[Prevalence of incidental findings of the Axial skeleton on computed tomograph of severely injured patients]. / Prävalenz von Zufallsbefunden des Achsenskeletts in computertomographischen Untersuchungen polytraumatisierter Patienten.

Computed tomography has become an important component in the initial assessment of severely injured patients over the last years. The liberal use coupled with advances in imaging technology often result in incidental findings. In our present investigation, the prevalence incidence of incidental findings of the spine and skull amounted to 58% of all patients with trauma. Degenerative changes were most commonly found, followed by congenital defects and neoplasms. Within the latter, further investigation was necessary in six cases, of which two findings proved to be malignant neoplasms. The high incidence of incidental findings calls for a uniform documentation, handling and clarification of responsibility in treatment and insurance-related competence.

La tomodensitométrie est devenue un examen important dans la salle d'urgence au cours de ces dernières années. Parallèlement aux blessures causées par accidents, d'autres résultats sont apparus par hasard et sans lien direct avec l'accident. Dans ce travail, l'incidence sur le crâne et la colonne vertèbrale se chiffre à 58%. En majorité sont découverts des changements dégénératifs, suivis par des anomalies congénitales et des néoplasies. Six cas ont nécessité d'être clarifiés et deux cas se sont avérés malins. Suite à la répercution de ces découvertes fortuites, il s'est avéré nécessaire d'établir des critères uniformes afin de clarifier la nécessité d'intervention ainsi que pour des questions d'assurance.

Low tidal volume ventilation in a porcine model of acute lung injury improves cerebral tissue oxygenation.

BACKGROUND: In study, we investigated the effects of different tidal volumes on cerebral tissue oxygenation and cerebral metabolism in a porcine model of acute lung injury (ALI). We hypothesized that mechanical ventilation with low tidal (LT) volumes improves cerebral tissue oxygenation and metabolism after experimentally induced ALI. METHODS: After inducing experimental ALI by surfactant depletion, we studied two conditions in 10 female pigs: 1) LT volume ventilation with 6 mL/kg body weight, and 2) high tidal (HT) volume ventilation with 12 mL/kg body weight. Variables of gas exchange, hemodynamic, continuous cerebral tissue oxygen tension (p(ti)O2), cerebral microdialysis, and systemic cytokines were analyzed. After induction of ALI, data were collected at 2, 4, and 8 h. The primary end point was the change in p(ti)O2. For group comparisons, a t-test was used. A value of <0.05 was considered to indicate statistical significance. RESULTS: At baseline and after induction of ALI, no differences between groups were found in p(ti)O2; however, p(ti)O2 was significantly lower in the HT group after 4 and 8 h. PaO2 and PaCO2 showed no significant differences between the groups at all timepoints. Regarding cerebral microdialysis, a significantly higher level of extracellular lactate could be demonstrated after 2, 4, and 8 h in the HT group. The release of cytokines resulted in higher values for interleukin-6 and interleukin-8 in the HT group. CONCLUSION: Protective ventilation with LT yielded a significant improvement in cerebral tissue oxygenation and metabolism compared to HT ventilation in a porcine model of ALI. There was dissociation between arterial and cerebral tissue oxygenation. Cerebral oxygenation and metabolism might have possibly been impaired by a more distinctive inflammatory response in the HT group.