in PCOS patients carrying a potential risk for developing CVD and diabetes and compared with age- and body mass index-matched controls. RESEARCH DESIGN AND METHODS: We studied 68 PCOS patients and 26 healthy controls. We conducted an observational study examining noninvasive markers of early CV disease in women with PCOS including structural CIMT. Noninvasive markers of early CVD, CIMT were measured in PCOS patients and control subjects. Metabolic parameters included fasting insulin and glucose levels, lipid and androgen levels, TAFI levels, hsCRP. RESULTS: Fasting glucose levels, prolactin, TSH, Total-cholesterol, LDL-cholesterol, triglyceride, estradiol, DHEA-S and age were similar in the two groups, whereas serum insulin, fibrinogen, hs-CRP, 17-OHP, free-testosterone, total testosterone, HOMA-IR, HDL were significantly elevated in PCOS patients in comparison to control subjects (p<0.05). Plasma TAFI levels were similarly in PCOS patients compared with healthy controls. No difference was observed in the combined IMT among the studied groups. CONCLUSIONS: In our study, no significant difference in lipid parameters was determined between patients with PCOS and healthy controls. In our study, we did not observed any difference in CIMT measurements and TAFI levels between patients with PCOS and healthy controls that can be explained by their low ages and short duration of PCOS.

Erdoğan M, Karadeniz M, Alper GE, Tamsel S, Uluer H, Cağlayan O, Saygılı F, Yılmaz C.

1Department of Endocrinolgy, Ege University School of Medicine, Izmir, Turkey.

[Anaesthesia in developing countries]

The German society \”Anaesthesia in Developing Countries\” aims at improving the anaesthetic care in the so called Third World. Main fields of activity are training/qualification and technical support, chiefly in East African countries; only recently steps towards the French speaking countries of Black Africa have been taken.

[The role of patient flow and surge capacity for in-hospital response in mass casualty events]

Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.

Sefrin P, Kuhnigk H.

Sektion für präklinische Notfallmedizin der Klinik und Poliklinik für Anästhesiologie. sefrin@agbn.de

[Emergency medicine and myocardial ischaemia - thrombolysis during cardiopulmonary resuscitation - available data and recommendations]

Patients suffering cardiac arrest still have a poor prognosis. Up to the present, no drug therapy has shown to improve longterm survival after cardiac arrest. Acute myocardial infarction (AMI) or massive pulmonary embolism (PE) are the underlying causes for sudden cardiac arrest in 50-70 % of patients. Thrombolysis is an effective and causal therapy in patients with AMI or PE. Therefore, combining cardiopulmonary resuscitation (CPR) with thrombolysis may be a promising therapeutic approach. Experimental studies have demonstrated that thrombolytic therapy during CPR is not only a causal treatment for coronary or pulmonary arterial thrombi, but may also improve microcirculatory reperfusion after cardiac arrest. Although numerous case series and small clinical studies showed evidence for the success of thrombolytic therapy during CPR, a large randomised study did not confirm these results. Thrombolysis during CPR today can not be recommended as a standard therapy in patients suffering cardiac arrest. However, it should be considered if a massive PE is supposed to be the cause of cardiac arrest or if conventional CPR has not been successful in a patient with presumed thrombotic cause of cardiac arrest. The expected bleeding risk is outweighed by the potential benefit of this therapy in selected patients.

Spöhr F, Böttiger BW.

Klinik für Anästhesiologieund Operative Intensivmedizin der UniversitätKöln. fabian.spoehr@uk-koeln.de

[Management of the acute myocardial infarction in the prehospital emergency setting. Reperfusing and antithrombotic therapy]

The early reperfusion of the occluded epicardial coronary artery and the antithrombotic therapy is of eminent importance in the management of the acute myocardial infarction with ST-segment-elevation. The emergency physician has a key role in establishing the diagnosis and deciding about the therapy. The following article describes modern concepts and the evidence of the emergency management of patients with myocardial infarction.

Hilker E, Breithardt G.

Medizinischen Klinik und Poliklinik C (Kardiologie und Angiologie) des Universitätsklinikums Münster. hilkere@uni-muenster.de

[In Process Citation]

Weber T, Van Aken H.

Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin des UK Münsterund Arztlicher Leiter Rettungsdienstder Stadt Münster.