[Increasing Number of Road Traffic Fatalities in Germany - Turnaround or Snap-Shot]. / Warum wieder mehr Menschen im Straßenverkehr sterben ­ Trendwende oder Ausreißer?

Introduction: For the first time since 20 years, the number of road accident fatalities in 2011 increased on German roads compared to earlier periods. Methods and Results: The presented paper submitted by the expert group for accident prevention investigates and discusses possible reasons for the observed increase in road traffic fatalities. Results: Climate changes as well as changes in economic environment, and technological progress in car and passenger safety are identified as possible reasons for the observed increase. Discussion: Mentioning the "Decade of Action for Road Safety" initiated by the UNO and coordinated by the WHO, the overall goal is a worldwide reduction of accident related road fatalities. But prognostic calculations predict an asymptotic approximation to a limit of road fatalities. To achieve a reduction by half until 2020 intense collaboration and disproportional expenditure are necessary. Conclusion: From the authors' point of view the current increase of traffic fatalities in Germany is rated as a snapshot rather than a turnaround.

[P.A.R.T.Y. An initiative for more risk awareness among young road users]. / P.A.R.T.Y. Eine Initiative für mehr Risikobewusstsein bei Jugendlichen.

BACKGROUND AND OBJECTIVES: Accident prevention strategies aim to inform young people about risk-taking behavior and the consequences of trauma. The Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.) program is an accident prevention program that focuses on the prevention of road traffic accidents among young road users. Initial results of the program were evaluated to find out if the implementation of this prevention program is feasible in Germany. MATERIAL AND METHODS: During a 1-day interactive course young road users were introduced to the work carried out in an accident trauma unit and were informed about injury mechanisms and about the consequences of trauma. A systematic evaluation was made by all participants. The results were analyzed to find out whether it is possible to implement the program and the impressions gained by the participants of the program in order to be able to make further adjustments. RESULTS: A total of 219 young road users participated in the P.A.R.T.Y. program between 2011 and 2013. All participants reviewed the structure of the program with the help of school grades. Of the participants 59 % (n = 129) rated the program as "very good" and 41 % gave the rating of "good". Overall, 70 % of all participants advocated that all people of the same age should participate in the program. The structure was described as being well-balanced with respect to the theoretical and practical stations. CONCLUSION: The P.A.R.T.Y. program is a standardized and well-established concept that can also contribute to accident prevention in Germany. It provides the possibility to implement an accident awareness program throughout Germany. Initial results show that the program can be implemented in German hospitals and that the program appeals to the target group of young road users.

[While Others are Sleeping - Performance of Major Trauma Care at Night]. / Wenn andere schlafen ­ Leistungsfähigkeit der Patientenversorgung in der Nacht am Beispiel der Schwerverletztenversorgung.

Introduction: The literature indicates that medical staff suffer from a decline in cognitive and physical performance at night. This study evaluates the process quality and outcomes of emergency care during night-time and daytime. Method: Out of 1,226 prospectively registered patients, 420 were included into this study (observation period: 76 months). Inclusion criteria were an ISS ≥ 16 and admission to trauma room during "DAY" (8 am to 4 : 49 pm) or "NIGHT" (9 pm to 5 : 59 am). The fundamental part was the 130 items of the TraumaRegister DGU. The additional 350 items contain data about prehospital treatment, trauma room management and intensive care. Data were collected by a research assistant over a 24-h period. Results: The study sample contained 268 DAY-patients and 152 NIGHT-patients. Patients admitted during night were injured more severely: ISS 34.9 (± 16.4) vs. 31.1 (± 14.2), p = 0.015 and younger: 33.3 (± 16.6) vs. 43.6 (± 22.3) years old, p < 0.001. However, this had no impact on outcome prediction scores like RISC, RISC2 or TRISS, p ≥ 0.775. Furthermore, no difference in process quality was observed like the time to gain an arterial access: NIGHT 4.5 (± 3.7) vs. DAY 5.0 (± 3.7) min, p = 0.116, time for splinting 3.8 (± 3.7) vs. 3.4 (± 3.1) min, p = 0.922, or other parameters, like time to CT: 26.9 (± 11.2) vs. 26.6 (± 14.5) min, p = 0.520. Nor was there any difference in outcome: 17.8 % of the NIGHT-patients (RISC-prognosis: 23.8 %, SMR 0.74) died in hospital, and 18.3 % of the DAY-patients (RISC-prognosis: 24.0 %, SMR 0.77), p = 0.894. As well the comparison of the Glasgow Outcome Scale revealed no difference: NIGHT 3.8 (± 1.5) vs. DAY 3.8 (± 1.6), p = 0.491. Discussion: Although evidence suggests a drop of performance by medical staff at night, this effect could not be demonstrated. Considering this, the level of process quality and outcome - regardless of the time of arrival - remained constant on a high level. These results might be attributable to the quality management and the standardisation of the treatment.

[AltersTraumaZentrum DGU®]. / AltersTraumaZentrum DGU®

Orthopaedic surgeons are faced with a large number of geriatric patients. An ageing society will lead to a significant increase in the number of geriatric patients in orthopaedic trauma units in the future. Due to the significant number of comorbidities an orthogeriatric service seems to be effective during acute care to maintain patients' independency. During the last 2 years the orthopaedic and geriatric medical societies in Germany have developed joint criteria for orthopaedic-geriatric trauma centres. These were evaluated and improved during a pilot certification procedure. The German trauma society (DGU) is now starting the certification procedure AltersTraumaZentrum DGU®. Simultaneously a geriatric trauma registery for hip fractures (AltersTraumaRegister DGU®) is being established in Germany. All certified hospitals will have to participate in the registery. This will allow the participants to benchmark their own results with the data from the registery. Because of the identical core data set comparisons with similar international registeries will also be possible.

[Assessment of injury severity at the accident scene by the emergency physician: utility of technical crash parameters: results of a pilot study]. / Notärztliche Einschätzung der Verletzungsschwere am Unfallort: Diagnostischer Wert technischer Parameter - Ergebnisse einer Pilotstudie.

BACKGROUND: Technical parameters of road traffic crashes are routinely documented by emergency physicians on scene. It is, however, unclear whether this information contributes to the estimation of injury severity of vehicle drivers. MATERIALS AND METHODS: In this study, three experienced emergency physicians were asked to predict the injury severity of vehicle drivers [categorized according to Injury Severity Score (ISS) values of <16 and ≥16 as moderate to severe or life-threatening] based on increasingly complex technical crash information, ranging from routine variables to photo documentation of the crash scene. A sample of 100 cases (mean ISS 23.6±26.9) was obtained from the prospective database of an in-depth technical and medical car crash research project conducted in the northeastern part of Germany. Statistical analysis comprised inter-rater agreement beyond chance (kappa values) and indicators of diagnostic test accuracy (i.e. sensitivity, specificity and so on). RESULTS: The inter-rater agreement of injury severity based on technical crash information was moderate to substantial (kappa 0.42-0.66). Amongst the three observers and various amounts of technical data, sensitivity ranged between 18 and 80%, and specificity ranged between 41 and 89% in predicting the presence of major trauma. Presentation of photographs from the crash scene increased diagnostic accuracy. Still, the presented information led to a shift from a 50% prior probability of life-threatening injuries to a maximum of 40% in the negative and 67% in the positive case. CONCLUSION: Neither basic technical parameters that are easy to obtain after a car crash nor additional technical information markedly contribute to the emergency physician's estimation of a vehicle driver's injury severity. The presented results should be supported by a subsequent study including a larger sample.

[Accidents, illness and injuries involved in road haulage : consequences for medical care and prevention]. / Unfälle, Erkrankungen und Verletzungen im Güterkraftverkehr : Konsequenzen für die medizinische Versorgung und Prävention.

This article reviews basic characteristics of road traffic crashes of heavy vehicles and the current health status of truck drivers. It summarises previous findings from research with a focus on orthopaedic diseases and injuries. These findings comprise a risky health behaviour and high prevalence of associated diseases which can be attributed to both the occupational framework and personal risk-taking behavioural patterns. These are of major importance given the increasing number of drivers and the consequences for acute care and prevention. On the other hand there is a substantial lack of medical care for the drivers on the road. Therefore this article presents the"DocStop Initiative" for medical care on the road, an initiative that runs an international network of care providers (http://www.docstop-online.eu).

[Road traffic crashes in developing countries]. / Verkehrsunfälle in Entwicklungsländern.

Road traffic crashes pose a major threat to individuals and national health systems. Developing countries account for 48% of motorized vehicles, but for 91% of the 1.3 million fatalities per annum. While ranked ninth among the causes of disabilities adjusted life years lost in 2004, crash injuries are projected to rise to third position by 2030. This article reviews current prognoses of deaths and disabilities, the characteristics of crashes in low and middle income countries and evidence-based road safety interventions. This article is considered a wake-up call for trauma, orthopaedic, and emergency surgeons in high-income countries to join the global community in fighting the neglected yet potentially curable epidemic named road traffic injuries.

[Physicians in traumatology. Critically endangered? Results of an inquiry]. / Arzte in der Unfallchirurgie. Unglücklich und vom Aussterben bedroht? Ergebnisse einer Umfrage.

INTRODUCTION: The aim of this investigation was to describe the current situation and atmosphere among residents and consultants in traumatology, using the results of a questionnaire. Wishes and needs concerning training programs in traumatology were addressed. METHODS: A questionnaire consisting of 25 items was distributed among members of the German Society of Traumatology (DGU) to document basic data concerning the state of residency and physicians' current workload. The participants were also asked about their personal interests and aims within traumatology. Finally, questions concerning educational programs, compensation, and work-life balance were addressed. The results were analysed descriptively. RESULTS: The final analysis included 549 questionnaires. The mean age of the participants was 36 years (SD +/-7.5). Sixty percent (329) were residents, and 16% (88) served as consultants. The mean workload per week was 61 h (SD +/-10.8 h), and participants were on call seven times (SD +/-5.6) a month. The work-life balance was rated a mean of only 5 ("mediocre"). The majority of participants rejected working longer in order to reduce the duration of their educational program. On the other hand, most of the participants would also reject a reduction in working time accompanied by a reduced salary. Nevertheless, 78% (428) of the participants would, in retrospect, choose the same profession, and 85% (466) would even choose the same specialty. DISCUSSION: The study reports on the atmosphere among residents and consultants in traumatology. Despite European regulations, the individual workload is exceptionally high. It is a clear task of hospital administrators to increase the attractiveness of hospital jobs in order to ensure qualified personnel in the future.

[Two wheels - too dangerous? Analysis of real-world crash data and federal statistics]. / Two wheels - too dangerous? Eine Analyse von Unfalldaten und Bundesstatistik.

BACKGROUND: Motorcyclists profit from improved safety measures and medical care only slightly compared with other road users. The aims of this study were to gain new insights into crash mechanisms and the resulting injuries of motorcyclists and to understand trends in road traffic accident statistics over the last 10 years. METHODS: In our prospective analysis we documented data from collisions in which at least one subject sustained an injury of 2-6 on the Maximum Abbreviated Injury Scale (MAIS). Additionally, key parameters published by the German Federal Statistical Office were analysed. RESULTS: Data were studied for 66 motorcycle crashes and 66 injured subjects. The mean ISS was 17.9, with injuries of the lower limb (44%) and head (41%) being the most frequent in motorcyclists. Psychometric questionnaires revealed that motorcyclists had a significantly higher willingness to take risks compared with drivers of other vehicles. Federal statistics revealed a dramatic increase in mortality in the first months of 2007, but in the next months, mortality decreased to levels comparable to those of the preceding year. CONCLUSIONS: Knowledge of crash mechanisms, injury patterns and profiles of high-risk drivers can help reduce the collision rates and injury severity of motorcyclists.

Not another 4th of July report: uncommon blast injuries to the hand.

OBJECTIVES: Blast injuries to the hand are rare during peacetime and are mainly caused by fireworks. The injury patterns combine a variety of tissue destruction (laceration, dissemination, avulsion, blast, crush and burns). Emergency department staff play a key role in identifying the cause of injury, recognising the full extent of the lesion and referring patients for appropriate treatment. A review was undertaken to examine specificities in emergency department diagnosis and treatment of a separate subgroup of blast injuries. METHODS: The diagnosis and treatment of patients admitted with work-related blast injuries of the hand were retrospectively reviewed. Demographic, clinical and diagnostic data were evaluated and treatment algorithms were analysed. RESULTS: Treatment algorithms of 14 patients suffering blast injuries of the hand due to a vole captive bolt device were analysed. The non-homogeneous injury pattern showed complex multistructural lesions. Relatively innocent-looking superficial wounds mask extensive deep tissue damage, the full extent of which could only be recognised after rigorous surgical exploration. All patients but one were treated by immediate surgery, debridement of tissue necrosis and lavage. A delay before surgery resulted in phlegmonous infection in one case. CONCLUSION: Emergency staff must be aware of the potential dangers of this subgroup of blast injuries and the worsening effect of delay before surgery. Only knowledge of the underlying mechanism of the accident enables the emergency physician to understand the complexity and full extent of the injury pattern and to refer patients early for appropriate surgical management. Conservative treatment is inappropriate, dangerous and may become a focus of negligence claims.

Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction.

Osteomyelitis following arthroscopic assisted anterior cruciate ligament (ACL) reconstruction has not been reported in literature. We describe an aggressive progression of septic arthritis and osteomyelitis leading to the complete destruction of the condylar region in a young non-immunosuppressed patient after reconstruction of the ACL. In addition we discuss the steps in diagnostics and our salvage procedures.

Harm set, harm get: hand injuries caused by vole captive bolt devices.

INTRODUCTION: Vole captive bolt devices are special mouse traps which belong to the spring guns. Devices and ammunition are available over the counter, age of consent (18 years) is the only legal restriction. Loaded with a 700 J cartridge the device is positioned in the vole passage. By slightly touching a metal ring in front of the muzzle the mouse triggers the shoot and is killed by a high-pressure gas jet. In spite of the high-potential danger causing injuries no study on accidents due to blank cartridge mouse shooters has been published yet. METHODS: Patients suffering hand injuries due to vole captive bolt devices were identified. Both type and severity of injury and treatment were recorded. An assessment instrument was designed to identify the critical circumstances leading to injury. Also safety regulations and security measures were examined. RESULTS: Between August 2004 and February 2007 20 male patients (average age 48.65 years) suffered accidental hand injuries due to vole captive bolt devices. Patterns of injury reached from cutaneous burning up to traumatic amputation of fingers and separation of the whole hand. In 9 of 20 cases an unintended shoot was triggered in secured status of the devices so the accidents were caused by failure of the security mechanism. Ballistic considerations, casualties and the injury pattern itself differ from well-studied hand injuries caused by blank cartridges or fireworks. CONCLUSION: The study presents a previously unpublished injury pattern due to vole captive bolt devices. Forensic approach has to keep in mind this previously unknown mechanism as cause of accident or self-mutilation.

[Tree collisions in road traffic accidents - mechanism and pattern of injury]. / Baumunfälle im Strassenverkehr - Unfallmechanismus und Verletzungsmuster.

INTRODUCTION: In Germany, the county of Mecklenburg-Vorpommern has got the highest frequency of traffic accidents. 42 % of all deadly injured car accident victims in Mecklenburg-Vorpommern sustained a tree collision. Aim of this study was to analyze tree collisions regarding typical pattern and severity of injury. METHODS: During an on-going prospective, non-interventional accident survey within a defined area of the county of Mecklenburg-Vorpommern tree collisions with minimum one victim sustaining a Maximum Abbreviated Injury Scale of 1-6 injury were analyzed. RESULTS: In between January 2001 and June 2004 287 accidents were documented. 19 % (54) were tree collisions. 81 % of drivers were male. 36 of 54 tree collisions (67 %) occurred on straight roadways. The mean ISS was 31.3 (SD +/- 29.8), 30 % (23) of the passengers died. 70 of 78 individuals sustained more than one injury. With that, the combination of head- and chest trauma was most frequent and associated with the highest injury severity. DISCUSSION: Especially tree collisions lead to severe trauma. Interestingly, most accidents did occur on straight roadways.

Oldie but goldie: Bristow-Latarjet procedure for anterior shoulder instability.

PURPOSE: To analyse the functional and radiological outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability. METHODS: Records of 29 patients were reviewed retrospectively. Date of first dislocation, injury mechanism, and number of recurring dislocations before and after surgery were recorded. The overall function and stability of the shoulder was evaluated. RESULTS: 24 (83%) of the glenohumeral instabilities were caused by trauma. The mean number of recurring dislocations was 8 (95% confidence interval [CI], 0-18); one patient had had 40 recurrences. No dislocation ensued postoperatively. The overall functional outcome was good, with a mean Rowe score of 90 points (95% CI, 78-100). Scores of 17 (59%) of the patients were excellent, 7 (24%) were good, 3 (10%) were fair, and 2 (7%) were poor. CONCLUSION: The Bristow-Latarjet procedure is a good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint.

[Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate]. / Ergebnisse nach Versorgung instabiler proximaler Humerusfrakturen mittels winkelstabiler Platte.

BACKGROUND: Fixed-angle implants are being increasingly used in surgery of fractures of the proximal humerus. The aim of this retrospective investigation was to evaluate the outcome after fracture reduction utilizing a fixed-angle plate (Königsee). MATERIALS AND METHODS: Between January 2003 and April 2004, 58 patients were operated, 52 of whom received a fixed-angle implant; 46 cases were harvested for a follow-up examination. Each patient was re examined clinically and radiologically at least 6 and 18 months after surgery. The functional outcome was evaluated using the Constant Score and the Simple Shoulder Test. The results were compared to results of other investigations. RESULTS: The mean patient age was 68.8 years (34-94 years). Fractures were classified using the Neer Classification: 12 were classified as two-part, 25 as three-part, and 9 as four-part fractures. Three of the three-part and four of the four-part fractures were rated as luxation fractures. The overall functional outcome of all cases was good. More than 18 months after surgery the mean general "Constant Score" was 57; the mean side-related "Constant Score" was 89%. The Simple Shoulder Test revealed a pain-free range of motion in 41 (89.1%) of the individuals. The majority of the patients were satisfied with the results regarding remaining range of activity of the injured limb. In five cases significant complications occurred. In two cases the head of the humerus collapsed, and in one case a necrosis of the head occurred. In one individual the implant broke after an additional trauma. In this case a re-osteosynthesis utilizing a tibia plate was performed and the patient was excluded from further follow-up investigations. One soft tissue infection occurred after initial surgery. CONCLUSION: It has been shown that results after fixation of proximal humerus fractures with fixed-angle implants are good. The functional outcome is good and complications are rare. Our results correlate with other investigations regarding fracture reduction using fixed-angle plates and nails.

Does the frontal airbag avoid thoracic injury?

INTRODUCTION: The airbag is an established car safety device. However, recent studies pointed out that even the airbag might cause injuries. Nevertheless, most physicians do consider a lower risk in accident victims sustaining severe injury of the chest, when a deployed frontal airbag has been reported. We set out to verify the frequency and pattern of thoracic injury in car drivers protected by a frontal airbag during traffic accidents. METHODS: This investigation was conducted as part of a prospective surveillance analyzing traffic accidents. Enrolled were car drivers included in a databank between January 2001 and December 2004 consecutively. The chance for sustaining chest injury with or without a frontal airbag was described using the relative risk. RESULTS: A total of 188 car drivers were included in the analysis. In 54 (28.7%) cases a deployed airbag and in 134 (71.3%) the absence of an airbag has been documented. Out of those cases 16 (29.6%) drivers with airbag and 30 (22.4%) without airbag sustained a chest injury. The mean abbreviated injury scale (AIS) of chest injuries in drivers with deployed airbag was 2.3 (1-5; SD +/- 1.45; mean injury severity scale [ISS] 21.1 [SD +/- 17.18]), in drivers without airbag 1.6 (1-4; SD +/- 1.12; mean ISS 15.8 [SD +/- 20.6]). For belted drivers with an airbag the relative risk to sustain chest injury was 1.96 compared to those without an airbag. CONCLUSIONS: The airbag does not avoid chest injury definitively. Much more, it has been demonstrated that the relative risk to sustain relevant thoracic injury seems to be almost higher in restrained drivers with a frontal airbag.

Failed or inadequate bone marrow aspiration: a fast, simple and cost-effective method to produce a cell suspension from a core biopsy specimen.

Failure to aspirate bone marrow (BM) diminishes diagnostic accuracy and efficiency because BM cell suspensions are crucial for modern haematological diagnostic methods such as cytomorphology, flow cytometric immunophenotyping (FCI), cytogenetics or fluorescent in situ hybridization (FISH). We mechanically disaggregated unfixed BM core biopsies with the Dako Medimachine in 65 cases of macroscopically suspected dry taps. Cytospins, three-colour FCI and in some cases karyotyping and FISH were performed successfully. Most cytospins (34 of 50; 68.0%) were of good quality, while a further 18.0% showed moderate but still informative quality. FCI showed good quality in 36 of 60 (60.0%) cases; in 13.3% quality was moderate, but diagnostically useful results were obtained. Surprisingly, all four cases of formerly undiagnosed BM-carcinosis could be clearly detected on cytospins. Finally, five of seven (71.4%) attempts yielded analysable metaphases mostly in cases where no metaphases could be obtained from BM or peripheral blood. The described method of mechanical disaggregation of unfixed BM core biopsies compares favourably with other published approaches, allowing the application of all techniques where BM cell suspensions are needed. Thus, it can help to establish the underlying diagnosis in patients with abnormalities in peripheral blood and unsuccessful marrow aspirations.

CD38 expression is an important prognostic marker in chronic lymphocytic leukaemia.

Employing a multicolour flow cytometry assay, 133 B-chronic lymphocytic leukaemia (B-CLL) cases were analysed for surface expression of CD38. Based on a cut-off value of 20%, CLL patients were categorised into a CD38-positive (> or = 20%, n = 56) and a CD38-negative subgroup (< 20%, n = 77) and separately analysed for clinical and laboratory parameters. Patients in the CD38-positive cohort were characterised by an unfavourable clinical course with a more advanced disease stage, poor responsiveness to chemotherapy, short time to initiation of first treatment and shorter survival. In contrast, the CD38- negative group required minimal or no treatment, remained treatment-free for a longer time period and had prolonged survival (P < 0.05). CD38 expression was a robust marker in the majority of patients in that it was stable over time and not significantly influenced by chemotherapy. In conclusion, our data confirm recent studies suggesting a role of CD38 as a predictor of clinical outcome in patients with B-CLL.

The histone acetyltransferase activity of PCAF cooperates with the brahma/SWI2-related protein BRG-1 in the activation of the enhancer A of the MHC class I promoter.

Major histocompatibility complex (MHC) class I proteins are an essential component of the immune system allowing the organism to protect from viral infections and neoplastic transformation. Expression of the MHC class I genes is regulated by a variety of cis-regulatory promoter elements among which the enhancer A is of particular importance. This enhancer is synergistically activated through AP-1/ATF and NF-kappa B transcription factors. NF-kappa B recruits the histone acetyltransferase (HAT) p300/CREB-binding protein (CBP) to the multiprotein complex bound to the enhancer A. Here we present evidence that acetylation and deacetylation processes are involved in the activation of the enhancer A. The p300/CBP associated factor PCAF, but not p300/CBP, counteracts the repression of the enhancer A mediated by the histone deacetylase HDAC1. Furthermore, overexpression of PCAF results in an increase in the acetylation of histone H4 bound to the enhancer A and HDAC1 counteracts the PCAF-mediated H4 acetylation. The activation function of PCAF requires the p300/CBP binding motif indicating that PCAF might be recruited to the enhancer A through an association with p300/CBP. Moreover, PCAF and the Brahma/SWI2-related protein BRG-1, which is a key factor of the human ATP-dependent chromatin remodelling complex SWI/SNF, synergistically up-regulate the enhancer A. Synergistic activation requires the HAT domain of PCAF. Taken together our data suggest that members of two different groups of chromatin modifying complexes are involved in the activation of the enhancer A of the MHC class I promoter.

Differential expression of chemokine receptors in B cell malignancies.

Chemokines are a family of 8-10 kDa proteins with a wide range of biological activities including the regulation of leukocyte trafficking, modulation of haemopoietic cell proliferation and adhesion to extracellular matrix molecules. Using a panel of chemokine receptor-specific monoclonal antibodies (MoAb) in a multicolour flow cytometry approach we analysed the expression of the lymphocyte-associated chemokine receptors CXCR4, CXCR5, CCR5 and CCR6 in B cell acute lymphoblastic leukaemia (precursor B-ALL; six cases), B cell chronic lymphocytic leukaemia (B-CLL; 31 cases), multiple myeloma (10 cases), mantle cell lymphoma (MCL, four cases), follicular lymphoma (FL, three cases) and hairy cell leukaemia (HCL, five cases). We demonstrate that CXCR4, CXCR5 and CCR6 are differentially expressed in these B lymphoproliferative disorders depending on the maturational stage of the malignant B cell population investigated. In particular, we found that CXCR4 is strongly expressed on immature ALL blasts whereas no surface immunoreactivity for CXCR5, CCR5 and CCR6 was observed. By contrast, non-Hodgkin's lymphomas (NHLs) corresponding to more mature peripheral B cell subsets (ie B-CLL and MCL) exhibited high expression levels of CXCR4 and CXCR5. Analysis of terminally differentiated myeloma cells revealed a down-regulation of CXCR4, CXCR5 and CCR6. CCR5, which is not expressed in normal B cells, was also absent from the majority of NHLs. However, CCR5 staining was seen in three of five cases of HCL, representing the first example of cross-lineage aberrant chemokine receptor expression in malignant haemopoietic cells.