[Patient volume, diagnosis and injury mechanisms in a level 1 trauma center at the beginning of the COVID-19 pandemic in comparison to the mean of the 3 previous years : A retrospective, epidemiological evaluation of 4967 patients]. / Patientenaufkommen, Diagnosen und Verletzungsmechanismen eines überregionalen Traumazentrums mit Beginn der COVID-19-Pandemie im Vergleich zum Mittelwert der 3 Vorjahre : Eine retrospektive, epidemiologische Auswertung von 4967 Patienten.

BACKGROUND: As part of the COVID-19 pandemic, political decisions were made to reduce social interaction and to reduce the number of infections. The aim was to create capacities for the in-hospital care of the patients. OBJECTIVE: The aim of the study was to check whether a reduction in the number of trauma patients compared to the mean of the previous 3 years could be observed. MATERIAL AND METHODS: We retrospectively analyzed all patients who presented in the emergency admission from 1 March to 15 April 2020 with the mean of the patients from the previous 3 years 2017-2019. The age of the patients, time of presentation, diagnoses, whereabouts of the patients, inpatient or outpatient, number and duration of the operative care and required capacity on the normal ward and intensive care units (ICU) were recorded. The injury mechanism was also examined. RESULTS: A total of 4967 patients between 1 March and 15 April were included. On average over the 3 previous years, a total of 1348 patients, i.e. 29.3 patients per day were counted in our emergency room. In 2020 a total of 923, i.e. 20 patients per day (p < 0.01) were counted. On average 227 (24.6%) were admitted to hospital compared to 311.5 (23.1%) in 2020. On average 143 operations were performed compared to 136 in 2020. The days on the ward were reduced from 2442 on average for the previous years, in 2020 to 1172 days by 52.1% (p < 0.01). The number of days on the ICU was 450 days on average in previous years and 303 days in 2020 (-32.7%, p < 0.01). CONCLUSION: The number of patients in the emergency admission was significantly reduced in the observation period in 2020 compared to the mean of the previous 3 years. This directly made resources available for the care of COVID-19 patients.

Icing the Pain-Ultrasound-Guided Cryoablation of Symptomatic Post-Amputation Stump Neuroma.

PURPOSE: To assess the feasibility and outcome of ultrasound-guided cryoablation in patients with a sensitized stump neuroma after limb amputation. MATERIAL AND METHODS: Seven patients (3 females, 4 males; mean age 42 years) were included in this retrospective study. Ultrasound-guided cryoablation of a previously identified painful stump neuroma was performed. Pain was assessed on the visual analogue scale (VAS) and compared before and after cryoablation (Wilcoxon Test). The degree of pain alleviation was correlated with patient age, duration of pain before ablation and time interval between amputation and ablation (Spearman correlation). A p-value less than 0.05 was deemed statistically significant. RESULTS: Nine cryoablations were performed for 8 neuromas. Technical success was 100%, there were no major complications. Mean follow-up was 27 months. There was a statistically significant decrease of pain from mean 8.3 / 10 (baseline) to 4 /10 (on day one), 2.1 / 10 (at one week) and 3 / 10 (at last follow-up) (p < 0.05). Patient satisfaction with cryoablation treatment was very high (median score 70 / 100). CONCLUSION: In our small population observational study, ultrasound-guided cryoablation of a sensitized stump neuroma was effective and safe for pain alleviation with very good long-term results. LEVEL OF EVIDENCE: Level 2, Observational study with dramatic effect.

Impact of pooling on accuracy of hepatitis B virus surface antigen screening of blood donations.

Expenditure on screening blood donations in developing countries can be reduced by testing donations in pools. This study evaluated serological screening in pools for hepatitis B virus (HBV) at the Israeli national blood bank and a hospital blood bank in Gaza, the Palestinian Authority. The accuracy of HBV surface antigen (HBsAg) enzyme immunoassay performed on pools of 3-24 samples was compared with individual tests. Delay in detecting positive samples due to dilution in pools and the possibility of antibody-antigen neutralization were analyzed. The sensitivity of pooled testing for HBsAg was 93-99%, prolonging the window period by 5 days (8.3%). Neutralization of HBsAg by hepatitis B surface antibodies (anti-HBs) could be minimized by testing immediately after pooling. Serological testing for HBsAg in pools may be performed using manually created pools of up to six samples, with 5% loss in sensitivity and a risk of neutralization by anti-HBs present in the donor population. Pooling can therefore be considered as an option only in countries with a low prevalence of HBV.

Estimation of delay in detecting hepatitis C virus antibodies in pools compared to individual testing on seroconversion panels.

Testing for anti-hepatitis C virus (HCV) antibodies in pools may reduce blood screening costs, making this approach affordable for developing countries, provided that the dilution of infected blood does not significantly increase the number of undetectable viral particles, especially in seroconverters. This study assessed the delay in detection of HCV antibodies in five HCV seroconversion panels, tested in pools of 6-48 samples, and estimated the risk of transfusion-transmitted HCV caused by pooling. The delay in detection of positive samples was 5-12 days for pools of all sizes, adding 7% to the risk of HCV transmission that occurs when blood donors' samples are tested individually.

Management of penile incarceration.

A case of penile incarceration is presented. Two steel bushings compromising the penile vascular supply in a young man were removed with the aid of a carbide disk dental drill. Management of this case is described, and guidelines for managing similar cases of penile incarceration are discussed.

Epineurial versus perineurial repair of peripheral nerves.

A survey of clinical and experimental work concerning the efficacy of epineurial versus perineurial suture techniques for the treatment of peripheral nerve disruption has been presented. It seems that little differences result from the utilization of either of these methods. Therefore, suture of the outer epineurium is the technique of choice for most acute nerve lacerations, since it is easier, faster, and requires less manipulation of the delicate internal neural structure. Clinical indications for outer epineurial or inner epineurial (group funicular) repair have also been discussed. The reasons why these techniques lead to similar results remain unclear. However, it would seem to be impossible to align individual axons if their vast numbers and the dynamic disruptive phenomena that occur after nerve transection are taken into account. It is now recognized that peripheral nerve regeneration studies must address events occurring at the level of the injury and additionally in the periphery and the cell body itself. The answer to the clinical problem of nerve transection will lie in our ability to manipulate axonal regeneration from the central nervous system to correct peripheral end organs. This question will not be solved by the position in which suture material is placed.

Xeroderma pigmentosum: oldest living survivor?

Xeroderma pigmentosum is an infrequently occurring disease characterized by premature solar skin degeneration owing to an inherent deficiency in the enzymatic process of excision repair of x-ray-induced DNA alterations. Currently, there are six known genetic forms of this disease. The presence or absence of central nervous system involvement is a manifestation of the heterogeneity of the disease. Survival beyond the third decade of life is unusual. The authors present a 46-year-old patient with proven xeroderma pigmentosum who manifests many characteristic features of this affliction and may be one of the oldest, if not the oldest, living survivor of this unusual disease.

A double-split gluteus maximus muscle flap for reconstruction of the rectal sphincter.

A double-split gluteus maximus muscle flap has been described as a method for reconstructing difficult cases of rectal sphincter disruption secondary to trauma. Anatomic considerations and three case reports are documented. All three patients have derived nearly complete rectal continence after this procedure. The use of the inferior portion of only one gluteus maximus muscle preserves posterior hip stability and the proximal neurovascular supply to the portion of muscle that surrounds the anus. This procedure could potentially be used for rectal sphincter reconstruction in selected cases after ablative surgery in the anal region.

Epineurial vs. perineurial repair.

Previous work concerning the efficacy of different types of nerve repair has been reviewed. We describe a model in which epineurial and perineurial suture techniques were studied by quantitative ultramicroscopy and electrophysiology. In this model, we believe suture of the perineurium was shown to have a slight advantage over suture of the epineurium. Microscopic control and fascicular alignment are advocated to increase the percentage of axons growing into the distal stump and the periphery. The model described should lend itself to the study of other traumatic peripheral neuropathies.

A comparison of light and scanning electron microscopy in nerve regeneration studies.

An assessment of qualitative axonal regrowth after injury using standard light microscopy compared to scanning electron microscopy has been presented. The superior resolution of the scanning electron microscope demonstrates a view of axonal surface anatomy not previously available. Once certain technical problems have been resolved, these methods should become routine in nerve regeneration research.

Pulsing electromagnetic field therapy in nerve regeneration: an experimental study in the cat.

A multidisciplinary approach to the study of peripheral nerve regeneration in the cat has been presented. The purpose of this work has been to determine if pulsing electromagnetic field (PEMF) therapy can enhance peripheral nerve regeneration after injury. In equal groups of animals, two types of pulsing electromagnetic field treatment were compared with untreated controls. All animals underwent quantitative electrophysiologic and morphologic assessment at the area of injury. In addition, muscle fiber sizing in the periphery and retrograde labeling of anterior horn motoneurons with horseradish peroxidase were studied. Results have shown no statistical differences between the groups in electrophysiologic or morphologic parameters. However, in animals treated with a pulse-burst electromagnetic field there was a statistically significant improvement in the labeling and localization of anterior horn cells in the central nervous system. These results indicate that pulse-burst electromagnetic radiation can increase the numbers of motor neurons that reestablish appropriate connections to the periphery after nerve injury. It remains to be seen if this improved spinal cord organization can translate to improved peripheral functional return.

A multivariate approach to the treatment of peripheral nerve transection injury: the role of electromagnetic field therapy.

A multivariate approach to the treatment of peripheral nerve transection injury has been used in a rat model. A pilot study (48 animals, 8 groups) examined variables associated with the method and timing of surgical repair, the arrest of wallerian degeneration, and the role of pulsing electromagnetic field therapy (PEMF) in functional recovery. A second phase (90 animals, 6 groups) then studied the timing and duration of pulsing electromagnetic field therapy as the only variable in larger groups of animals. The pilot study revealed that a vein-graft conduit did not improve functional recovery compared with standard epineurial repair. Additionally, delayed repair compared favorably with immediate repair. The use of chlorpromazine to inhibit the toxic effects of calcium influx appeared to enhance early functional recovery, and the combination of delayed nerve repair and pulsing electromagnetic field therapy seemed to consistently improve function. The second phase of the study has demonstrated (for the first time) statistical improvement in ambulation in animals treated with delayed surgical repair and prolonged pulsing electromagnetic field therapy. We postulate that future treatment of nerve transection injuries will involve a combined treatment regimen consisting of the immediate arrest of wallerian degeneration, delayed surgery, and pulsing electromagnetic field therapy.

A clinical guide to the diagnosis and treatment of heroin-related sexual dysfunction.

It is apparent that a significant degree of sexual concern exists in male and female heroin addicts in the predrug, drug and postdrug periods. The Sexual Concerns and Substance Abuse Project recommends that each opiate abuser entering in to treatment has a brief sex history taken and, if a primary or secondary sexual dysfunction is discovered, then additional evaluation is indicated. Furthermore, the Project stresses the importance of educating the patient to the physiological, as well as psychological, relationship between heroin-related sexual dysfunction and concomitant side effects. For example, in women chronically abusing high doses of heroin, one may not only see a reduction of sexual desire and performance, but also irregular menstrual cycles, and occasionally, amenorrhea, as a result of the depressive effects of the opiate on pituitary hormones. The woman may misinterpret this physiological effect and believe that such changes in her menstrual cycle are irreversible, and that she is sterile. Following the evaluation and patient education phase, the findings obtained from the evaluation of the drug cycle, as it relates to the sociosexual response cycle, should be incorporated into the overall treatment approach for counseling the opiate abuser. When a specific sexual dysfunction exists, particularly if it predates the heroin involvement, referral to a qualified sex therapist is often indicated, to work in co-therapy with the drug counselor and the referring physician. Greater awareness of heroin-related sexual dysfunction may help reduce the relapse rate back to heroin as well as improve the quality of the individual's life during the recovery period.

[Results of a quantitative study of the interaction of pathogenic enterobacteria with a cell monolayer]. / Rezul'taty kolichestvennogo izucheniia vzaimodeistviia patogennykh énterobakterii s kletochnym monosloem

A study was made of the cytopathic effect and dynamics of intracellular reproduction of S. typhimurium and shigellae in the monolayer of HeLa cells, macrophages (monocytes) of the peritoneal exudate of rabbits and rats and microphages (granulocytes) of the pleural exudate of rabbits. The presence of bactericidal mechanism in the host cell to the invaded infectious agent is postulated. An important role of the cell component of defence in insensibility in shigellosis is supposed.

[Comparison of the physiological and biochemical indices of the phagocytosis of ram erythrocytes by macro- and microphages]. / Sravnenie fiziologicheskikh i biokhimicheskikh pokazatelei fagotsitoza baran'ikh éritrotsitov makro- i mikrofagami.

Morita and Perkins' method was applied to the study of the stage of ingestion and destruction of an antigen (sheep erythrocytes) in the macrophages of peritoneal exudate of rabbits and rats and in the microphages of rabbit pleural exudate. Ingestion and intracellular destruction of the antigen were accompanied by intensified respiration and glycolysis of phagocytes. Respiration of the three types of phagocytes at two stages of phagocytosis and also the digestive capacity of microphages proved to be sensitive to cyanide and colchicine. The latter failed to influence the ingestion of the antigen by the three types of phagocytes and its digestion by macrophages. The differences in the metabolism routes of macro- and microphages in intracellular destruction of the antigen was postulated. An intensification of the phagocytic activity after the immunization was characteristic of rabbit and rat macrophages.

[An information subsystem for the epidemiological surveillance of hepatitis B]. / Informatsionnaia podsistema épidemiologicheskogo nadzora za gepatitom B.

The improvement of prophylaxis and the decrease of morbidity rate in hepatitis B are possible on the basis of the introduction of the information subsystem of epidemiological surveillance into practical health service, including health service in rural areas. The necessity of ensuring the specificity of highly sensitive immunodiagnostic techniques by using the combination of these techniques and competitive radioimmunoassay, as well as increasing their availability by the cooperation of laboratories at the district and regional levels, is emphasized.

[Rheophoresis--a practical method of hepatitis immunodiagnosis in rural public health institutions]. / Reoforez--dostupnyi metod immunodiagnostiki gepatita v uchrezhdeniiakh sel'skogo zdravookhraneniia.

The study has revealed that the concentration of HBsAg preparations is simple and easily performed with the use of polyacrylamide, but not dextran gels. Rheophoresis has been shown to be a more sensitive method of indication than countercurrent immunoelectrophoresis. Rheophoresis has been proposed for introduction into medical practice at rural health institutions.

[Erroneous information in the epidemiological surveillance of hepatitis B]. / Ob oshibochnoi informatsii v épidemiologicheskom nadzore za gepatitom B.

False positive results obtained in the determination of the immune markers of hepatitis A by the methods of the passive reverse hemagglutination test and the enzyme immunoassay distort the course of the registration of the epidemic process and deteriorate the quality of the antiepidemic measures ensured to the population. The necessity of the standardization of available test systems is postulated.

[Hemagglutinating test for HBsAg and antibodies in epidemiological practice]. / Gemaggliutinatsionnye diagnostikumy na HBsAg i antitela v épidemiologicheskoi praktike.

The use of Alsever's solution has abolished the necessity for taking intravenous blood and made it possible to divide the determination of HBsAg and antibodies to this antigen into two stages. The combined determination of HBsAg and its antibodies by the third-generation techniques improves the quality of the epidemiological survey of hepatitis B cases and the epidemiological observation of risk groups.

[Experience in verifying hepatitis E in Ukraine]. / Opyt verifikatsii gepatita E na Ukraine.

An outbreak of viral hepatitis B at a sugar refinery in the Ukraine was verified by the detection of HBs antigens and IgM antibodies to hepatitis A virus in the radioimmunoassay. Cases of hepatitis E among workers, employed mainly in heat-treatment departments, appeared due to mass contamination of water mains with sewage water from the residential zone in the presence of a few cases of the disease.