[Intracranial pressure monitoring in polytrauma patients with traumatic brain injury]. / Hirndruckmonitoring beim Polytraumatisierten mit Schädel-Hirn-Trauma.

BACKGROUND: The monitoring of intracranial pressure (ICP) represents a cornerstone in the intensive care of patients with traumatic brain injury (TBI) and the industry provides various technical solutions to this end. Decompressive craniectomy can be an option if conservative measures fail to reduce excessive ICP. OBJECTIVE: To examine the pathophysiology of ICP in trauma, the management of polytrauma involving TBI, and the indications for decompressive craniectomy; and to compare the different monitoring systems and their complications. MATERIAL AND METHODS: A retrospective analysis of TBI patients between 2010 and 2016 was performed. Relevant publications are discussed, particularly those relating to the indications for monitoring and its influence on polytrauma management. RESULTS: Between 2010 and 2016, 106 patients with closed TBI and a mean age of 65.9 years received a total of 120 ICP monitors, most of which were parenchyma devices (111/120), followed by intraventricular catheters (8/120), and one combined system (1/120). Of these patients, 27.4% had sustained polytrauma, whilst 33% regularly used anticoagulants. ICP monitors were removed after 8.5 days on an average and the mean ICU stay was 20 days. Probe insertion was combined with craniectomy in 69.8% patients. Probe-related complications, most commonly involving malfunction, were seen in 6.6%. The duration of monitoring was significantly related to polytrauma (p ≤ 0.001) and age <60 (p = 0.03). ICU stay was also significantly related to polytrauma (p = 0.02) and monitoring complications (p ≤ 0.001). Mortality was related to anticoagulant medication (p = 0.01) and age <60 (p = 0.03). CONCLUSIONS: ICP monitoring is one of the most important tools in TBI treatment. The course and outcome of these severe injuries is affected by polytrauma, age, and the use of anticoagulants.

The impact of geographical, clinical, dietary and radiation-induced features in epidemiology of thyroid cancer.

Cancer of the thyroid accounts for less than 1% of all cancers recognised each year, but the incidence is rising. Much of the early work of the epidemiology and aetiology of thyroid cancer was based on the assumption that thyroid cancer can be treated as an entity. The recognition that two distinct types of endocrine cell occur within the thyroid has made it clear that any discussion of the aetiology and epidemiology of thyroid malignancies must take into account the histological classification of these tumours. Moreover, there are difficult problems to be considered when comparing thyroid cancer incidence across tumour registries, because of a lack of standardisation or morbidity data collection, difficulties in histological diagnosis, varying rates of diagnosis of occult papillary carcinoma, and prevalence and techniques of autopsies. So far only a relatively small proportion of thyroid cancer cases can be explained with adequate certainty as regards epidemiology and aetiology. As in cancer in general, the aetiology and epidemiology of thyroid cancer in detail remains unknown in the majority of cases.

Thyrotropin and thyroglobulin as an index of optimal iodine intake: correlation with iodine excretion of 39,913 euthyroid patients.

The recommendations for the dietary allowance of iodine are 150 micrograms per day for adolescents and adults. Thyrotropin (TSH) and thyroglobulin (Tg) can be used as surveillance indicators for assessing iodine deficiency disorders. We compared the relation between TSH and Tg, free triiodothyronine, and thyroxine serum levels with urinary iodine excretion in 2311 untreated euthyroid patients using our modified cericarsenite method. An adequate iodine intake may be assumed when TSH and Tg values are at the lower end of the normal range. Patients were grouped according to urinary iodine excretion and goiter size. In the group with an iodine excretion between 201 and 300 micrograms of iodine per gram of creatinine, the lowest TSH values and even low Tg levels could be shown. We conclude that an iodine intake of approximately 250 micrograms/day is associated with the lowest TSH stimulation to thyrocytes. In the groups separated according to thyroid size, significantly higher Tg levels were found in the patients with uninodular and multinodular goiter as a result of longstanding iodine deficiency, whereas actual urinary iodine excretion did not differ significantly. Additionally, iodine excretion of 39,913 euthyroid patients between 1984 was 1996 was examined. In Austria iodized salt (10 mg KI/kg) was introduced by law in 1963 and increased to 20 mg KI/kg salt in 1990. An initial increase of iodine excretion until 1993 was followed by a decrease in 1994 and 1995 without further changes in 1996. These results show that iodine intake has improved since 1984; however, in 1996 iodine excretion in one-third of the investigated patients was under 100 micrograms per gram of creatinine and more than 80% had less than 200 micrograms per gram of creatinine.

Impact of stress and triiodothyronine on plasma magnesium fractions.

The differential regulation of free and bound plasma magnesium was studied in healthy volunteers exposed to various forms of stress, and patients screened for thyroid disorder. Both ergometric (7 min) and psychological (45 min) stress had no effect on free plasma magnesium, but increased the bound fraction. Before combined physical and psychological stress (45 min aerobatics) there was no correlation between the plasma fractions of magnesium; thereafter, there was a strong negative correlation between increased free and decreased bound magnesium. Three days of training in ground combat increased significantly the plasma levels of both magnesium fractions. Patients screened for thyroid disorder had a significant, positive correlation between both plasma fractions of magnesium, and a highly significant negative correlation between plasma T3 and the two magnesium fractions. No clear correlation between plasma catecholamines and magnesium levels was seen under any of the above conditions. Overall, the data show that the evaluation of the functions of circulating magnesium requires the specific measurement of the free and bound fractions.

The influence of immediate surgical treatment of proximal femoral fractures on mortality and quality of life. Operation within six hours of the fracture versus later than six hours.

We compared the mortality and outcome of 182 patients with proximal fractures of the femur after immediate and delayed surgical treatment. Seventy-nine patients were operated upon within six hours of the fracture (group 1) and 103 patients were operated upon after this period of time (group 2). At six months follow-up, group 1 had a significantly lower mortality rate. There was a good outcome in both groups with no differences in the outcome. Neither surgical nor anaesthetic factors appeared to have influenced mortality. The subdivision of groups revealed that patients operated on within 24 hours had a better outcome than those whose surgery was delayed. Although there may have been a bias, as patients were not randomly assigned to immediate or delayed surgical treatment, the data suggest that early stabilisation may be associated with a lower mortality rate. Even with pre-clinical delays of more than six hours early treatment should still be attempted, as better results seem to be achieved after 24 hours compared to a later time in our patients.

[Changes in zinc level in the serum, whole blood and erythrocytes in disorders of thyroid function]. / Veränderungen des Zinkspiegels im Serum, Vollblut und im Erythrozyten bei Schilddrüsen-Stoffwechselstörungen.

The zinc level in serum and whole blood was determined in a series of 121 patients, 20 suffering from overt hyperthyroidism, 34 with manifest hypothyroidism and a control group of 67 euthyroid subjects. The zinc content per deciliter of erythrocytes was calculated from the haematocrit. The hyperthyroid group revealed a highly significantly elevated serum zinc level (p less than 0.01), but a most significantly reduced zinc content in whole blood (p less than 0.001) in comparison with the euthyroid group. On the other hand, the reverse changes were observed in the hypothyroid group, i.e. a most significantly reduced serum zinc content (p less than 0.001) and a highly significantly increased zinc content in whole blood (p less than 0.01). These results suggest that the determination of zinc levels both in serum and in whole blood may be a useful additional parameter of peripheral thyroid hormone effect.

[Basket wires--a percutaneous surgical procedure for the treatment of unstable Colles' fractures]. / Körbchendrähte--Ein perkutanes Operationsverfahren zur Behandlung der instabilen Colles-Fraktur.

Colles fractures are usually treated with closed reduction and forearm plaster. Even if reduced perfectly, some of these fractures tend to redislocate dorsally and radially, requiring repeated reduction maneuvers. Since K-wires cannot be firmly anchored in the distal fragment if comminution exists, Kapandji proposed a method whereby the distal fragment is not pinned at all. He introduced the pins through the fracture itself and into the medullary canal of the proximal fragment, anchoring the wires into the opposite cortices of the radius shaft. In order to "pre-stress" the K-wires, Böhler and Zifko modified the technique and the wires themselves. They inserted the wires through small skin incisions into the fracture and into the proximal fragment as medullary pins. The specially bent pins glide smoothly into the medullary cavity and snugly fit along the distal fragment; thereby minimizing the chance of damaging extensor tendons. One pin is inserted proximal to Lister's tubercle and another radially, proximal to the radial styloid. Technique, indication, and possible technical errors are discussed based on the follow-up of forty one patients.

[Indications and Application of a Standard and Long Gamma-nail.]. / Indikácie a pouzitie standardného a dlhého gamma-klinca.

An alternative treatment of fractures of the coxal femur side is a new implant - gamma-nail. Furthermore, we present the results of study of 77 patients, mainly women (71,4%) with an average on age of 65,5 years. In 52 percent, we found relevant instabilities (AO groups 31 - A2.2, A2.3 and A3.3). The modalities of treatment and mobilization are described, and the clinical and radiological results are presented. Mobilization was possible in 84,2% of these cases. The 6,5% of operative and postoperative complications we have to face, are described in detail. Key words: bone nails, femoral fractures, hip fractures.

[Trauma hospital. Knee arthroplasty as primary therapy for proximal tibial fracture]. / Unfallkrankenhaus. Knieendoprothese als Ersttherapie bei proximaler Tibiafraktur.

Ten patients aged 55-85 years with a tibial head fracture AO B3 or C3 were treated primarily by implantation of an endoprosthesis. There were one unilateral, three superficial, and six revision-type prostheses. Follow-up was 6 months to 3 years; two patients were lost to follow-up. There were no intra- or postoperative complications except one deep infection which could be cured by repeated arthroscopic lavage. At last follow-up all eight patients were completely or almost pain free; the extension deficit was less than 10 degrees , and flexion was 100 degrees or more. Primary endoprosthetic replacement of the knee joint is a valuable procedure for the treatment of complex tibial head fractures in elderly patients.

[Isolated ossicle of the dens axis. Case reports and differential diagnosis]. / Isolierte Ossikel am Dens axis. Fallbeispiele und Differentialdiagnose.

Two patients with an incidental finding of isolated ossicles adjacent to the dens axis are presented. One case was thought to be based on an isolated part of the dens axis, possibly due to trauma; the second case could be a true ossiculum terminale. Such ossicles can be confused with acute fractures, initiating treatment that is not indicated.

[Influence of nocturnal surgery on mortality and complications in patients with hip fractures]. / Auswirkungen von in der Nacht durchgeführten Stabilisierungsoperationen bei hüftnahen Femurfrakturen auf Mortalitätsrate und Komplikationen.

UNLABELLED: SUBJECT OF INVESTIGATION: The appropriate time of day for surgery of hip fractures and the question of whether surgery should be performed at night are controversial. We therefore investigated the influence of the time of day on mortality and complication rates in surgery for hip fractures. METHOD: A total of 170 persons were included in the study with 128 operations being performed during the day and 42 at night, after 9 p.m. All patients were operated as early as possible. Patients were randomly assigned to groups. The recorded data were mainly demographic, perioperative and those concerning the patient's history. Mortality and complication rates 6 months after surgery were compared. RESULTS: The two groups were largely homogeneous. Patients operated on at night had a non-significantly higher mortality rate. Mortality was highest in those operated on between 9 and 10 p.m. Of those who underwent surgery after midnight, no patient died. No differences were registered with regard to complications. The team of surgeons and anesthetists was equally qualified in both groups. CONCLUSIONS: Given a medical team with equal qualifications and size, we consider nocturnal surgery for hip fractures to be as appropriate as surgery during the day.

[Do increased lipoprotein(a) levels in euthyroid autoimmune thyroid diseases predict an increased risk of arteriosclerosis?]. / Bedeuten erhöhte Lipoprotein(a)-Spiegel bei euthyreoten Immunthyreopathien bereits ein erhöhtes Arterioskleroserisiko?

Elevated serum levels of lipoprotein(a) [Lp(a)] represent an independent risk factor in the development of arteriosclerosis and coronary heart disease. In overt but also in subclinical hypothyroidism a reversible increase of Lp(a) occurs. We compared Lp(a) serum levels, cholesterol, triglyceride, HDL- and LDL-cholesterol in 19 hypothyroid patients prior to and following the state of euthyroidism (group 1). On the other hand in group 2 we investigated 20 euthyroid patients having elevated thyroid antibodies as against 50 euthyroid normolipemic control subjects without detectable thyroid antibodies. Group 1: The elevated Lp(a) serum levels of the hypothyroid patients decreased significantly in the euthyroid state (37.9 +/- 8.24 vs. 28.1 +/- 6.13 mg/dl, mean +/- SEM). Group 2: The mean Lp(a) serum levels of the patients with increased thyroid antibodies were significantly higher than those of the control group (24.8 +- 5.78 vs. 9.6 +/- 1.56 mg/dl, mean +/- SEM). In other parameters of lipid metabolism and thyroidal function no significant differences between both groups could be seen. The question arises whether such isolated Lp(a) elevation will lead to an increased arteriosclerotic risk. To minimize this possible risk regular controls of thyroid function should be carried out in euthyroid patients with elevated thyroid antibodies. In this way hypothyroidism may be detected and treated at an early stage.

[Quantitative scintigraphy of the sacroiliac joints]. / Quantitative Szintigraphie der Ileosakralgelenke.

Effects of gender and age on quantitative sacroiliac joint imaging are discussed controversially. In most investigations the number of controls has been small and might not exactly reflect the change of sacroiliac/sacral (SI/S) ratios related to different age and gender. The aim of our study was to evaluate the changes SI/S ratios according to age and gender. In 125 patients without any history of either diseases or complaints of the sacroiliac joints a bone scintigraphy was obtained and the SI/S ratios were calculated. We observed a significant negative correlation of SI/S index with age. After separation into 4 different age groups a significant decline of the ratios could be shown. There were no significant differences between male and female patients. We conclude that the influence of age on SI/S ratios is substantial. But also many other factors like patient position, algorithm of SI/S ratio calculation, the time interval between application of the radiopharmaceutical and data acquisition may exert effects on SI/S ratios. It seems necessary for each department to evaluate their own age related reference values of SI/S ratios.

Injuries to the cervical spine causing vertebral artery trauma: case reports.

In four patients with lesions of the vertebral artery resulting from cervical spine injury, two were due to unilateral facet dislocation and two to fractures of the dens. There was one arterial occlusion with minor vertebrobasilar symptoms, and an arterial lesion with thrombosis causing embolic occlusion of the basilar artery with lethal outcome. In one patient a fresh fracture of the dens caused dislocation of C1/2 with reversible occlusion of the left and stenosis of the right vertebral artery, resulting in unconsciousness. In a patient with pseudarthrosis of the dens an aneurysm of the vertebral artery could be detected. Cerebellar or cerebral symptoms associated with cervical spine injury should be investigated by vertebral angiography because vertebral arterial injury may be more common than suspected and may simulate traumatic brain damage.

[Late potentials in high resolution ECG in thyroid gland dysfunction]. / Spätpotentiale im High-Resolution-EKG bei Schilddrüsen-Funktionsstörungen.

In this study we examined 278 patients as to the effect of thyroidal dysfunctions upon late-potential parameters in high-resolution ECG (HR-ECG). It could be demonstrated that both hyper- and hypothyroidism tend to produce late potentials. It is remarkable that even "subclinical" dysfunctions reveal significant alterations in HR-ECG. As late potentials represent a risk factor for ventricular arrhythmias these results are an additional indication that already "subclinical" dysfunctions of thyroid gland call for an appropriate therapy. In hyperthyroidism late potentials may be eliminated rapidly by propranolol even in low dosages.

[Seasonal variations in the diagnosis of hyperthyroidism]. / Jahreszeitliche Variationen im Auftreten der Hyperthyreose.

Seasonal variations in the frequency of thyrotoxicosis are known for a long time. Both, variations in the temperature and in the iodine supplementation are believed to affect the incidence of the diagnosis of hyperthyroidism. Seasonal variation of the incidence of hyperthyroidism was investigated before and after increase of salt iodination in 1990/1991. In the period from January 1987 to December 1995 hyperthyroidism was diagnosed for the first time on 4711 patients in our department. This population was subdivided according to etiology (Graves' disease, autonomous nodular goiter) and grade of hyperthyroidism (preclinical or clinical form). The so formed groups were divided according to the month of diagnosis into further 12 subgroups. Significant differences in month to month variation were found in the patients suffering from Graves' disease and autonomous nodular goiter with preclinical hyperthyroidism after increased iodine supplementation. The peak incidence of the diagnosis occurred in June, July, and August. Our results indicate that improved iodine supplementation may be the main cause of seasonal variations in the incidence of thyrotoxicosis.

[Measurement of free triiodothyronine (FT3) using an electrochemiluminescence immunoassay in patients with autoantibodies to triiodothyronine]. / Bestimmung von freiem Trijodthyronin (FT3) mittels Elektrochemilumineszenz-Immunoassay bei Patienten mit peripheren Autoantikörpern gegen Trijodthyronin.

Thyroid hormone autoantibodies may lead to abnormal values of free triiodothyronine (FT3) and free thyroxine (FT4) by interference with the radio immunoassay (RIA). We examined thyroid function in six patients with known triiodothyronine-binding autoantibodies using a RIA and an electro-chemiluminescence immunoassay (ECLIA). FT3 values measured by RIA were spuriously high, ECLIA measurement of FT3 led to correct values according to the patients' thyroid status. We conclude from these results that in patients with triiodothyronine-binding autoantibodies FT3 measurement by ECLIA is more useful than measurement by RIA.

[Effect of aceclofenac on thyroid hormone binding and thyroid function]. / Auswirkungen von Aceclofenac auf die Schilddrüsenhormonbindung und Schilddrüsenfunktion.

Influences of non-steroidal anti-inflammatory drugs (NSAID) on concentrations of thyroid hormones are known for a long time. These effects could be explained with interference between NSAIDs and thyroid hormone binding. We investigated the effects of a single dose of aceclofenac on thyroid function and thyroid hormone binding in 18 healthy volunteers. Serum levels of free thyroid hormones (FT3, FT4) and thyrotropin (TSH) were measured with commercial available kids and thyroid hormone binding was estimated with a specially modified horizontal argarose-gel-electrophoresis prior to and 2 hours after receiving a single dose of aceclofenac. We found a significant decrease in T3 binding on TBG and a significant increase of albumin-bound T3. All other investigated thyroid hormone binding parameters, FT3 and FT4, showed no significant changes. We conclude that aceclofenac leads to a significant redistribution of T3 protein binding. These effects seem to be explained by T3 displacement from TBG induced by aceclofenac.