[Subtrochanteric femur fractures-epidemiology, surgical procedures, influence of time to surgery and comorbidities on complications : A risk-adjusted regression analysis of routine data from 2124 cases]. / Subtrochantäre Femurfrakturen ­ Epidemiologie, Operationsverfahren sowie Einfluss der präoperativen Verweildauer und von Nebendiagnosen auf Komplikationen : Eine risikoadjustierte Regressionsanalyse mittels Routinedaten anhand von 2124 Fällen.

BACKGROUND: There are approximately 12,000 subtrochanteric femur fractures in Germany per year with a rising trend but studies about the epidemiology and the surgical outcome are rare. Furthermore, there are no guidelines from expert societies and there is no adequate quality assurance. OBJECTIVE: Presentation of the epidemiology and the current treatment situation with respect to the patient collective, comorbidities, time to surgery and surgical procedures used as well as the identification of modifiable risk factors with respect to complications. MATERIAL AND METHODS: Analysis of routine data based on an established data model in 2124 cases. The descriptive statistics contain data on basic patient characteristics, such as age, comorbidities, surgical procedure, time to surgery and mortality. In the analytical statistics the impact of risk factors (surgical procedure, time to surgery etc.) on the endpoints mortality, complications and decubitus was investigated by logistical regression analyses. RESULTS: Of the patients 55% were operated on within the first 24h. Intramedullary osteosynthesis (89%) is the most frequently used surgical method (prostheses 2%, extramedullary procedures 5%). Within the first postoperative year 37% of the patients received a higher level of care, where the care was moved from outpatient to inpatient treatment. The mortality in the first postoperative year was 26%, while early complications were observed in 6%. A delay in surgical treatment was associated with an increased mortality and intrinsic factors, which were difficult to influence. Intramedullary osteosynthesis had the lowest mortality and revision rates. CONCLUSION: Concerning the epidemiological data, the patient collectives of subtrochanteric fractures and femoral neck or pertrochanteric fractures were very similar. Major delays in the time to surgery of subtrochanteric fractures can be associated with increased complication rates and mortality. Therefore, programs to prevent older patients from falling have a high priority.

Increased prevalence of antibrain antibodies in the sera from schizophrenic patients.

The pathogenesis of schizophrenia is still unknown. In a previous study we found antibrain antibodies in the sera of schizophrenic patients, but not in normal controls. Therefore we have further examined the sera of schizophrenic patients versus normal controls, increasing the number of brain areas, to explore whether certain areas were involved more often than others in the antibody binding process. The sera of 50 patients suffering from an acute episode of schizophrenia (classified by DSM III-criteria) were tested. 70% of the patients showed antibody binding, while only 12% of the age- and sex-matched controls were positive. The binding was mediated by IgG- as well as IgM-antibodies. Amygdala, frontal cortex, cingulate gyrus, and septal area were the prominent targets, while hippocampus, parahippocampal gyrus, entorhinal cortex, putamen, mamillary bodies and head of the caudate nucleus were involved to a lesser degree. Binding was not present to nucleus olivaris, to the thyroid gland or to HEp-2 cells, which we included to test for unspecific antinuclear factors. Longterm studies of schizophrenic patients and biochemical analyses of the antigen(s) involved are in progress.