[Enhanced automatic collision notification system. First field experience]. / Automatische Unfallmelder. Erste Erfahrungen aus der Anwendung.

Motor vehicle accidents are the leading cause of severe injuries. Outcome of these victims is substantially influenced by rescue time and primary trauma centre care. Nowadays, automatic crash notification systems (ACN) are available offering the major possibility of immediate initiation of the rescue chain and thereby shortening rescue time up to 50%. According to the EU commission a nationwide equipping of motor vehicles with automatic crash notification systems could save up to 2,500 lives per year. Therefore, all new vehicles should be equipped with an automatic crash notification system by 2014. BMW is the first manufacturer to install an enhanced automatic crash notification system (eACN), which could optimize the rescue triage by estimating the risk for severe injuries (MAIS3+) based on telemetric transmitted accident data.

[End stage renal disease after ingestion of mushrooms]. / Dialysepflichtige Niereninsuffizienz nach Pilzessen.

This case report describes a 56 year old patient with acute renal failure caused by a mushroom poisoning. Unspecific symptoms like a gastroenteritis followed by kidney insuffiency lead to the diagnosis of an orellanus syndrome. The toxin can be proved by thin layer chromatography in renal biopsy. Fast processing of hemoperfusion may avoid lasting kidney damage and dialysis.

[Expression and dynamics of peptidergic nerve fibers in granulation tissue after distance osteosynthesis]. / Vorkommen und Dynamik peptiderger Nervenfasern im Granulationsgewebe nach Distanzosteosynthese.

The transmitters and/or modulators calcitonin gene-related peptide (CGRP), substance P (SP), neuropeptide Y (NPY) and vasointestinal polypeptide (VIP) are supposed to be involved in bone growth, fracture healing and internal remodeling. Immunohistochemical proof of neuropeptide positive fibers in normal bone let us assume that these substances effect the early phase of fracture healing. Exact time of appearance of neuropeptide positive fibers, localisation in the bone, chemospecifity and mode of genesis are unknown so fare. Research was done on a model of distance osteosynthesis of the rabbit tibia. Primary and secondary antibodies were used for indirect immunohistochemical technique. We put more strength on the concrete stereological calculation of length of the nerve fibers than on a conventional statistical evaluation. After histological preparation of tissue specimens from the interfragmental gap and the bone marrow beside the gap the neuropeptides CGRP, SP and NPY were immunohistochemically expressed. Sprouting of CGRP- and SP-positive nerve fibers has its origin in the bone marrow. A vascularisation in the early state of osteoneogenesis after fracture seems impossible without the nerval peptidergic influence and transmission.

[Introduction of the new DRG-based reimbursement system in German hospitals--a difficult operation? Experiences and possible solutions from the viewpoint of trauma surgery]. / Die Einführung des neuen DRG-basierten Entgeltsystems in Deutschen Krankenhäusern--Eine schwierige Operation? Erfahrungen und Lösungsansätze aus der Sicht der Unfallchirurgie.

Until recently the costs of patients in German hospitals have mainly been calculated according to the length of hospital stay. However, in December 1999, a dramatic change was announced in the social laws in the "Gesundheitsreform 2000." Beginning in 2003 a prospective payment system based on the classification of the "Australian Refined DRGs (AR-DRG)" will be introduced. DRGs are already used in quite a lot of industrialized countries and basically are "per case" payment systems that group patients with homogeneous average costs based on the diagnoses and procedures performed in the hospital. When preparing for this new system, the clinician has a lot of additional tasks. Besides correctly documenting all clinical findings with the ICD-10 Diagnoses and the German OPS301 procedure codes, a knowledge of the economical impact of the clinical decision is absolutely crucial. The most important task is the optimizing of all clinical treatment processes (e.g. by the introduction of clinical pathways), because only hospitals that can do highly efficient treatment will be able to survive in the upcoming competitive situation. In the Krankenhaus München--Schwabing DRGs have been used as a benchmarking tool since 1997. Based on valuable experience, many direct measures to optimize efficiency have been taken. Especially in patients with multiple trauma, it became evident that the use of efficient and standardized treatment can bring economic gain without loss of quality.

Kinetics of soluble interleukin-2 receptor after mechanical and burn trauma.

Extended trauma causes a failure of T-lymphocyte function due to suppressed interleukin-2 synthesis; however, the role of IL-2 receptor, especially its soluble form (sIL-2R), needs to be further evaluated. It was the objective of the study to assess the kinetics of sIL-2R within different settings of trauma and to define its clinical value and possible predictive role. Three groups of patients with trauma were included in the study. Groups 1 and 2 consisted of multiply injured patients (injury severity score 35 +/- 4 and 32 +/- 4, respectively); burned patients formed group 3 (injury severity score 38 +/- 9). Serum samples were collected at the site of the accident (group 1) and during the posttrauma course in the hospital (group 2, daily; group 3, weekly) and sIL-2R was measured in these samples. sIL-2R was within the normal range in groups 1 and 2, but was significantly increased in group 3. There was no correlation between serum concentrations of this mediator and susceptibility to infectious complications or outcome.

Kinetics of circulating adhesion molecules and chemokines after mechanical trauma and burns.

OBJECTIVE: To assess the role of circulating adhesion molecules and chemotactic cytokines within different settings of major trauma. DESIGN: Retrospective study. SETTING: Teaching hospitals, USA and Germany. SUBJECTS: Two groups of patients with multiple injuries (group I n = 155 and group II n = 12) with mean (SEM) injury severity scores (ISS) of 35 (4) and 32 (4) points, respectively, and 18 burned patients with a mean of ISS 38 (9) points. INTERVENTIONS: Serum samples were collected at the site of the accident and on admission to the (Group I) as well as during the post-trauma course in the hospital (Group II: days 1, 3, 5, 7, 10; Group III; weekly, up to week 10). MAIN OUTCOME MEASURES: Measurement of concentrations of soluble (s) adhesion molecules (sE-selectin, sP-selectin), and chemotactic cytokines (interleukin-8 [IL-8], epithelial cell derived neutrophil activating peptide 78 [ENA-78]) in serum after major mechanical trauma and burns. RESULTS: High concentrations of ENA-78 and sP-selectin were already present at the site of accident as well as one hour after injury. During recovery from the injuries, persistently high concentrations of IL-8, ENA-78, and sP-selectin were found, but sE-selectin was increased only during the first week after major trauma. CONCLUSION: Massive tissue trauma causes immediate activation of selected chemokines and adhesion molecules within minutes of the injury which will then persist depending on the type and severity of the injury for a substantial length of time. There was, however, no correlation between serum concentrations of the mediators investigated and susceptibility to complications or outcome.