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Obtaining informed consent is a challenging task and is part of the educational objectives in the German NKLM. Teaching formats are inconsistent and time-consuming, with little emphasis on legal aspects, although they have moved into the focus of attention since the implementation of patient rights laws and play an important role in legal proceedings.The aim of this study was the evaluation of medical students' knowledge about the legal aspects of obtaining informed consent. A legal analysis was performed, and the patient rights laws were reviewed with reference to implications for undergraduate medical education.After the analysis of laws and jurisdiction, multiple-choice questions regarding the legal aspects of obtaining informed consent were created and placed in the Progress Test Medicine (PTM). A statistical analysis of the results of Berlin medical students was performed descriptively.The answers of 2625 (winter semester 2018/19) and 2409 (summer semester 2019) medical students in Berlin were analyzed. The rate of students who answered the questions about the procedures requiring informed consent and adequate time for consideration increased over time but did not reach comparable values to all PTM questions. Questions about required content were answered correctly by 30 to 60% of the students, regardless of their level of training; we did not see an increase along with the time of study.In our study, we were able to show that medical students of all educational levels show tentativeness when it comes to the legal aspects of obtaining informed consent. Yet, the legal framework offers room for new teaching formats like "Co-Action", introduced in this paper for the first time, where students acquire informed consent while being supervised by the medical doctor in charge.HINTERGRUND: Das chirurgische Aufklärungsgespräch stellt eine komplexe Herausforderung dar und ist als Lernziel im Nationalen Kompetenzbasierter Lernzielkatalog Medizin verankert. Die wenigen bestehenden Lehrformate sind uneinheitlich und aufwändig; insbesondere juristische Implikationen nehmen im Studium wenig Raum ein, obwohl sie mit Inkrafttreten des Patientenrechtegesetzes vermehrt in den Fokus gerückt sind und u. a. bei Regressverfahren eine wichtige Rolle spielen.Ziel war eine Ermittlung des Wissensstandes von Medizinstudierenden zu den rechtlichen Aspekten des chirurgischen Aufklärungsgespräches auf Basis einer juristischen Analyse des Patientenrechtegesetzes. Dieses wurde auf Implikationen für die Lehre im Medizinstudium überprüft.Nach Analyse von Gesetz und Rechtsprechung wurden Multiple-Choice-Fragen zu den rechtlichen Aspekten des chirurgischen Aufklärungsgespräches erstellt und im Sinne einer Querschnittsanalyse im Progress Test Medizin platziert. Es erfolgte die deskriptive statistische Auswertung der Ergebnisse bei Berliner Medizinstudierenden.Es wurden die Antworten von 2625 (Wintersemester 2018/19) und 2409 (Sommersemester 2019) Berliner Studierenden ausgewertet. Bei den Fragen zur Art aufzuklärender Prozeduren sowie der Bedenkzeit nahm die Anzahl Studierender, die die Frage korrekt beantwortete, über die Zeit zu, erreichte jedoch nicht den Vergleichswert aller Fragen des Progress Test Medizin. Bei den Fragen zu den notwendigen Inhalten wählten, unabhängig vom Ausbildungsstand, zwischen 30 und 60 % die korrekte Antwort, eine Zunahme korrekter Antworten über die Zeit war nicht zu sehen.In der vorliegenden Arbeit konnte gezeigt werden, dass bei Medizinstudierenden über alle Semester hinweg Unsicherheiten bezüglich der juristischen Aspekte des Aufklärungsgespräches bestehen. Der gesetzliche Rahmen lässt allerdings Raum für neue Lehrformate wie der hier erstmals vorgestellten „Co-Aktion“: der Studierende führt die Aufklärung eines Patienten selbstständig, unter Aufsicht und Verantwortung des behandelnden Arztes, durch.

Practical experiences in clinical traineeships can shape the later specialty choice of medical students.The following study aimed to find factors in anesthesiological clinical traineeship that encourage students to specialize in the field.As part of a nationwide online survey conducted by the working group for education of the German Association for Orthopedics and Trauma Surgery (Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, DGOU), study participants (n = 479) answered questions about their minimum 4‑week traineeship in anesthesiology. The information on items was analyzed in six content categories: 1) integration into the team, 2) acquisition of skills, 3) teachers, 4) quality of teaching, 5) structure of teaching and 6) satisfaction with the clinical internship. The respondents were subdivided into 4 groups by answering the question "Could you imagine an elective in anesthesiology during the final year (PJ)" with "Yes, I have made this decision after the clinical traineeship" (JdF, n = 212, 44%), "No I have decided against an elective during the final year after the traineeship" (NdF, n = 56, 12%), "Yes I have decided for an elective in anesthesiology before the internship" (JvF Yes: n = 144, 30%) and "No, I have decided against an elective in anesthesiology before the internship" (NvF: n = 67, 14%). Answers of the participants regarding the six content categories were compared between the four groups.The survey reached all medical faculties in Germany and included participants with an average age of 25.8 years and a balanced gender ratio. There were significant differences between satisfied and dissatisfied students in all four subgroups. Of the 479 respondents, 211 (44%) were already set regarding their decision of choosing anesthesiology as an elective during the final year before the clinical traineeship. Of the respondents 268 (56%) were influenced by the internship, 212 (44%) of them positively. In total, 81% of the trainees rated the internship as "satisfying". Students who were satisfied with the overall internship and who spoke in favor of the PJ elective in anesthesiology differed significantly from the other groups in the categories of team integration, skills acquisition, structure and quality of teaching. The teaching of practical skills and specialist knowledge as well as the integration into diagnostics and treatment planning promoted the recruitment of young people.The positively evaluated anesthesiology internship promotes later specialty choice, with quality and structure of the teaching affecting student satisfaction. Trainees who were attracted by anesthesiology gave better overall ratings and acquired more skills during the course of the internship. In order to win aspiring doctors for anesthesiology, the medical team has to integrate trainees well and support the acquisition of practical skills and specialist knowledge. In addition, didactics and practical relevance should be given high priority.HINTERGRUND: Praktische Erfahrungen in Famulaturen können die spätere Weiterbildungswahl prägen.Ziel der Untersuchung war es, Faktoren in der anästhesiologischen Famulatur zu finden, die Studierende ermutigen, sich auf das Fachgebiet zu spezialisieren.Im Rahmen einer bundesweiten Online-Umfrage beantworteten die Studienteilnehmenden (n = 479) Fragen zu ihrer mindestens 4‑wöchigen Famulatur in der Anästhesiologie. Die Befragten wurden in 4 Gruppen aufgeteilt: Diejenigen, die sich aufgrund der Famulatur ein Wahltertial im praktischen Jahr (PJ) in der Anästhesiologie vorstellen konnten (n = 212; 44 %), wurden mit denjenigen, die dies verneinten (n = 56; 12 %) und denjenigen, die sich schon vor der Famulatur festgelegt hatten (Ja: n = 144; 30 % und Nein: n = 67; 14 %) varianzanalytisch verglichen.Die Umfrage erreichte alle medizinischen Fakultäten in Deutschland und befragte Teilnehmende im durchschnittlichen Alter von 25,8 Jahren. In allen 4 ausgewerteten Gruppen fanden sich signifikante Unterschiede. Die Studierenden, die mit der Famulatur zufrieden waren und sich für das PJ-Wahltertial in der Anästhesiologie aussprachen, unterschieden sich signifikant hinsichtlich Integration ins Team, Kompetenzerwerb, Struktur und Qualität der Lehre von den anderen Gruppen. Die Vermittlung von praktischen Kompetenzen und Fachwissen sowie die Integration in Diagnosefindung und Therapieplanung förderten ebenfalls die Nachwuchsgewinnung.Eine positiv bewertete anästhesiologische Famulatur fördert die spätere Spezialisierungspräferenz für dieses Fach. Für das Fachgebiet gewonnene Famuli erlangten mehr Fähigkeiten im Verlauf der Famulatur. Um angehende Ärzte für die Anästhesiologie zu gewinnen, sollte das ärztliche Team die oben genannten Kriterien bei der Famulaturgestaltung bedenken.

Near-infrared spectrophotometry assesses cerebral oxygen saturation (ScO2) based on the absorption spectra of oxygenated and deoxygenated hemoglobin, and the translucency of biological tissue, in the near-infrared band. There is increasing evidence that optimising cerebral oxygenation, guided by ScO2, is associated with improved outcomes in a variety of high risk surgical settings. However, in patients with liver disease, bilirubin can potentially render cerebral oximetry inaccurate. As a result, measurement of cerebral oxygen saturation is rarely undertaken in patients undergoing hepatobiliary surgery. We prospectively measured baseline and intraoperative cerebral oxygen saturation in patients undergoing major pancreatic surgery. Indices including bilirubin, sodium, platelets and maximum amplitude on thromboelastography were associated with low baseline ScO2. However, those patients with low ScO2 (≤51%) maintained a similar trend in cerebral oximetry values both at induction and intraoperatively to those with a normal ScO2. We conclude that the pattern of cerebral oximetry is similar in patients undergoing major pancreatic surgery regardless of their underlying liver dysfunction. Therefore, cerebral oximetry may have a role in monitoring neurological function in this high risk group of patients.

Objective Open abdominal aortic aneurysm (AAA) repair is associated with a high risk of renal injury with few known strategies demonstrating a reduction in this risk. Remote ischemic preconditioning (RIPC) has been identified as having the potential to minimize organ injury following major vascular surgery. This trial investigated the potential for RIPC to attenuate renal and myocardial injury in patients undergoing elective open AAA repair. Design Prospective, randomized double-blinded control trial. Setting Tertiary referral hospital. Participants Sixty-two patients undergoing elective open AAA repair. Intervention RIPC was achieved via three 5-minute cycles of upper limb ischemia using a blood pressure cuff or control (sham cuff). Measurements Primary outcome was the occurrence of renal injury, as measured by an increase in creatinine during the first 4 postoperative days. Secondary outcomes included urinary neutrophil-gelatinase-associated lipocalin (NGAL), occurrence of acute kidney injury (AKI), occurrence of myocardial injury as defined by troponin rise, incidence of postoperative complications, and mortality. There was no difference in postoperative creatinine levels, NGAL levels, or the occurrence of AKI between the groups at any postoperative time point. Similarly, there was no difference in the occurrence of myocardial injury or mortality. Of note, 6 patients in the RIPC group, while no patient in the control group, experienced postoperative complications that required repeat surgical laparotomy, potentially masking any renoprotective effects of RIPC. Conclusion RIPC did not reduce the risk of postoperative renal failure or myocardial injury in patients undergoing open AAA repair. The authors’ results do not support the introduction of this technique to routine clinical practice.

Background Previous reports suggest that acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is underdiagnosed in both adult and pediatric clinical practice. Underrecognition of this condition may be a barrier to instituting a low tidal volume ventilation strategy. This study aimed to determine the accuracy of clinical diagnoses of ARDS in daily practice using the American European Consensus Conference (AECC) criteria as a criterion standard and to investigate whether clinical recognition of ARDS altered ventilator management. Methods This retrospective study included intensive care unit (ICU) patients who died and underwent postmortem examination. Two independent reviewers assigned each patient to those with ALI/ARDS or no ALI. For those who met AECC criteria for ARDS, all patient records were reviewed for the presence of a documented diagnosis of the condition. The accuracy of the clinicians in diagnosing ALI/ARDS was determined, and ventilator settings between the clinically “diagnosed” and “non-diagnosed” groups were compared. The diagnostic accuracy in predetermined subgroups (those with diffuse alveolar damage, with ≥ 3 affected chest x-ray quadrants, with diagnosis ≥ 3 days, with pulmonary vs extrapulmonary cause) was also examined. Results Of 98 consecutive ICU patients who died and underwent autopsy, 51 met the inclusion criteria. Sixteen of 51 patients (31.3%) who had ALI/ARDS according to the AECC criteria had this recorded in their clinical notes. Those with histologic evidence of ALI/ARDS (diffuse alveolar damage) and with a more severe chest x-ray pattern or who satisfied the criteria for a number of consecutive days were no more likely to have a clinical diagnosis of ALI/ARDS recorded. However, those with a pulmonary cause of ALI/ARDS were more likely to have a diagnosis recorded. Tidal volumes, positive end-expiratory pressure, and mean airway pressure were higher in those with a clinical diagnosis of ARDS. Conclusions Acute respiratory distress syndrome is underrecognized by clinicians in ICU, and recognition does not result in lower tidal volume ventilation. Significant barriers remain to the recognition of ALI/ARDS and application of an evidence-based ventilator strategy.

Acute lung injury (ALI) is a severe form of hypoxic lung disease responsible for a large number of deaths worldwide. Despite recent advances in supportive care, no reduction in mortality has been evident since the introduction of a standard consensus definition almost two decades ago. New strategies are urgently required to help design effective therapies for this condition. A key pathological feature of ALI involves regional alveolar hypoxia. Because alveolar hypoxia in isolation, such as that encountered at high altitude, causes an inflammatory pulmonary phenotype in the absence of any other pathogenic stimuli, these regions may not be passive bystanders but may actually contribute to the pathogenesis and progression of lung injury. Unique transcriptional responses to hypoxia in the lung apparently allow it to express an inflammatory phenotype at levels of hypoxia that would not produce such a response in other organs. We will review recent advances in our understanding of these unique transcriptional responses to moderate levels of alveolar hypoxia, which may provide new insights into the pathogenesis of ALI.

Medical students' attitudes and expectations about their future working life are changing. To hire the best talents from Generation Y, hospitals must pay attention to these factors to make working in patient care more attractive. However, little detailed knowledge about the professional and career expectations of today's medical students is available to date.In a nationwide online survey, a total of 9079 medical students from all German medical faculties returned the questionnaire. Twenty-one questions related to future career choices and work satisfaction, followed by 21 questions dealing with reasons for not working in patient care.Factor analysis yielded five factors: work-life balance, career, professional needs, working atmosphere, and prestige. A correlation analysis between these factors and respondents' socio-demographic data revealed significant correlations with sex, specialty choice, and marital/parental status. A correlation analysis with "reasons for not working in patient care" revealed that work-life balance, career, professional needs, and working atmosphere had high priority for both sexes.It is crucial to collect data on the work satisfaction of Generation Y, whose members are motivated and willing to perform in today's highly demanding work environment. However, sex-dependent/independent expectations must be met to make the medical profession more attractive, to overcome the Germany-wide shortage of physicians, and to attract young doctors to the hospitals.

P-bodies are dynamic aggregates of RNA and proteins involved in several post-transcriptional regulation processes. P-bodies have been shown to play important roles in regulating viral infection, whereas their interplay with bacterial pathogens, specifically intracellular bacteria that extensively manipulate host cell pathways, remains unknown. Here, we report that Salmonella infection induces P-body disassembly in a cell type-specific manner, and independently of previously characterized pathways such as inhibition of host cell RNA synthesis or microRNA-mediated gene silencing. We show that the Salmonella-induced P-body disassembly depends on the activation of the SPI-2 encoded type 3 secretion system, and that the secreted effector protein SpvB plays a major role in this process. P-body disruption is also induced by the related pathogen, Shigella flexneri, arguing that this might be a new mechanism by which intracellular bacterial pathogens subvert host cell function.

The purpose of this study was to determine the accuracy of clinical diagnoses compared to autopsy findings in critically ill patients in the current medical era.We conducted a retrospective, blinded review of matched medical records and postmortem findings in patients who died between June 2006 and June 2011.An ICU of a major university teaching hospital in Dublin, Ireland.None.A modification of the Goldman criteria was used to classify diagnostic error. There were 629 ICU deaths during the study period. Two hundred and seven patients underwent autopsy and 204 records were available for review. The mean age was 59 ± 18.1 years, 62% were male, 70% were postoperative patients, and median length of ICU stay was 3 days. Admission diagnosis, admission source, and admission specialty were similar between autopsy and nonautopsy patients. Five patients (2.4%; CI, 0.8-5.6%) had a class I discrepancy and 11 patients (5.4%; CI, 2.4-9.7%) had a class II discrepancy. Minor missed diagnoses were present in 31 patients (15.2%; CI, 4.5-12.4%). There was complete concordance between clinical and postmortem findings (class V) in 161 patients (79%; CI, 72.7-84.3%). In more than half the cases of discrepancy, it was not possible for physicians to make the diagnosis antemortem in the time available, despite appropriate investigations.We detected a lower rate of clinicopathological discrepancy in critically ill patients than previously reported. Potential reasons for such findings include advances in diagnostic techniques and the use of a more robust definition to classify diagnostic discrepancies. Autopsy can still identify discrepancies in diagnosis even in patients who have undergone appropriate investigations. Prospective research is required to accurately define discrepancy rates in the critically ill population and to identify the patient subgroups in whom autopsy will continue to yield valuable information.

Acute respiratory distress syndrome is one of the leading causes of death in critically ill patients. Recent advances in supportive care have led to a moderate improvement in mortality. In particular, a much lower mortality rate than expected was evident in the severest category of patients (requiring extracorporeal membrane oxygenation) in Australia during the recent H1N1 pandemic. Though improvements in supportive care may have provided some benefit, there remains an absence of effective biological agents that are necessary to achieve further incremental reduction in mortality. This article will review the evidence available for current treatment strategies and discuss future research directions that may eventually improve outcomes in this important global disease.

Preservation of the hip joint function by treatment of the avascular necrosis of the femoral head in adults or at least avoiding progression.Avascular necrosis of the femoral head in adults in Steinberg stages I-III. In patients with Steinberg stage IVa (subchondral collapse ≤ 15% of the articular surface, depression 2 mm) hip joint salvage therapy in early stages of femoral head collapse.Manifest osteoarthritis of the hip joint. Joint infection. Relative contraindications: subchondral collapse 15% of the articular surface or depression 2 mm (Steinberg stage IVb and above). Persisting risk factors for a progression of avascular necrosis (e.g., alcohol abuse, chemotherapy, local irradiation, high-dose cortisone therapy) and obesity (BMI 40).Arthroscopy of the hip joint in case of cartilage defects and/or potential collapse of the femoral head. Without collapse of the femoral head and absence of severe damage of the cartilage: core decompression using a guiding sleeve through a lateral approach (Steinberg II, III). Subsequently curettage of the necrotic area through a central drill hole and insertion of autogenic bone cylinders using an OATS harvester (Steinberg II b/c, III b/c). In Steinberg stage IVa, reconstruction of the outline of the femoral head is attempted by reduction of the impressed portion (under intraoperative fluoroscopy).Limited weight bearing (10 kg) of the operated leg for 6 weeks. In cases of large necrotic defects located directly beneath the subchondral bone (Steinberg IIIc) as well as subchondral collapse with flattening of the femoral head (Steinberg IVa) limited weight bearing (10 kg) for 12 weeks.Early results of femoral head preserving therapy in 53 patients (56 hips, consecutively treated between June 2004 and December 2009) after 33 ± 20 months: success rate (no arthroplasty, no reoperation, no radiological progress associated with clinical symptoms) 86% for patients treated with Steinberg stages I-III. Failure of the head preserving therapy with concern to the mentioned criteria depending on the initial Steinberg stage: 0 (0%) for stage I, 2 (10%) for stage II, 3 (25%) for stage III, and 4 (31%) for stage IVa.

Chronic hypoxia causes pulmonary hypertension associated with structural alterations in pulmonary vessels and sustained vasoconstriction. The transcriptional mechanisms responsible for these distinctive changes are unclear. We have previously reported that CREB1 is activated in the lung in response to alveolar hypoxia but not in other organs. To directly investigate the role of α and Δ isoforms of CREB1 in the regulation of pulmonary vascular resistance we examined the responses of mice in which these isoforms of CREB1 had been inactivated by gene mutation, leaving only the β isoform intact (CREB(αΔ) mice). Here we report that expression of CREB regulated genes was altered in the lungs of CREB(αΔ) mice. CREB(αΔ) mice had greater pulmonary vascular resistance than wild types, both basally in normoxia and following exposure to hypoxic conditions for three weeks. There was no difference in rho kinase mediated vasoconstriction between CREB(αΔ) and wild type mice. Stereological analysis of pulmonary vascular structure showed characteristic wall thickening and lumen reduction in hypoxic wild-type mice, with similar changes observed in CREB(αΔ). CREB(αΔ) mice had larger lungs with reduced epithelial surface density suggesting increased pulmonary compliance. These findings show that α and Δ isoforms of CREB1 regulate homeostatic gene expression in the lung and that normal activity of these isoforms is essential to maintain low pulmonary vascular resistance in both normoxic and hypoxic conditions and to maintain the normal alveolar structure. Interventions that enhance the actions of α and Δ isoforms of CREB1 warrant further investigation in hypoxic lung diseases.

Orthopedic rehabilitation is a major entity in rehabilitation. Due to coming demographic changes and its challenges concerning mobility of elderly patients it will increase. The criticism on orthopedic rehabilitation in Germany focuses on its missing evidence in therapeutic eff ectiveness especially in chronic low back pain. This overall-criticism is actually no more valid as there are a number of studies showing eff ectiveness of orthopedic treatment in rehabilitation if psychosocial comorbidities are respected and treatment is focussed on occupational training and eintegration.This overview describes the actual situation in orthopedic rehabilitation and its research.The need for orthopedic rehabilitation will increase over the next years due to demographic changes. Important fi elds in orthopedic rehabilitation research are chronic low back pain, new rehabilitation models with focus on occupational reintegration, rehabilitation in elderly and following joint surgery as well as the analysis of health-care-system changes due to disease related groups.

Objective: The study asked whether an early botulinum toxin A (BTX-A) injection in subacute stroke patients may prevent a disabling finger flexor stiffness six months later. Design: Single-blind, randomized pilot study. Setting: Inpatient rehabilitation centre. Subjects: Eighteen stroke patients, interval 4–6 weeks, non-functional arm, Fugl-Meyer arm score (0–66) Interventions: In group A patients 150 units BTX-A (Xeomin) injected into the deep and superficial finger (100 units) and wrist flexors (50 units), no injection in group B patients. Comprehensive rehabilitation in both groups. Main measures: Primary variable was the Modified Ashworth Scale score (0–5) of the finger flexors; secondary variables were whole arm muscle tone with REPAS (a summary rating scale for resistance to passive movement), its motor control with the Fugl-Meyer arm score, and a disability scale, blindly assessed at T0 (start), T1 (four weeks) and T6 (six months). Results: Homogeneous groups at T0. Significantly less finger flexor stiffness in the BTX-A group at T1 and T6, the mean (SD) Modified Ashworth Scale scores in group A (B) were: 1.7 ± 0.5 (1.6 ± 0.5) at T0; 0.4 ± 0.5 (1.9 ± 0.7) at T1; and 1.4 ± 0.7 (2.4 ± 0.9) at T6. Among the secondary measures, the disability score, namely the items pain and passive nail trimming, was lower in group A at T1 and T6. Conclusions: The results indicate an effect of early BTX-A injection on finger flexor stiffness six months later, presumably attributable to a reduced contracture development. Effect size calculation suggests inclusion of at least 17 patients per group excluding drop-outs in a warranted placebo-controlled trial.

Traumatic brain injury is one of the leading causes of death and disability among young people. However outcomes from traumatic brain injury can be improved by use of parameters such as intracranial pressure monitoring (ICP) to guide treatment, early surgical intervention and management of these patients in a neurosurgical centre. To examine the incidence of traumatic brain injury, compliance with best practice guidelines and outcomes in patients admitted to an intensive care unit in a major teaching hospital in Ireland. Retrospective chart review. Forty-six patients were admitted over a 3-year period, half of whom had GCS

The recreational use of the so-called “legal-highs” has been in both the medical and political arena over the last year as a result of the appearance of “head shops” in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds.

The aim of the study was to determine the incidence of deep vein thrombosis (DVT) after pelvic trauma and surgical stabilisation of pelvic and acetabular fractures under medicamentous prophylaxis.Within 20 months we prospectively included 50 patients. 25 had an isolated pelvic trauma, 25 patients had multiple injuries. 21 of them were polytrauma patients (average ISS: 31.4; min. 26 pts., max. 50 pts.), four patients had additional highly unstable spine fractures or fractures of the lower extremities. Low molecular-weight heparin (Enoxaparin 40 g/d) was administered on average within 24 hours of injury in 44 cases, one patient received low-dose heparin (Liquemin 15,000 to 22,500 I. E./d), five patients received both. 31 patients were treated operatively and 19 conservatively. Colour-flow duplex ultrasonography was performed within 72 hours of injury and stabilisation of the pelvic and acetabular fracture, or weekly. By means of ultrasound, 97 to 100 % of the deep and superficial leg veins could be examinated safely, as well as 88 to 89 % of the external iliac veins and 64 to 66 % of the common iliac veins. Only in 36 to 40 % of the patients the internal iliac veins were visible by ultrasound.Proximal DVTs were detected postoperatively in two patients (4 %), one patient (2 %) died after a fatal P. E. before the scheduled duplex scan.Early medicamentous prophylaxis can prevent deep vein thrombosis after pelvic trauma. Delayed applications due to pelvic operations are risk factors. In such cases duplex scanning should be performed routinely and postoperative medicamentous prophylaxis should be increased.

Comparison of the central corneal refractive power before and after myopic LASIK using the Keratograph and the Pentacam. The Scheimpflug technique (Pentacam) enables the measurement of the corneal refractive power by examining the anterior and posterior corneal curvature.The corneal refractive power of 59 eyes was examined before, 3 months and 6 months after myopic LASIK. The refractive power was measured at the corneal apex and at a distance of 2 and 4 mm. Statistical analysis was performed using the Wilcoxon signed rank test; a p value of 0.05 or less was considered statistically significant.At the corneal apex and at a distance of 2 mm the findings with the Keratograph showed a higher refractive power of up to 1.05 D. The differences were statistically significant at all times. At a distance of 4 mm from the corneal apex postoperatively there was no statistically significant difference.The results using the Pentacam system showed a lower corneal refractive power following myopic LASIK at all times. Its measuring principle compared to that of the Keratograph should be preferred when detecting changes of the refractive power of the central cornea after corneal refractive procedures.

The small GTPase ADP-ribosylation factor-1 (Arf1) plays a key role in the formation of coat protein I (COP I)-coated vesicles. Upon recruitment to the donor Golgi membrane by interaction with dimeric p24 proteins, Arf1's GDP is exchanged for GTP. Arf1-GTP then dissociates from p24, and together with other Golgi membrane proteins, it recruits coatomer, the heptameric coat protein complex of COP I vesicles, from the cytosol. In this process, Arf1 was shown to specifically interact with the coatomer beta and gamma-COP subunits through its switch I region, and with epsilon-COP. Here, we mapped the interaction of the Arf1-GTP switch I region to the trunk domains of beta and gamma-COP. Site-directed photolabeling at position 167 in the C-terminal helix of Arf1 revealed a novel interaction with coatomer via a putative longin domain of delta-COP. Thus, coatomer is linked to the Golgi through multiple interfaces with membrane-bound Arf1-GTP. These interactions are located within the core, adaptor-like domain of coatomer, indicating an organizational similarity between the COP I coat and clathrin adaptor complexes.

Background An increasing number of patients with alcoholic liver disease (ALD) are being referred for critical care support, but limited information is available on their short- and medium-term outcomes. This study aimed to determine mortality rates, identify optimal predictors of prognosis, and determine the appropriate time to apply these predictors in patients with ALD admitted to intensive care unit (ICU). Methods In this retrospective study, patients admitted to ICU between 2009 and 2012 with a primary diagnosis of ALD were included. Survival was calculated using the Kaplan-Meier method, risk factors for death determined by logistic regression analysis, and discriminative capacity of models using receiver operating characteristic curves. Results Of 170 patients admitted with liver disease, 62 met the inclusion criteria. Survival rates in the ICU, in hospital, and at 6 months were 40.3% (95% confidence interval [CI], 30.7%-49.9%), 35.5% (95% CI, 25.35%-45.65%), and 29% (95% CI, 19.4%-38.6%), respectively. Multiple linear regression analysis of day 1 variables produced an equation with Sequential Organ Failure Assessment score and lactate as significant predictors of mortality; this model had an area under the receiver operating characteristic curve of 0.93. A score greater than 12 in this model correlated with a mortality of more than 80% at all time points and was more accurate than any other score examined. Conclusion Patients admitted to ICU with ALD have a very high inhospital mortality. A combination of the established Sequential Organ Failure Assessment score and lactate provided the most accurate predictor of outcome on day of admission and at all subsequent time points.

The long-time benzodiazepine use by a considerable part of the population and its adverse consequences such as somatic and cognitive side effects, interactions with other drugs and alcohol and its possible impairment of quality of life has provoked a critical discussion about the practice of prescribing benzodiazepine and the information provided by physicians. We therefore investigated these issues in admitted patients of a general hospital. All patients having been admitted to the department of Internal Medicine and taking benzodiazepine were asked by means of a semi-structured interview, which was repeated after 1 year. In 90% of later benzodiazepine discontinuers and in almost 50% of benzodiazepine continuers, tranquilisers were first prescribed during hospital admission. Only 2% of all patients estimated the information provided by the prescribing physicians as satisfying and about 2/3 reported that they did not get any information at all. 66% of all patients were informed about dependency risks. This information was mainly provided by pharmacies, friends and patient information leaflets; only about 20% of all patients were informed by the prescribing physician. Guidelines for tranquiliser prescription only seem to have a poor impact on the clinical practice. The education of physicians about the risks of low-dose dependencies and especially about complementary therapy methods needs to be improved.

This report describes dual infection with Citrobacter freundii and Haemophilus influenzae type b causing septic arthritis and osteomyelitis of the elbow in a previously healthy 5-year-old boy. The patient was treated successfully with intravenous fosfomycin for 4 weeks. Infections with Citrobacter beyond the neonatal period are rare in paediatric patients. When Citrobacter spp. is isolated, coinfection with other bacterial pathogens should be considered.

Suppression of Epstein-Barr virus (EBV) lymphoproliferation by three commercial human immunoglobulin (hu-Ig) preparations, one enriched with immunoglobulin A (hu-IgA-IgG) and the other two containing more than 97% immunoglobulin G (hu-IgG) with anti-EBV antibodies was studied. All three human preparations suppress EBV-induced lymphoproliferation in vitro and reduce release of interleukin (IL)-6 and IL-10 dose-dependently, irrespective, however, of the titer of EBV-specific antibodies present. This result was unexpected. Human Ig also reduces human recombinant IL-6-induced lymphoproliferation in EBV-free cultures and augments low-dose human recombinant IL-10-provoked suppression. In vivo studies used mice with severe combined immunodeficiency (SCID), reconstituted with human tonsillar mononuclear cells, and then infected with EBV from B95-8-derived supernatants. Immediate injection of hu-Ig after EBV infection, if given only once, delayed, and if given every two or four weeks, abolished the induction of EBV-associated lymphomas. Delay of hu-Ig injection by 48 hours after infection was less effective. Hu-IgG was consistently more efficacious than hu-IgA-IgG. Under these conditions the best survival rates were obtained with sustained hu-IgG administrations every two weeks. Serum hu-IL-6 and hu-IL-10 were detectable only in lymphoma-bearing SCID mice. Hu-Ig treatment reduced the detectability of both cytokines. These results suggest that hu-Ig-with antibodies to EBV-may exert a beneficial treatment potential for EBV-induced lymphoproliferation in immunocompromised patients. The dependence of this suppressive effect of hu-Ig on specific anti-EBV antibodies in vivo remains to be resolved.

A simple test that could guide successful cessation of continuous renal replacement therapy (CRRT) in critically ill patients would be clinically useful. This study aimed to investigate whether a 2-hour creatinine clearance (2h-CrCl) measurement could more accurately predict successful cessation of CRRT than serum creatinine or urine output alone.This retrospective study identified all patients admitted to a university teaching hospital intensive care unit who received CRRT and had a 2h-CrCl measurement performed in the 12 hours preceding CRRT cessation. The ability of 2h-CrCl to predict successful discontinuation of CRRT was compared to other renal indices.Of 85 patients who had 2h-CrCl performed prior to CRRT cessation 53 (62.4%)(success group) remained dialysis free 7 days after CRRT cessation. 2h-CrCl was a better predictor of remaining CRRT free at day 7 (OR, 1.108 [1.05-1.17] per 1 mL/min increase in 2 hours CrCl, P.001) than urine output, serum creatinine or age. A 2h-CrCl value of 23 mL/min had a sensitivity, specificity and positive predictive value for remaining CRRT free at day 7 of 75.5%, 84.4%, and 88.8%, respectively.2h-CrCl may be a useful measurement to help guide discontinuation from CRRT.

About two years ago pharmacies in the Federal Republic of Germany began to offer motorists test sticks named "Alco Screen" in order to evaluate the concentration of alcohol in the saliva. According to the producers it should be a quick and simple method giving a high correlation between the alcohol level both in blood and saliva. As advertised, a drunken driver could estimate his own extend of alcohol impairment by himself. We checked the reliability of this method by comparing the alcohol level in the blood with the extend of colour change of the sticks in 20 adult volunteers engaged in drinking tests. 85% of them demonstrated distinct discrepancies. In most cases the saliva concentration estimated was too low. Those, depending on the result of this test kit, take a high risk of being misled and can probably assume sobriety in contrast to their actual state. A warning concerning this test is necessary.

Previous plaque-pH telemetry studies reported the acidogenicity of various foods and dietary patterns to estimate potential cariogenicity. To avoid patient discomfort, improve compliance, and minimize electrode malfunctions, we have simplified our telemetry method and compared it to our previously published model. A removable partial prosthesis with a glass electrode set in the approximal space left by a missing first molar was used in 2 subjects. In the modified method, subjects suspended oral hygiene for 3 days, the prosthesis was then installed on the 3rd day, and accumulated plaque was spread on the electrode and covered with gauze for retention. In comparative tests, the same subjects wore the prosthesis in the mouth during plaque accumulation. Test sessions compared the plaque pH response to 4 treatments: a 10% sucrose rinse, a 10% sorbitol rinse, a snack roll with marmalade and coffee, and the snack followed by gum chewing. Overall, pH curves were similar (mean baselines and minimas) and no significant differences in mean pH response were noted between the 2 methods. The modified method improved subject participation, demonstrated greater reliability, and showed Stephan curves comparable to conventional methods.

Saliva stimulation by gum chewing has been reported to neutralize plaque acidity. We compared the plaque pH response to bread with honey followed by sucrose-or sorbitol-sweetened gum chewing for 20 minutes. Bread and honey was chosen as previous work in our laboratory found this a worst case challenge in terms of the extent and duration of the pH decline. The study design was factorial with: 4 subjects x 2 replicates x 3 treatments. Each subject received each of the 3 treatments: food (bread and honey), food followed by sorbitol chewing gum, and food followed by sucrose chewing gum. Subjects accumulated plaque for 3 days on a partial prosthesis with a glass electrode set in the approximal space in the gap left by a missing first molar. Plaque pH was monitored for 150 min: baseline (0-10), food (11-30), +/- gum chewing (31-50), post-chew monitoring (51-150). ANOVA of mean plaque pH showed no difference between treatments at baseline. Significantly higher pH levels (p0.01) were shown with both gums compared to no gum during the chew and post-chew phases. Plaque pH data were also converted to absolute acid values (cH). Food alone produced 1703 mumol/min.; food followed by sorbitol chewing gum produced 53 mumol/min.; and food followed by sucrose gum produced 156 mumol/min. While the post-chew pH curves were not identical for sucrose vs. sorbitol chewing gums, both neutralized plaque acidity, probably due to the induced salivary action.

Using oral plaque-pH-telemetry the cariogenic potential of a sucrose-solution (10%), a sorbitol-solution (10%), of a roll with honey, a roll with jam together with sweetened coffee and the "Milchschnitte" has been examined. All sugar containing products cause a deep pH-drop in dental plaque. The duration of demineralization (time of plaque-pH below 5.5)-amounts to 75 min. after mouthrinsing with sucrose-solution, 80 min. after consuming a half roll with honey, 140 min. after eating a roll with jam and drinking sweetened coffee and 82 min. after consuming a "Milchschnitte". All these products shouldn't be used as in-between-meals or snacks without a consequent oral hygiene afterwards.

In 1987, 12 years after fluoridation of drinking water, caries prevalence of Prague school-children is very low, and the goals of WHO have already been reached and undercut. Children from Rostock, where no fluoridation of drinking water was introduced, have an unchanged high caries experience in 1985. Degree of treatment and percentage of successfully treated children show only little differences in both towns. These results emphasize the demand for an introduction and/or a continuation of an effective caries prevention in children once more.

The results of a cross-sectional study of caries prevalence in 22,112 children age 6 to 14 years in Rostock Country are classified as moderate to high according to WHO criterions. Territorial differences in the caries prevalence have a strong connection to the degree of realisation of preventive measures. Over a control period of 20 years the average caries experience in children showed only little changes, a general caries decline couldn't be watched.

In relation to the goals for oral health by the year 2000 a detailed territorial analysis of caries prevalence in 12 years-old children in performed. There from a prognosis of the future caries development in this age group considering regional conditions is given.

Using CPITN recommended from the WHO periodontal treatment needs in 22,118 children between 6 and 14 years from Rostock County were estimated. According to that the need of periodontal care in the examined young population is low and preventive care has precedence. For children until 12 years of age the evaluation of CPITN has some problems. The routine application of the CPITN is recommended as a screening for high-risk patients.

Saliva of 95 patients of different ages was investigated for S-IgA and free secretory component (SC). The two-directional rocket method was used as assay for separating S-IgA and free SC in the presence of heparin-Ca-EDTA. The method employs electrophoresis in an antibody containing agarose/agar gel.--The value of S-IgA in children about 4 years old was 40,0 mg/l and the relation of free SC to S-IgA was 1 to 5. The S-IgA level in patients over 50 years old was 55,2 mg/l, in no case free SC was detectable.

In continuation of the program of data recording presented earlier a computer program for analysis and calculation of a data base which consists of the results of dental examination of children is introduced. The presented possibilities of data processing are fitted to the general reports in dentistry of children. They are recommended in solving the problems of a simple and modern data processing in this special field of dentistry.