RESUMEN
Smartphones may provide a highly available access to simplified hypertension screening in environments with limited health care resources. Most studies involving smartphone blood pressure (BP) apps have focused on validation in static conditions without taking into account intraindividual BP variations. We report here the first experimental evidence of smartphone-derived BP estimation compared to an arterial catheter in a highly dynamic context such as induction of general anesthesia. We tested a smartphone app (OptiBP) on 121 patients requiring general anesthesia and invasive BP monitoring. For each patient, ten 1-min segments aligned in time with ten smartphone recordings were extracted from the continuous invasive BP. A total of 1152 recordings from 119 patients were analyzed. After exclusion of 2 subjects and rejection of 565 recordings due to BP estimation not generated by the app, we retained 565 recordings from 109 patients (acceptance rate 51.1%). Concordance rate (CR) and angular CR demonstrated values of more than 90% for systolic (SBP), diastolic (DBP) and mean (MBP) BP. Error grid analysis showed that 98% of measurement pairs were in no- or low-risk zones for SBP and MBP, of which more than 89% in the no-risk zone. Evaluation of accuracy and precision [bias ± standard deviation (95% limits of agreement)] between the app and the invasive BP was 0.0 ± 7.5 mmHg [- 14.9, 14.8], 0.1 ± 2.9 mmHg [- 5.5, 5.7], and 0.1 ± 4.2 mmHg [- 8.3, 8.4] for SBP, DBP and MBP respectively. To the best of our knowledge, this is the first time a smartphone app was compared to an invasive BP reference. Its trending ability was investigated in highly dynamic conditions, demonstrating high concordance and accuracy. Our study could lead the way for mobile devices to leverage the measurement of BP and management of hypertension.
Asunto(s)
Hipertensión , Aplicaciones Móviles , Humanos , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea , Hipertensión/diagnóstico , Teléfono Inteligente , CánulaRESUMEN
BACKGROUND: This biomechanical study aimed to test if the fixation of the posterior malleolus (PM) only with screws inserted from posterior to anterior (PA) restores stability comparable with the natural condition. The extent of stability was also compared with that of anterior to posterior (AP) screw osteosynthesis (OS) with an additional syndesmotic screw (SS). METHODS: First, the stability of the upper ankle joint in seven pairs of intact lower legs were examined. Subsequently, half of the lower legs were treated with PA screw fixation of a PM fracture without SS and the other half with AP screw fixation with additional tricortical SS. RESULTS: PA OS without SS showed significantly more diastasis (p = 0.027). The AP OS with an SS revealed a diastasis that was comparable with the intact condition (p = 0.797). The use of SS led to significantly higher stability compared to OS without SS (p = 0.019). CONCLUSIONS: The Fixation of the PM alone without an additional syndesmotic screw cannot achieve intact upper ankle stability. Fixation of a PM fracture with an SS helps in nearly achieving the natural condition.
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Fracturas de Tobillo , Traumatismos del Tobillo , Inestabilidad de la Articulación , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Tornillos Óseos , Fijación Interna de Fracturas , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
Extensor tendon injuries of the thumb include lesions of the tendons of the extensor pollicis longus, extensor pollicis brevis and abductor pollicis longus muscles. The latter is practically only affected in open injuries. Open injuries require a tendon reconstruction by suture followed by immobilization in the distal and an adequate aftercare depending on the zone of injury. In distal injuries static splinting is applied, whereas proximal injuries from T4 on require a dynamic after-treatment. Different courses of the tendon of the extensor pollicis brevis muscle exist distal to the metacarpophalangeal joint and must be considered. The rare ruptures of the extensor hood at the metacarpophalangeal joint provoke an ulnar displacement of the extensor pollicis longus or both extensor tendons with concomitant lack of active extension in the metacarpophalangeal and interphalangeal joints. This injury is often misdiagnosed as a rupture of the ulnar collateral ligament of the metacarpophalangeal joint. It should be treated by refixation of the ruptured structures. Closed chronic ruptures of the extensor pollicis longus tendon go along with a defect that requires a tendon transfer or a tendon autograft.
Asunto(s)
Traumatismos de los Tendones , Pulgar , Humanos , Articulación Metacarpofalángica , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/cirugía , Transferencia Tendinosa , Tendones , Pulgar/cirugíaRESUMEN
BACKGROUND: Drug-induced photosensitivity refers to the development of cutaneous adverse events due to interaction between a pharmaceutical compound and sunlight. Although photosensitivity is a very commonly listed side-effect of systemic drugs, reliable data on its actual incidence are lacking so far. OBJECTIVES: A possible approach to evaluate the real-life extent of drug-induced photosensitivity would be an analysis of the frequency of exposure to a given photosensitizing drug combined with an indicator of its photosensitizing potential. This could serve as a basis for developing a pharmaceutical 'heatmap' of photosensitivity. METHODS: The present study investigated the number of reimbursed dispensed packages of potentially photosensitizing drugs in Germany (DE) and Austria (AT) between 2010 and 2017 based on nationwide health insurance-based databases. In addition, an indicator for the photosensitizing potential was established for each drug based on the number of reports on photosensitivity in the literature. RESULTS: This analysis includes means of 632 826 944 (+/-14 894 918) drug dispensings per year in DE and 113 270 754 (+/-1 964 690) in AT. Out of these, the mean percentage of drugs that enlist photosensitivity as a potential side-effect was 49.5% (±0.7) in DE and 48.2% (±1.2) in AT. When plotting the number of reimbursed dispensed packages vs. the number of reports on photosensitivity, two categories of drugs show high numbers for both parameters, that is diuretics and non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS: Diuretics and NSAIDs appear to be responsible for the greatest part of exposure to photosensitizing drugs with potential implication on public health.
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Prescripciones de Medicamentos/estadística & datos numéricos , Trastornos por Fotosensibilidad/inducido químicamente , Trastornos por Fotosensibilidad/epidemiología , Fármacos Fotosensibilizantes/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/farmacología , Austria , Correlación de Datos , Diuréticos/efectos adversos , Diuréticos/farmacología , Interacciones Farmacológicas , Alemania , Humanos , Fármacos Fotosensibilizantes/farmacología , Edición/estadística & datos numéricosRESUMEN
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100â000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation >â92â% can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48â-â72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
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Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Neumonía/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Neumología/normas , Adolescente , Antibacterianos/administración & dosificación , Niño , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/virología , Europa (Continente) , Alemania , Humanos , Lactante , Neumonía/diagnóstico , Neumonía/virología , Sociedades MédicasRESUMEN
BACKGROUND: Plasmatic coagulation disorders in trauma patients are common and their management is subject to current guidelines. Less evidence exists for platelet function. Although it is known that several trauma-associated factors have a negative influence on platelet function, routine monitoring has not yet become established. METHODS: A retrospective single center study was carried out at a German level 1 trauma center from 2010 to 2016. In all patients fulfilling the requirements for the German Trauma Society (DGU) Traumaregister® who were admitted directly from the scene of the incident, platelet function was analyzed using the Platelet Function Analyzer (PFA 100®) with adenosine diphosphate (ADP) and epinephrine as activation factors. After exclusion of patients with intake of long-term anticoagulant and antiaggregant medication, possible influencing factors of a reduced platelet function were identified. RESULTS: The results from 310 patients (44.0⯱ 14.7 years, 76% male, Injury Severity Score, ISS 28.4⯱ 14.2 points) were available. A delayed platelet activation was found in 25.5% using ADP and 31% using epinephrine. Laboratory parameters indicated a greater blood loss. Prolonged closure times were associated with an increased transfusion rate of packed red blood cell concentrates and a higher mortality rate. Logistic regression revealed hemoglobin (Hb) and fibrinogen levels at admission to be independent predictors for a decreased platelet activation in the assay with ADP (pâ¯< 0.001, Cohen's fâ¯= 0.61) and with epinephrine (pâ¯< 0.001, fâ¯= 0.42). CONCLUSION: Approximately one quarter to one third of primarily admitted trauma patients without long-term anticoagulation medication showed a delayed platelet activation in the PFA-100 test. By considering all trauma patients an even higher rate can be expected. The Hb and fibrinogen levels at admission can be helpful to estimate platelet disorders. The development of platelet assays to guide the resuscitation of individual patients seems to be absolutely necessary. The contribution of platelet disorders to trauma-induced coagulopathy is not sufficiently understood. Regarding the importance assigned to platelet transfusion or administration of desmopressin, these aspects should be the subject of further research.
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Trastornos de las Plaquetas Sanguíneas/sangre , Heridas y Lesiones/sangre , Adulto , Coagulación Sanguínea , Pruebas de Coagulación Sanguínea , Plaquetas , Transfusión Sanguínea , Femenino , Fibrinógeno/análisis , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Based on a case study, the injury pattern and surgical procedure for traumatic dislocation of the posterior tibial tendon is presented. A 32-year-old ice hockey player suffered a direct impact from a puck at the dorsomedial aspect of the inner ankle. In the course of the injury a ganglion developed due to recurrent dislocation of the posterior tibial tendon. Intraoperatively, a distracted retinaculum and a flattened retromalleolar sulcus were present. An open wedge osteotomy and suture anchor refixation of the retinaculum were performed. This procedure is described in the context of a review of the literature.
Asunto(s)
Traumatismos del Tobillo/cirugía , Luxaciones Articulares/cirugía , Traumatismos de los Tendones/cirugía , Adulto , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/etiología , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/cirugía , Hockey/lesiones , Humanos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/etiología , Masculino , Osteotomía , Anclas para Sutura , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/etiologíaRESUMEN
BACKGROUND: Open reduction and internal fixation is the current standard of treatment of displaced distal fibula fractures, whereupon using a lag screw often is impossible because of a multifragmantary fracturezone. This study investigates in what extend polyaxial-locking plating is superior to non-locking constructs in unstable distal fibula fractures. METHODS: Seven pairs of human cadaver fibulae were double osteotomized in standardized fashion with a 5mm gap. This gap simulated an area of comminution, where both main fragments were no longer in direct contact. One fibula of the pair was managed using a 3.5-mm screw in a polyaxial-locking construct and the other fibula in a non-locking construct.
Asunto(s)
Fracturas de Tobillo/cirugía , Placas Óseas , Peroné/cirugía , Fijación Interna de Fracturas/instrumentación , Fracturas Conminutas/cirugía , Fracturas de Tobillo/fisiopatología , Fenómenos Biomecánicos , Tornillos Óseos , Cadáver , Femenino , Peroné/lesiones , Peroné/fisiopatología , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/fisiopatología , Humanos , Masculino , Modelos AnatómicosRESUMEN
We report a difficult healing process after a femoral shaft fracture in childhood. We present surgical correction options of femoral shortening due to pseudarthrosis after elastic stable intramedullary nailing. First, we tried to establish distraction using an external fixator, followed by plate osteosynthesis. After material failure of plate osteosynthesis, we treated the refracture with intramedullary nailing, after which bone healing occurred.
Asunto(s)
Alargamiento Óseo/métodos , Terapia Combinada/métodos , Fracturas del Fémur/complicaciones , Fracturas del Fémur/terapia , Fijación Interna de Fracturas/métodos , Diferencia de Longitud de las Piernas/etiología , Diferencia de Longitud de las Piernas/terapia , Adolescente , Niño , Femenino , Fracturas del Fémur/diagnóstico por imagen , Humanos , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
After examining the causes of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed between the parties involved. In addition, this must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability. In contrast to scientifically based findings serving as a prognosis of osteoarthritis, in the case of endoprostheses forecasts can only be based on medical experience, which in this case has to satisfy the standard of proof of a high level of probability, since necessary replacement operations after insertion of a prosthesis are sufficiently probable. The prosthesis supplements that have been applied to date in the context of an assessment of prognosis have their justification. In applying them, however, it must be considered on one hand that this supplement is comprised of an equally weighted proportion for future risk and on the other hand a preventive portion. This increases in significance with different prostheses on one and the same limb.
Asunto(s)
Evaluación de la Discapacidad , Determinación de la Elegibilidad/legislación & jurisprudencia , Testimonio de Experto/legislación & jurisprudencia , Prótesis Articulares/estadística & datos numéricos , Medición de Riesgo/legislación & jurisprudencia , Alemania , Humanos , Seguro por Accidentes/legislación & jurisprudenciaRESUMEN
A monolateral sacrum fracture was primarily diagnosed with a CT and treated with PMMA augmented SI screw fixation. The following CT showed an unexpected contralateral fracture which led to the need for a lumbopelvic stabilization. In the course of 6 months, successively occurring adjacent fractures required recurrent vertebroplasty. Most of these fractures could only be diagnosed through MRI. It remains unclear, whether initially even the contralateral sacral ala was fractured.
Asunto(s)
Fracturas por Estrés/cirugía , Sacro/lesiones , Fracturas de la Columna Vertebral/cirugía , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Fracturas Múltiples/diagnóstico por imagen , Fracturas Múltiples/cirugía , Fracturas por Estrés/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Polimetil Metacrilato/uso terapéutico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Reoperación , Sacro/diagnóstico por imagen , Sacro/cirugía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fusión Vertebral/métodos , Tomografía Computarizada por Rayos X , VertebroplastiaRESUMEN
INTRODUCTION: Established treatment options of spondylodiscitis, a rare but serious infection of the spine, are immobilization and systemic antibiosis. However, the available data for specific treatment recommendations are very heterogeneous. Our intention was to develop a classification of the severity of spondylodiscitis with appropriate treatment recommendations. MATERIALS AND METHODS: From 10/1/1998 until 12/31/2004, 37 cases of spondylodiscitis were examined regarding medical history, gender status, location and extent of spondylodiscitis, type and number of operations. Subsequently, a classification of six grades according to severity has been developed with specific treatment recommendations. The further evaluation of our classification and corresponding treatment modalities from 1/1/2005 to 12/31/2009 including further 132 cases, resulted in a classification of only three grades of severity (the SSC--spondylodiscitis severity code), with a follow-up until 12/31/2011. Between 01/01/2012 and 12/31/2013, a prospective study of 42 cases was carried out. Overall, 296 cases were included in the study. 26 conservatively treated cases were excluded. RESULTS AND CONCLUSION: The main localization of spondylodiscitis was the lumbar spine (55%) followed by the thoracic spine (34%). The classification of patients into 3 grades of severity depends on clinical and laboratory parameters, the morphological vertebral destruction seen in radiological examinations and the current neurological status. Therapies are adapted according to severity and they include a specific surgical management, systemic antibiotic therapy according to culture and sensitivity tests, physiotherapy and initiation of post-hospital follow-up. 40.6% of patients are associated with neurological deficits, classified as severity grade 3 and treated surgically with spinal stabilization and decompression. 46.9% of patients corresponded to severity grade 2, with concomitant vertebral destruction were dorsoventrally stabilized. The 31 patients of severity Grade 1 were treated surgically with dorsal stabilization. From 1998 to 2013, the time from the onset of symptoms to the first surgical treatment was about 69.4 days and has not changed significantly. However, the time from admission to surgical treatment had been reduced to less than 2 days. Also the time of hospitalization was reduced and we see positive effects regarding the sensation of pain. 270 patients underwent surgery. We treated 89% dorsally and 21% dorsoventrally. With the spondylodiscitis severity code, a classification of the severity of spondylodiscitis could be established and used for a severity-based treatment. In addition, specific parameters for the treatment of individual grades of severity can be determined in a clinical pathway.
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Discitis/diagnóstico , Adulto , Anciano , Antibacterianos/uso terapéutico , Descompresión Quirúrgica/métodos , Discitis/clasificación , Discitis/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: Trauma-induced coagulopathy (TIC) in multiple trauma patients is a potentially lethal complication. Whether quickly available laboratory parameters using point-of-care (POC) blood gas analysis (BGA) may serve as surrogate parameters for standard coagulation parameters is unknown. The present study evaluated TraumaRegister DGU® of the German Trauma Society for correlations between POC BGA parameters and standard coagulation parameters. METHODS: In the setting of 197 trauma centres (172 in Germany), 86,442 patients were analysed between 2005 and 2012. Of these, 40,129 (72% men) with a mean age 46 ± 21 years underwent further analysis presenting with direct admission from the scene of the accident to a trauma centre, injury severity score (ISS) ≥ 9, complete data available for the calculation of revised injury severity classification prognosis, and blood samples with valid haemoglobin (Hb) measurements taken immediately after emergency department (ED) admission. Correlations between standard coagulation parameters and POC BGA parameters (Hb, base excess [BE], lactate) were tested using Pearson's test with a two-tailed significance level of p < 0.05. A subgroup analysis including patients with ISS > 16, ISS > 25, ISS > 16 and shock at ED admission, and patients with massive transfusion was likewise carried out. RESULTS: Correlations were found between Hb and prothrombin time (r = 0.497; p < 0.01), Hb and activated partial thromboplastin time (aPTT; r = -0.414; p < 0.01), and Hb and platelet count (PLT; r = 0.301; p < 0.01). Patients presenting with ISS ≥ 16 and shock (systolic blood pressure < 90 mmHg) at ED admission (n = 4,329) revealed the strongest correlations between Hb and prothrombin time (r = 0.570; p < 0.01), Hb and aPTT (r = -0.457; p < 0.01), and Hb and PLT (r = 0.412; p < 0.01). Significant correlations were also found between BE and prothrombin time (r = -0.365; p < 0.01), and BE and aPTT (r = 0.327, p < 0.01). No correlations were found between Hb, BE and lactate lactate. CONCLUSIONS: POC BGA parameters Hb and BE of multiple trauma patients correlated with standard coagulation parameters in a large database analysis. These correlations were particularly strong in multiple trauma patients presenting with ISS > 16 and shock at ED admission. This may be relevant for hospitals with delayed availability of coagulation studies and those without viscoelastic POC devices. Future studies may determine whether clinical presentation/BGA-oriented coagulation therapy is an appropriate tool for improving outcomes after major trauma.
Asunto(s)
Anticoagulantes/uso terapéutico , Servicios Médicos de Urgencia/métodos , Servicio de Urgencia en Hospital , Traumatismo Múltiple/sangre , Accidentes , Adulto , Anciano , Coagulación Sanguínea , Análisis de los Gases de la Sangre , Femenino , Hemoglobinas/análisis , Humanos , Puntaje de Gravedad del Traumatismo , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Sistemas de Atención de Punto , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Sepsis and septic shock are major contributors to morbidity and mortality in intensive care patients. Early identification and adequate therapy are of utmost importance to reduce the still high mortality in patients with severe sepsis. Many of the pathophysiologic changes are nonspecific. Thus, a combination of symptoms and laboratory results are necessary to confirm the diagnosis. Impairment of the Horovitz index is identified as being a primal prognostic criterion for early diagnosis in serious progression of sepsis, after exclusion of a few differential diagnoses. Based on this fact, the prevalence of this symptom compared to other sepsis parameters is of specific interest. METHOD: In a retrospective study 33 cases of serious sepsis were analysed during the patient's course of intensive care treatment focusing on oxygenation. The deterioration of oxygenation, meaning a drop in the Horovitz index below 200 mm Hg (25.7 kPa) or a decrease in paO2 by 67.5 mm Hg (9 kPa) in spontaneously breathing patients with sepsis was the mean inclusion criteria. We compared the sequence of occurrence of known sepsis markers (e. g. PCT, WBC, CRP) with the deterioration in oxygenation to answer the question whether impairment of oxygenation could be an early symptom of severe sepsis. The Mann Whitney Utest and a discriminant analysis were performed to verify differences of the variables investigated between surviving and deceased patients. Furthermore a regression analysis was performed to confirm the results of the discriminant analysis. RESULTS: The mean drop in the Horovitz index was 90 ± 24 mm Hg (12 ± 3.2 kPa) within 4.5 h respectively. This was highly significant (p < 0.001). In all patients impairment of oxygenation indicated an individual onset and further progression of a serious sepsis. In more than ¾ of all cases this symptom occurred in an earlier stage than other organ dysfunctions. In 79 % of cases, patients showed an impairment of oxygenation before PCT increased on values of >2 ng/ml. In 76 % of cases impairment of oxygenation occurred earlier than all other investigated parameters. Significant differences were found between surviving and deceased patients regarding to their age as well as the timeframe from the beginning of impaired oxygenation to the onset of the effect of the administered antibiotics. These two parameters (age, time to sufficient antibiotic therapy) were confirmed by regression analysis and showing similar effect coefficients, age 1.09 and time to sufficient antibiotic therapy 1.04 respectively. CONCLUSION: An urgent worsening of pulmonary function in patients in intensive care requires immediate differential diagnostics due to substantial therapeutic consequences. Our results confirm that impairment of pulmonary oxygenation is the first prognostic symptom of severe onset of sepsis. Consequently, we recommend that this parameter be considered in diagnostic staging. After exclusion of a few differential diagnoses impairment of oxygenation can be the very first symptom of severe sepsis. The patient's age and time to sufficient antibiotic therapy are two very important prognostic factors with respect to mortality. Early and sufficient antibiotic therapy, and in a few cases surgical intervention are of utmost importance.
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Oxígeno/sangre , Sepsis/diagnóstico , Adulto , Anciano , Algoritmos , Antibacterianos/uso terapéutico , Biomarcadores , Análisis de los Gases de la Sangre , Cuidados Críticos , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oximetría , Prevalencia , Pruebas de Función Respiratoria , Estudios Retrospectivos , Sepsis/tratamiento farmacológico , Análisis de SupervivenciaRESUMEN
AIM: The aim of this review was to evaluate the time-related risk for knee osteoarthritis in patients after ACL injury. MATERIALS AND METHODS: The primary search was carried out in different medical databases with the deadline 12.01.2014. The search strategy for the evaluation was [ACL] AND [osteoarthritis] including "all fields". All 1656 title/abstracts were reviewed by two independent researchers who selected 140 papers for full text review. Finally, a total of 21 relevant publications were identified for inclusion in this current paper. RESULTS: The incidence of knee osteoarthritis rises significantly over time. Two years after injury it was 6.9%, after 5 years 32.2%, after 7 years 36.3%, and after 10 years 79.6%. At the same time, the crude relative risk of OA rises as the time interval since injury increases. The relative risk of OA has already doubled by 2 years after ACL injury). By 7 years it has increased fivefold and compared with OA status at the time of injury it is still increasing significantly after 10 years. CONCLUSIONS: The ACL injury is a significant risk factor for the development of early-onset secondary knee osteoarthritis. Within 5 years of the injury the knee shows clear signs of osteoarthritis on MRI. However, these lesions are often not associated with any clinical signs. Knee osteoarthritis as a severe disease starts 8 years or later after the injury, when it requires treatment.
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Lesiones del Ligamento Cruzado Anterior , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/epidemiología , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/epidemiología , Factores de Tiempo , Causalidad , Comorbilidad , Femenino , Humanos , Masculino , Medición de RiesgoRESUMEN
After examining the cause of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed upon between the parties involved. In addition, this person must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability.The sole risk of the evolution of the functional deficit arising from a proven or prognosticated post-traumatic osteoarthritis is excluded from this standard of proof which means that flat-rate risk supplements are not suited to this individualized approach and thus do not apply.
Asunto(s)
Evaluación de la Discapacidad , Determinación de la Elegibilidad/legislación & jurisprudencia , Testimonio de Experto/legislación & jurisprudencia , Seguro por Accidentes/legislación & jurisprudencia , Osteoartritis/diagnóstico , Medición de Riesgo/legislación & jurisprudencia , Alemania , HumanosRESUMEN
We present the case of a patient with osseous Ewing's sarcoma of the big toe occurring during the healing process after a fracture of the little toe, which significantly delayed diagnosis, despite striking findings on imaging. We subsequently performed further diagnostics, neoadjuvant chemotherapy, tumor resection in the form of a resection of the first ray, and adjuvant chemotherapy. This case shows that the occurrence of a secondary disease should always be considered in untypical courses of healing.
Asunto(s)
Neoplasias Óseas/diagnóstico , Neoplasias Óseas/terapia , Hallux/diagnóstico por imagen , Hallux/cirugía , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/terapia , Adulto , Antineoplásicos/uso terapéutico , Terapia Combinada/métodos , Diagnóstico Tardío/prevención & control , Diagnóstico Diferencial , Femenino , Humanos , Examen Físico/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: A fast and comprehensive diagnostic by means of whole-body CT has been shown to reduce mortality in the adult trauma population. Therefore whole-body CT seems to be the standard in adult trauma-patients. Due to the higher radiation exposure of whole-body CT the use of this diagnostic toll in pediatric trauma patients is still under debate. It is not yet clear if whole-body CT in children can increase the probability of survival. METHOD: In a retrospective, multicenter study, we used the data recorded in the TraumaRegister DGU(®) to calculate the probability of survival according to the revised injury severity classification (RISC) and standardized mortality ratio (SMR). The SMR reflects the ratio of recorded to expected mortality. Included in the study were all children (1-15 years) and adults (16-50 years) with an Injury Severity Score (ISS)>9, who were directly admitted to the hospital from the scene of accident. We compared the groups of patients given whole-body CT or non-whole-body CT. Subgroup analysis was performed for children 1-9 years, children 10-15 years and adults. RESULTS: A total of 1,456 pediatric trauma patients (mean age 9.9 years) and 20,796 adults (mean age 32.7 years) were included in the study. In contrast to adult trauma patients, were the SMR in the whole-body CT group was significant lower; we observed no advantage for the whole-body CT in pediatric trauma patients. CONCLUSION: Due to the missing advantage of whole-body CT in the pediatric trauma population and the higher radiation exposure of whole-body CT a non-whole-body CT approach seems equivalent with a lower radiation exposure.
Asunto(s)
Traumatismo Múltiple/diagnóstico por imagen , Sistema de Registros , Tomografía Computarizada por Rayos X/métodos , Imagen de Cuerpo Entero/métodos , Adolescente , Adulto , Niño , Preescolar , Bases de Datos Factuales , Errores Diagnósticos/prevención & control , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/mortalidad , Dosis de Radiación , Estudios Retrospectivos , Tasa de Supervivencia , Adulto JovenRESUMEN
INTRODUCTION: Residual limb pain and phantom pain are severe complications following an amputation. Various reasons are responsible for these complaints. It must be distinguished between amputation stump pain, phantom sensations and phantom pain. CAUSE AND THERAPY: In this paper we describe the most common reasons for stump pain and propose some non-operative therapeutic approaches. Furthermore path physiology and phantom pain therapy will be discussed. The recommendations offered in this paper are based on practical experience over three decades in a specialized out-patient department for patients with amputation injuries.