[Influence of extreme weather conditions on the deployment volume of emergency medical services]. / Einfluss von Wetterextrema auf Einsatzzahlen im Notarztdienst.

BACKGROUND: Due to global warming a worldwide increase in the frequency and intensity of heat waves have been forecast. In the context of the overall increasing number of emergency service calls, weather-induced effects on the number of calls are highly relevant. We evaluated the influence of extreme temperatures on emergency medical services. MATERIALS AND METHODS: The study was conducted in Bochum, Germany. The authors examined the data from 16,767 emergency calls. In addition, the daily updated temperature data were collected for each emergency doctor call. Data were collected from 01 January 2014 until 31 December 2015. The primary question was the influence of extremes of the perceived temperature (PT; on the day of the call and the three previous days) on the diagnosis group of cardiovascular diseases. A secondary question was the influence of extremes of the temperature parameters (air temperature, PT, physiological equivalent temperature [PET]) on the day of call and the three previous days. RESULTS: A total of 16,767 calls were assessed. The threshold values (upper and lower 5%) were -8.7 and 32.5 °C for PT and -0.7 and 26.7 °C for air temperature. Examination of the PT indicated a significantly increased rate of calls for cold spells on the day of the call (RR = 1.14; p = 0.033) as well as a lag effect of 3 days (RR = 1.1; p = 0.049). CONCLUSION: The present study shows that during cold spells there is an increased rate of calls for cardiovascular diseases. This effect is not only observable on the extreme day itself but also 3 days later.

Risk of overconstraining femorotibial rotation after anatomical ACL reconstruction using bone patella tendon bone autograft.

INTRODUCTION: Numerous studies have focused on the anteroposterior stability after anterior cruciate ligament (ACL) reconstruction, with less emphasis on rotational stability. It has been hypothesized that bone patella tendon bone (BTB) autograft for ACL reconstruction restores knee rotation closely to normal due to its comparable fiber orientation to the native ACL. MATERIALS AND METHODS: Twenty patients with unilateral ACL rupture and an uninjured contralateral knee were included in this study. The ACL was reconstructed using the medial third of the patellar tendon. Tunnel placement was controlled by fluoroscopy. Implant-free press-fit graft fixation was used on both femoral and tibial side. Bone blocks were carefully placed to restore fiber orientation of both the anteromedial and posterolateral bundle, similar to the native ACL. Rotatory laxity of both knees was measured at 0° and 25° of flexion pre- and post-surgery, using an active opto-electronical motion-analysis system (LUKOTRONIC AS 100®). All measurements were performed under general anesthesia during surgery. RESULTS: Knee rotation was reduced significantly in both 0°and 25° of flexion following ACL reconstruction (p < 0.001). The side to side difference (SSD) of the rotatory laxity in extension was greater in the ACL-deficient knee (14.9° ± 8.9°), but decreased significantly after ACL reconstruction (- 5.9° ± 7.7°, minus value means less than in the uninjured knee). There was a similar finding at 25° of knee flexion where greater rotation of the ACL-deficient knee (5.7° ± 10.3°) prior to surgery changed to lower degree of rotation after surgery (- 11.3° ± 8.4°) in comparison to the uninjured knee. CONCLUSIONS: ACL reconstruction with a BTB graft in anatomical position using press-fit implant-free fixation is able to restore rotatory knee stability close to the intact contralateral knee. Despite the fact that the BTB graft offers fiber orientation close to the natural ACL, the surgeon should be aware of the potential risk of over-constraining the knee in terms of rotation. LEVEL OF EVIDENCE: II.

Haem arginate infusion stimulates haem oxygenase-1 expression in healthy subjects.

BACKGROUND AND PURPOSE: Haem oxygenase 1 (HO-1) is an inducible protein that plays a major protective role in conditions such as ischaemia-reperfusion injury and inflammation. In this study, we have investigated the role of haem arginate (HA) in human male subjects in the modulation of HO-1 expression and its correlation with the GT length polymorphism (GT(n)) in the promoter of the HO-1 gene. EXPERIMENTAL APPROACH: In a dose-escalation, randomized, placebo-controlled trial, seven healthy male subjects with a homozygous short (S/S) and eight with a long (L/L) GT(n) genotype received intravenous HA. HO-1 protein expression and mRNA levels in peripheral blood monocytes, bilirubin, haptoglobin, haemopexin and haem levels were analysed over a 48 h observation period. KEY RESULTS: We found that the baseline mRNA levels of HO-1 were higher in L/L subjects, while protein levels were higher in S/S subjects. HA induced a dose-dependent increase in the baseline corrected area under the curve values of HO-1 mRNA and protein over 48 h. The response of HO-1 mRNA was more pronounced in L/L subjects but the protein level was similar across the groups. CONCLUSIONS AND IMPLICATION: HA is an effective inducer of HO-1 in humans irrespective of the GT(n) genotype. The potential therapeutic application of HA needs to be evaluated in clinical trials.

Cardiac surgery in patients with previous carcinoma of the breast and mediastinal irradiation: is the internal thoracic artery graft obsolete?

BACKGROUND: The increasing number of patients of more advanced age undergoing cardiac surgery means the number of those with previous curative (relapse free) mastectomy and irradiation of the chest is also increasing. A higher incidence of postoperative complications such as sternal infection in these patients is considered possible. Furthermore the question of whether mediastinal irradiation leads to a relevant internal thoracic artery (ITA) gaft damage remains unclear. In this context the benefit of arterial revascularization (CABG) using one or both ITAs is not sufficiently proven by data available from clinical studies. METHOD: 70 patients (49-85 years) with previous mastectomy or Hodgkin/non-Hodgkin's disease and mediastinal irradiation underwent CABG (n = 59) or an aortic valve replacement (AVR, n = 11). 20 patients received bilateral internal thoracic artery grafts, 34 a single internal thoracic artery graft, and in 16 patients an internal thoracic artery was not used. Perioperative data and data concerning postoperative complications such as mortality, myocardial infarction, and sternal infection or refixation was gathered and compared with all other patients receiving CABG (n = 5102). An histological investigation of ITA segments was done in 12 patients. RESULTS: There was no significant enhancement of the perioperative risk in comparison with other patients of a corresponding age group. Internal thoracic artery damage induced by irradiation was not present. There was no increased incidence of sternal instability requiring refixation observed. CONCLUSION: In the patient cohort investigated there is in general no need for restrictive use of the ITA in CABG.

Partial anastomosis between the lingual and mandibular nerves for restoration of sensibility in the mental nerve area after injury to the mandibular nerve. Case report.

A 35-year-old woman had to be operated on because of a displaced wisdom tooth combined with a follicular cyst in the right mandible. During the excision, the mandibular nerve was disrupted, and a piece about 1 cm in length was removed together with the whole specimen. Not being planned beforehand, and because of the lack of an operating microscope, the nerve repair in terms of a graft and fascicular suture was impossible. A partial anastomosis between the distal mandibular nerve stump and the lateral third of the lingual nerve recreated normal sensibility in the mental nerve area without leaving behind a sensibility defect in the tongue.