Knee ligament injuries in U.S. pedestrian crashes.

OBJECTIVE: Projectile legform tests are used to evaluate pedestrian lower extremity injury risk, including risk of injury to the cruciate and collateral ligaments. However, it has been suggested that cruciate ligament injuries rarely occur without collateral ligament injuries, making a cruciate ligament injury requirement unnecessary in pedestrian test procedures. Therefore, the current study examines cruciate ligament injuries among U.S. pedestrians with and without other injuries that are evaluated in pedestrian test procedures. METHODS: Injury data for pedestrians treated in U.S. trauma centers from 2007 to 2017 were drawn from the National Trauma Data Bank (NTDB) Research Data Set (RDS) and from its successor, the Trauma Quality Program (TQP) Participant User Files (PUF). Crash and demographic details for individual cases with documented knee ligament injuries were obtained from the Pedestrian Crash Data Study (PCDS). RESULTS: Among pedestrians aged 16 and older with knee ligament injuries, 38% had only collateral injuries, 31% had only cruciate injuries and 31% were documented with injuries to both. Younger pedestrians also sustained cruciate injuries without collateral injuries, with 36% of the 0-15 year-old pedestrians diagnosed with knee ligament injuries having isolated cruciate injuries. Given that injuries to the left and right knee could not be distinguished in NTDB cases, these estimates of isolated ligament injuries are likely conservative, so that at least 31% of pedestrians aged 16 and older and at least 36% of younger pedestrians sustained cruciate ligament injuries without collateral ligament injuries in the same knee. A PCDS case study illustrated how cruciate injury can occur without collateral injury in a lateral bumper impact below the knee. CONCLUSIONS: Cruciate ligament injuries can occur in pedestrian crashes, with or without other injuries that are evaluated in pedestrian test procedures. Isolated cruciate injuries may be more likely in impacts above or below the knee and in impacts with a component of anterior-posterior loading. The frequency of cruciate injury in the absence of collateral injury in lateral and non-lateral impact supports inclusion of injury measures correlating to cruciate injury risk in pedestrian legform test procedures.

[Retinal arteritis in pregnancy]. / Retinale Arteriitis in der Schwangerschaft.

The case of a 35-year-old pregnant patient is described who presented with acute bilateral visual loss. As the reason for this a retinal arteritis could be demonstrated. The patient also suffered from acute unilateral hearing loss in combination with cerebral changes detectable by MRI. After exclusion of other causes the diagnosis of Susac syndrome (retinocochleocerebral microangiopathy) was made and appropriate therapy was initiated.

[Familial exudative vitreoretinopathy]. / Familiäre exsudative Vitreoretinopathie.

Familial exudative vitreoretinopathy (FEVR) is an autosomal dominant inherited disease with a penetrance of nearly 100% and is mostly found in Asia. The most important sign is a temporal avascular retina with pathologically changed vessels combined with a temporal dragging of the disk and a heterotopy of the macula. In contrast to retinopathy of prematurity, only full-term children without oxygen therapy are affected. Clinical severity is highly variable. A stage of an asymptomatic gene carrier with peripheral ischemia only visible on angiography up to a massive deterioration of vision because of a combined tractional and rhegmatogenous retinal detachment is possible. All stages with intra- or subretinal exudates require therapy. First-line therapy is the coagulation of the leaky vessels to reduce the exudation. In addition cryocoagulation is possible. Advanced stages with complex retinal detachments usually require a vitrectomy to prevent further loss of visual function.

[Retinal arteriovenous malformation]. / Retinale arteriovenöse Malformation.

The case of a 27-year-old patient is described who presented at our hospital with an asymptomatic retinal vascular alteration which was found during a routine check-up. The typical clinical presentation led to the diagnosis of an arteriovenous malformation. Further diagnostics did not show any indications for an involvement of brain or facial blood vessels.

[Unusual stromal corneal deposits]. / Ungewöhnliche stromale Hornhauteinlagerungen.

We describe the case of a 70-year-old woman who presented with slowly progressive vision deterioration in both eyes and an increase in glare sensitivity. A slit-lamp examination showed stromal corneal deposits that were atypical for a dystrophy. Protein electrophoresis with immunofixation and bone marrow aspiration led to the diagnosis of an IgG-kappa myeloma. Chemotherapy relieved systemic disease and improved the patient's visual symptoms.

[Acute retinal necrosis]. / Akute Retinanekrose.

Acute retinal necrosis (ARN) is a rare entity caused by Herpes viruses. An immunocompromised background and the complications of ARN mostly lead to a poor visual outcome. Confirmation of the early diagnosis through polymerase chain reaction and antibody detection from aqueous or vitreous taps is recommended to improve the medical management and prevent disease progression with an increased risk of complications. Favourable outcomes are possible by means of combined antiviral systemic and intravitreal strategies with Acyclovir, Foscarnet and Ganciclovir. We report on the relevant literature recommendations and our own experience.

Mechanical properties of a novel PVA hydrogel in shear and unconfined compression.

Poly(vinyl alcohol) (PVA) hydrogels have been proposed as promising biomaterials to replace diseased or damaged articular cartilage. A critical barrier to their use as load-bearing tissue replacements is a lack of sufficient mechanical properties. The purpose of this study was to characterize the functional compressive and shear mechanical properties of a novel PVA hydrogel. Two formulations of the biomaterial were tested, one with a lower water content (75% water), and the other with higher water content (80% water). The compressive tangent modulus varied with biomaterial formulation and was found to be statistically strain magnitude and rate dependent. Over a strain range of 10-60%, the compressive modulus increased from approximately 1-18 MPa, which is within the range of the modulus of articular cartilage. The shear tangent modulus (0.1-0.4 MPa) was also found to be strain magnitude dependent and within the range of normal human articular cartilage, but it was not statistically dependent on strain rate, This behavior was attributed to the dominance of fluid flow and related frictional drag on the viscoelastic behavior. Compressive failure of the hydrogels was found to occur between 45 and 60% strain, depending on water content.

Etiology and pathogenetic mechanisms of optic disc swelling with visual loss. An interdisciplinary prospective pilot study of 102 cases.

A nonrandomized, prospective, interdisciplinary pilot study of 102 patients with noncompressive optic disc swelling with visual loss (ODSWVL) was performed in order to investigate etiologic and pathogenetic mechanisms. Forty-six patients suffered from underlying inflammatory disease. Seventeen patients suffered from highly probable cardiogenic embolization, 16 patients from multiple vascular risk factors. The remaining patients of the noninflammatory disease group suffered from leukemia, previously unknown or severely decompensated diabetes mellitus, acute arterial hypertension, different kinds of coagulopathies and others. Ninety-six of the 102 patients required medical treatment according to general medical standards. Inhomogeneity of the underlying disease processes explains the ineffectiveness of different monotherapies in previous studies. Interdisciplinary search for the underlying causes allows causative treatment. ODSWVL and anterior ischemic optic neuropathy in particular seem to be a common final pathway of various pathogenetic mechanisms due to different etiologies rather than a disease entity by itself.

[Mooren ulcer. 4 severe bilateral disease courses with systemic cyclosporin A therapy]. / Ulkus Mooren. Vier schwere beidseitige Verläufe unter systemischer Ciclosporin-A-Therapie.

BACKGROUND: Mooren's ulcer is a rare autoimmunologic disease of the cornea. Many forms of medical and surgical treatments have been proposed in the past, but none of them was regularly successful. Severe progressive cases of Mooren's ulcer are therefore still a blinding disease. Only the use of systemic cyclosporin A (CSA) treatment appears for the first time to have a significant positive effect on the outcome. PATIENTS: One male (30 years old) and three female (52 y, 68 y, 84 y) patients with severe progressive bilateral Mooren's ulcer were treated with cyclosporin A systemically. RESULTS: On the male patient constant blood levels of CSA were not achievable and he became blind suffering basically from a severe proliferative diabetic retinopathy. The 52-year-old female patient got a relapse of Mooren's ulcer in the graft after penetrating keratoplasty à chaud. With increased blood levels of CSA the progression of the relapsing of Mooren's ulcer could be stopped. Also only with high-dose CSA further progression of the rapidly progressive colliquation of both corneas of a 68-year-old female could be stopped. A definitive improvement with some residual activity could be achieved in a 84-year-old female after only three months of follow-up. CONCLUSIONS: High-dose systemic CSA treatment with plasma trough levels of 150-200 ng/ml is recommended as initial treatment of choice and should be started immediately. For what period of time after clinical healing this high-dose therapy must be contained without the risk of a relapse of Mooren's ulcer remains to be seen.